Is a public health insurance option essential?

By Reuters Staff
August 17, 2009

The debate over healthcare reform heated up this weekend when a top U.S. health official called into question the government-run health insurance option favored by President Barack Obama.

Health and Human Services Secretary Kathleen Sebelius
said on Sunday a public option was “not the essential element” of any overhaul, and that non-profit cooperatives being considered by a Senate panel could also fulfill the White House goal of creating more competition on insurance.

Democratic dissenters of this view come out in full force.

“You can’t have reform without a public option,” Howard Dean, a former Democratic National Committee chairman and a vocal supporter of an overhaul, said on CBS’s “Early Show.”

“I don’t think it can pass without the public option,” Dean said. “There are too many people who understand, including the president himself, the public option is absolutely linked to reform.”

Democratic Representative Anthony Weiner of New York, who backs a public option, said in a statement “leaving private insurance companies the job of controlling the costs of healthcare is like making a pyromaniac the fire chief.” asked a panel of experts to weigh in on the debate. Here are their responses:
(Updated at 8:15 pm ET)
ted-okonTed A. Okon is the executive director of the Community Oncology Alliance, a professional organization representing community oncologists. The views expressed are his own.

A government-run insurance program — the public plan option — is not essential to health care reform and could even be detrimental. The government should focus first on creating a consumer-friendly insurance exchange that provides transparency and easy comparison of private health care options. This combined with regulatory reform at the federal level will foster greater competition within the private insurance sector.

Proponents of a public plan want a low-cost, government-run insurance option that will force private payers to reduce premiums to compete. This would be achieved in large part by basing provider reimbursement on Medicare, or a nominal percentage above Medicare. Thus, between Medicare and the public plan, the government would have the leverage to virtually control provider payments.

Greater government control over provider payments would force practitioners to close their practices because in many cases Medicare rates are not realistic. For example, Medicare already pays for approximately 45 percent of cancer care at rates that are forcing community cancer clinics, which treat over 80 percent of Americans with cancer, to cut staff and close facilities. In 2010, Medicare is planning further payment cuts for the administration of life-saving cancer drugs by over 20 percent.

Extending the influence of Medicare pricing through a public plan offering would have catastrophic consequences on the cancer care delivery system in this country.

steffie-himmelstein-comboDr. Steffie Woolhandler and Dr. David Himmelstein are both associate professors of medicine at Harvard Medical School and primary care doctors at Cambridge Hospital. They co-founded Physicians for a National Health Program. The views expressed are their own.

Even with a strong public option the president’s plan for health reform was far too timid, falling well short of the single payer reform that would resolve the health care crisis.  Dropping the public option assures that reform will merely pump more money into private insurers’ coffers and reinforce their stranglehold on America’s health care system. The measure the president appears ready to accept would do little or nothing to help patients, and much to help the corporate interests who profit from care.

Wendell PotterWendell Potter is the senior fellow on healthcare for the Center for Media and Democracy in Madison, Wisconsin. The views expressed are his own.

I’m hoping the comments from the White House over the past few days are part of a trial balloon to gauge the reaction to the possibility of throwing the public option overboard–and that the reaction from the president’s core supporters has been swift and clear.

There can be no meaningful reform without the public option. The suggestion that nonprofit co-ops can be created as an effective alternative to the public option is fantasy. The insurance industry would love to see the idea of co-ops included in the bill that reaches the president because insurance executives know co-ops would have no chance of ramping up to be competitive in any market.

Sen. Conrad should spend more time learning about what has happened to the insurance industry in recent years before championing an idea that would ensure the continued profitability of insurers at the expense of his constituents and millions of other Americans.

For full Reuters coverage on the healthcare reform debate, click here.


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I do not understand the fear of having a public option. I think must people opposed to it have been brainwashed with the fear mongering of the Health Care Companies lobby. What they do not know or love to ignore is that Health Care companies wants to drain your wallet even further deny most of your health care. I fear the Health Care Companies that exploit us with their continual denial of health care and fleecing of my wallet. I rather trust a public option than Blue Cross Blue Shield, Kaiser Permanente or the rest of the Health Care thieves. In my own opinion, health care companies in this country should be run as non-profit companies. Their fat profits should provide great health care for the rest of us.

