Health Care Reform

A pair of articles in the LA Times over the past couple of weeks lay out the contours of the national health care debate and the role that the insurance industry is playing in it.  Unfortunately though not surprisingly, it looks like a single payer system is off the table (but that doesn't mean we should keep quiet about this option:  Health Care for All Texas).  Here's what the first article says about the areas of agreement (Consensus Emerging on Universal Health Care):

The idea of a federal, single-payer system patterned on those in Europe and Canada, long a dream of the political left, is now virtually off the table.

Rejected as well is the traditionally conservative concept, championed by Sen. John McCain (R-Ariz.) during the presidential campaign, of reforming healthcare mainly by giving incentives for more Americans to buy insurance on their own.

There also is a widespread understanding that any expansion of coverage must be accompanied by aggressive efforts to bring down costs and reward quality care. And key players in the healthcare debate increasingly back a massive investment of taxpayer money for healthcare reform despite the burgeoning budget deficits.

Beyond those areas of basic agreement, the details of what would be one of the most momentous changes in domestic policy since World War II remain vague.

On the one hand, it's good to see that the Obama Pre-Administration is taking steps to make sure that the health care debate is going to be public  and involve the Congress.  It's unclear whether Clinton's health care push would have failed otherwise but it's certain that the secrecy surrounding that effort doomed it from the start.  I do hate to see the consensus that single payer doesn't have a chance.  Honestly, we're at a point where bold visions actually have a chance because people recognize the need for universal care and if we keep the insurance companies in the mix we are writing middleman profits and market inefficiencies into the law.

What?  Blasphemer!!  Did he just say "market inefficiencies"???  Yes, I did.  I had surgery over the summer, way back in July.  Ever since that time (and my follow-up doctor's visit two weeks later) emails, phone calls and queries have been flying back and forth between my insurance company, the doctor's office, the radiologist, the hospital and they've even included me in some of the correspondence.  The day before I left for Thanksgiving, five months after the procedure, I got a bill from the hospital--the first I'd heard from them at all.  You can't tell me that's an efficient way for the medical system to work and all that was for a relatively simple, relatively cheap surgery (not cheap to me but, compared to a quadruple bypass, it was a bargain).  And I'm assuming that for hernia surgery there's a pretty well-established framework for determining costs and that my insurance company has a pretty rigid payment schedule for the procedure used.  And yet I got the first bill from one of the providers five months after the surgery!  So I'll say it again, "market inefficiency".  A single payer system would cut through all of that.

This time around, the insurance industry is getting in on the debate early and it doesn't look like they are aiming to scuttle the movement to universal care but to make certain that they retain their privileged position.  Just this week a group that represents the interests of big insurance, America's Health Insurance Plans (AHIP), put it's proposal on the table (Insurers Propose Universal, Centralized Healthcare):

AHIP would require all Americans to get coverage, a new mandate that Obama rejected during the presidential campaign.

In exchange for such a mandate, insurers would agree to longtime demands from consumer advocates that they no longer reject people with preexisting medical conditions.

The group is urging Congress to set up an advisory organization to identify ways to cut the increase in healthcare costs by 30% over the next five years.

It also backs expansions of Medicaid and the State Children's Health Insurance Program, which Democrats plan to tackle soon after the new Congress convenes in January.

Potentially most controversial, however, is the insurance industry's call for a new "portable health plan" that would not be subject to the minimum coverage standards set by individual states.

Many states require insurers to cover myriad services such as cancer screenings and obstetric care. Some also guarantee patients the right to an independent medical review if an insurer denies coverage.

But the standards can vary widely from state to state, a longtime complaint of insurers and some businesses that have to deal with 50 different sets of regulations.

Cutting the states out of insurance regulation is troubling but it may be a step that eventually must be taken.  Currently, each state has oversight of insurance products offered within the state and they are able to mandate minimum levels of care for insurance.  Though it is difficult for insurance providers to tailor their offerings for each state, the states provide an essential oversight role that could be lost if national standards preempted state standards (and I'm saying this in Texas, where oversight of any industry is less than robust). 

I didn't like this idea when McCain was floating it and I can't say that I like it much now, but I think we need to have a wide ranging debate, one that includes this kind of proposal from the insurance industry and also proposals for a single payer system. It's clear that our government has a mandate to address our health care system and fix it.  We need to make sure that the best ideas are on the table and that the best people are involved in the debate to make sure that the bad ideas are weeded out.  If we create another broken system it will feed people's worst fears that government is part of the problem and not the solution.

Comments

[Gaye Kopas]

As long as we keep insurance companies involved and running the system, we will continue to see very high prices for inferior health care. Six major ins.companies in 2007 made 11 BILLION dollars in profit. They enable drug companies and hospitals to charge much more than they do in other countries. Most FP,IM, and OB/GYN docs would stay the same with Universal care, but highly paid specialists would not be paid nearly as much. Just to compare, all other developed countries and some undeveloped have Universal Healthcare and those systems are ALL NON-PROFIT for the most part.

[Graham Smith]

Thanks, Gaye.