Posted by Fedorov Cadmius | Report as abusive

There can be no meaningful reform without the public option. Unchecked the insurance industry will continue to raise premiums, deduct coverage and make more money. It is unfortunate that the focus of attention is on soundbites that inflame and polarize individuals. Health care reform, insurance reform and understanding the moral imperative that we should all work to the betterment of all humans. Health care can continue to be “priced based” and those who have the money can continue to get the care that they can pay for. This select group of people will always be able to pay for what they want. Reform is about those who use insurance companies, earn an income and support families on salaries or wages. It is for those who have not received wage increases or bonuses in recent and in some cases over ten years. The wage and salary increases have all gone into paying for insurance. It is estimated by some that insurance cost per employee is $12,000 for a family plan. Where will we be when this is $24,000? Ten years ago the average insurance cost per family was $6,000.
Blame it on what you would like, but it is something we should be addressing.

Posted by Rosemary Duggan | Report as abusive

Without the public option health care reform is a waste of time. An alternative is necessary to bring the health insurance industry to heel – or else market conditions will return to those most favorable to them, as they are now.

Posted by Ron Reed | Report as abusive

People who are against this reform are either profiting from this broken healthcare system or not paying for healthcare.

Posted by limnu | Report as abusive

According to the Bureau of Labor Statistics, the number of medical administrators has increased twenty-six times since 1970! In that same time, the number of doctors and nurses hasn’t even doubled. That is the primary source of rising costs along with 15% of all medical costs coming from billing fraud according to the Government Accountability Office. In comparison, medical malpractice insurance amounts to less than one percent of all costs.

Minnesota already has Obama’s vaunted non-profit, insurance co-ops, yet it hasn’t lowered our costs much at all. We’re still suffering from prices skyrocketing at three times the rate of inflation and 40% of our state’s budget goes to medical care even after years of cuts.

America already has the most socialist health care system on Earth. We pay more than everyone else, even only counting government dollars, yet most industrialized nations cover everyone with less rationing than American insurance companies use. If America becomes more Socialist, it won’t be because of a public plan. It will be because Congress passes a plan which guarantees more tax dollars to subsidize the insurance, drug, and medical industries which are lobbying them at an expense of millions of dollars of your premiums and medical costs every day.

Posted by Colin | Report as abusive

Dear Editors,
All your sayings on this subject are worth for debates and for final conclusions.
After reading,writing,debates and comments from various sections of American society,Mr.Obama!s new health care insurance proposals will be accepted.
Generally speaking,America always follows capitalist system in larger ways.
Thats why,many Americans are having second thoughts to this new proposal
The concerned authorities also find very difficult to convince Americans to accept it for future national interests.
The best way is,this new health care policy can be optional to them
Let both government and private agencies participate to it.
To sum up,since so many days, the above topic became prominence to entire media networks.

Greyfox, apparently most countries in the world follow that particular idealistic dream and their citizens are very proud of it – that is what taxes are all about.
There is hardly any idealism behind it; it is strict pragmatism to consider the well being of ALL citizens to keep a country stable without the use of crushing military might. Think about it.
Many countries also rely on their government-run and volunteer fire departments that work hand in hand with both private and public hospitals. Private practices co-exist with public and everybody gets what they want.

There are many public hospitals in the USA that are the best at some specialization or another, same as with private. The best schools and universities where a particular student wishes to specialize are, for the most part, public. All medical doctors must be licensed to practice, as so must be nurses.
In MANY private insurance deals today, the patient/customer has no choice in the doctor they wish to have: it HAS to be a company doctor/hospital/clinic.
The death squads exist based on the monetary capabilities of the patient or his family. They’ll easily deny treatment and pull the plug on who isn’t deemed profitable. While they sense dollars, they’ll keep you alive and add as many irrelevant tests and treatments as they possibly can.

I find it offensive and reminescent of national-socialist party tactics for takeover [of democratic systems like in Europe 80 years ago] what certain groups are doing at local levels of government:

Were a certain white mayor who got a very serious death threat in the shape of a dummy hung by a rope black instead, the outcry against such tactics would be far greater. Why isn’t it now? It’s anti-democratic and disrespectful to everybody to have it happen over a critical issue of national interest, not to mention to the man and his family. No good citizen should do this. No good citizen is doing this. There are people in jail over less than has been done.

There is extensive literature providing enough evidence of graffiti, violent manifestations, interruptions and subversion of town hall meetings, posters, use of violent gangs and vigilantes in post-WWI Germany.
I wonder if the nazi symbol they use to brand elected officials isn’t instead a gang tag.

The loss of composure in public meetings shows how little those people know about their democratic responsibilities and about exercising their democratic rights. What do they have to fear in the great American democracy to resort to this?

Why should they have a say and why should they be listened to regarding a public health care option?

Barack Obama has turned out to be a little coward. At the end of his term he won’t be re-elected if the Bill isn’t appropriate to the betterment of the lives of American society.

Posted by SG | Report as abusive

Why can’t just those why pay taxes get health benefits…how b’out that Obama and the rest of the health care reform starters??? NO seriously, this I could be in favor of, but not just letting any old person that comes to America, even the illegal’s to get health care and our taxes go up the roof???? No, sure, I will cont. to fight this…

I think it’s critical for insurance companies to pay some of the highest health care costs in the world. That is what smart insurance companies do. I also think that old people are a burden to the insurance system and should not be insured once they start making claims. Only people who do not need insurance should be insured. The average person without insurance should borrow heavily to pay for their medical bills and then simply declare bankruptcy.

See, our objective is to send thousand of soldiers to die for no good reason in distant countries. Because we like having dead people. It’s wonderful when parents are proud when they send their children to die for oil. To think we would actually use public funds for free health care is truly American. As soon as our kids our born, there isn’t really any point waiting for them to grow up. Kill them off right away. Save the state the expense of education and health care. Children and indeed all people are a liability. The world is kind of overpopulated.

So I personally believe that we shouldn’t have any kind of public health care. It was a dumb idea from the start. When people get sick, they should sell their organs. When people are hungry, they should eat their kids. That’s what it means to be a great nation. Public health care can’t work. Look at all those other people around the world with public health care. Their economies are falling apart. Meanwhile the United States is a total economic juggernaut. Shock and awe. Look at us. We smart. They dumb.

Posted by Don | Report as abusive

Healthcare is a supply and demand issue.

Costs will remain high while demand surpasses supply.

To increase supply of health care we need to:
1. Create multiple competing Master Healthcare Indexes so medical devices and software can communicate seamlessly. Today its complete tower of babel. HL7 is almost worthless.

2. Stop worshiping doctors. Most medical procedures can be done by people with two year degrees. We should make at least three competing Medical Procedure Certification authorities for regulating how these new medical procedure specialists are injected into the healthcare industry. AMA has had a monopoly long enough.

3. Reduce monopoly on patents for all new drugs. Encourage pharma to become more efficient and not focus purely on the next 50 dollar pill.


Posted by ERic | Report as abusive

1. Utopia.
We know that current health care doesn’t work. (It is no.1 in price while number 37 in overall ranking).
So people decide to come up with something new. Old health care system must compete or die.

2. Facts

a. Every single procedure must be approved by doctor and insurer. After every visit doctor sends papers to insurer seeking approval. Serious procedures must be pre-approved.

b. Current insurance only work while you are employed. If you lose your job while sick you ultimately end-up paying out of your packet. That may reason why medical cost bankrupt families. People losing insurance while they need it most and go bankrupt.

c. Individuals pay 1.5-3 times more than than insurance companies for the same service.

d. States/boards/insurers mandate minimum charges for medical procedures.

Posted by Sergey | Report as abusive

All the proposals being thrown around do not go to far. In my opinion healthcare should not be a for profit enterprise, it should not be a drain or a money sinkhole either, but people making fat cash off the current healthcare system while people are going bankrupt from needing operations or other services at the same time is not a pretty picture.

Posted by Chris | Report as abusive

As a registered nurse who has practiced within the Oncology specialty, I can only add that outpatient chemotherapy will be “gone with the wind” and that even the simplest 5 minute chemo infusions will have to be administered in the hospital. The patient will have to undergo the hospital admission process in addition to the travel time to the hospital and the additional time expediture that the patient will have to endure. Many cancer patients are fatigued from their disease.Requiring that they travel to the hospital for their treatments when they could have had their therapy administered across the hallway from the exam room is couterproductive. How will this avenue of treatment save the system any money at all? I think we will only see more deficits and fewer staff.

Posted by Pamela | Report as abusive

I have private healthcare that is rising my cost again for the third time in 7 years and it was already high when I first got it through my job. I can’t even afford to take my kids nor myself to a primary doctor which is $25.00 a visit through UnitedHealthcare, much less a specialist who is 45.00 dollars a visit. In the past I received medicaid because I only made below $20,000 a year while going to school with my girl who where under 5 years old back in the early 90′s. They are young adults with the same insurance problem while going to school and work. It’s harder for them because they don’t have kid’s of their own. The system make it easier for teen mothers and single mothers to get help while making it harder for my daughters to make ends meet. Why is the insurance company allowed to raise our premuim when ever they want and drop us at any given date even after paying for years. I’ve worked in nursing for nearly 18 years and know the greed of the hospital, insurance, doctor and pharmactical companies. They DO NOT look out for us. You my not realize it, but you already have a socialist Healthcare system in place. And their paying for those fear factor commericals your seeing on TV everyday. Why else does it seems like Obama is still running a campaign that should have ended November 4th. Come on everyone. Get over the angry. Obama is in office.Okay. And before listening to another Hannity, Rush, and Beck, find out what their motives for telling you what’s what. Find out if it’s true. You already know they hate Obama from the beginning and that’s okay under a normal debate. We are talking about the issue of REAL peoples health. And as I last recall, you only get one body to take care of, so get the facts and stop this hating.

Posted by eliza holmes | Report as abusive

Doctor or no better. My specialist was/is a drug pusher. One of many who works for the phamacial companies and not for your best interest. From the beginning I told my specialist the problem I had and she still wanted me to use a prescription drug that the insurance paid $148.00 for and I paid $40.00. Not a lot of money for some, but two meals too me. I was filled with rage when I read the details of the medication. Turn out it was a new none tropical drug for the scalp the pharmacial company was having the specialist to push on patients. (The pharmacist told me it was new)I went back to this specialist without an appointment two days after getting the medication and asked to speak with the doctor. She took 30 minutes to see me. Which was odd because it only took her half that the first visit and there were no other visitors present. The first thing I asked her was “Why didn’t you listen to me when I gave my complaint?” Then I told her I did not appricate how unimportaintly I was treated. Also, that I was tried of running into doctors who treated the patients like cash flow and not as human beings. She apologized to me and actually looked at me directly while we talked. She wasn’t looking at a note pad or writing down a prescription. I told her I need an antibotic. (I don’t like taking them) After a second examation she still saw nothing on my scalp other then and old head injury I got almost a year ago. I had scalp ploblems since that injury. As before, I told her I was going insane from itching and I was not leaving without a FREE treatment with the antibotic. She told me I had to have an infection for one and she can get the other now. I told her while pointing and touching behind my left ear lobe at a swollen spot, “This is an infection.” I remain claim while she look through and probe my whole head again. After she finished she apologized again and wrote me a new prscription. NOW I am finally, finally happy. She even called me this past friday to ask how I was doing. I haven’t had a doctor do that since I left from back home in Arkansas. I know there or good doctors out there that look out for us, but they few and far apart. They are a small part of a big problem.And directly link to the big ones now. Doctor or being made to be puppets to the Health insurances and the big untouchable REAL socialist drug companies.

Posted by eh35 | Report as abusive

Requiring Americans to purchase health insurance is not the same thing as vehicle accident insurance, where you can elect not to drive and therefore not have to buy the insurance. Forcing people to buy health insurance would amount to requiring payment for U.S. citizenship, and could be challenged on constitutional grounds. The only way to get truly universal health coverage for everyone in the U.S. is to offer a free (public) health care option. I don’t understand why health insurance is being touted as the ‘cure’ for the health care crisis in this country — people need health CARE, not health INSURANCE. I, personally, would be happy to pay higher taxes if I got a free non-profit health care system in exchange.

Posted by LVehko | Report as abusive

We all know that some countries have coverage for all and they do not have a Government run public option.

I’d like to see us start with removing the barriers that are in place to competition. We keep using Medicare as an example of a program that could be modeled on. Why then do we not let insurance companies compete on a national level and get rid of the state boundaries. Medicare does not face these restricitions and we should begin to adopt that for all insurance.

Next lets set caps on pain and suffering. Run away jury awards have done nothing but drive up rates and force some physicians to leave areas where malpractice insurance is too high.

Thank you

Posted by Tom | Report as abusive