Is a public health insurance option essential?
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.”
Reuters.com asked a panel of experts to weigh in on the debate. Here are their responses: (Updated at 8:15 pm ET) Ted 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.
Experts weigh in on nonprofit healthcare cooperatives
Reuters.com asked members of our expert panel on healthcare reform what role, if any, nonprofit cooperatives should play in healthcare reform policy? Here are their responses: (Updated at 14:35 ET on July 30 to include Ted Okon’s view.)
Wendell Potter is the senior fellow on healthcare for the Center for Media and Democracy in Madison, Wisconsin. The views expressed are his own.
The idea of nonprofit cooperatives being able to compete effectively with the cartel of large for-profit insurers that dominate the market today is so naive one has to wonder if the legislative language proposing their creation was written by insurance company lobbyists.
The proposal, sadly, reflects a shocking lack of understanding in Congress of how the health insurance industry now operates in the United States. Over the past 15 years, seven for-profit health insurers have become so large that one of every three Americans is enrolled in a plan owned and operated by those seven insurers. The consolidation in the industry has also resulted in 94 percent of insurance markets in America being controlled by a handful of big insurers, often just one or two in many of the country’s biggest metropolitan areas. This means that other insurers cannot enter the market and expect to be competitive.
If large, profitable insurers cannot enter markets dominated by competitors, cooperatives, starting from scratch, wouldn’t have a remote chance of succeeding. Creating co-ops instead of a national public insurance option that actually could compete with the big insurers would be a gift to the industry.
Peter Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.
Leading Democrats on the Senate Finance Committee have expressed cautious optimism that they’ll be able to attract bipartisan support for their reform effort by substituting “nonprofit health cooperatives” for the highly controversial public option. The federal government would provide states with the seed money — some $6 billion — to set up state-based or regional co-ops.
As the HR person in a small company of 12 aging employees I feel that a co-op would be the perfect solution. What I need is to be part of a larger group that doesn’t have to go thru that horrible under-writing process only to be rated up to the highest rate.
Peddling damaged goods
– Dr. 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. –
Once they’re finished mandating that we all buy private health insurance, Congress can move on to requiring Americans to purchase other defective products. A Ford Pinto in every garage? Lead-painted toys for every child? Melamine-laced chow for every puppy?
Private health insurance doesn’t work. Even middle class families with supposedly good coverage are just one serious illness away from financial ruin. In a study carried out with colleagues from Harvard Law School and Ohio University we found that medical bills and illness contributed to 62 percent of all personal bankruptcies in 2007 – a 50 percent increase since 2001. Strikingly, three quarters of the medically bankrupt had insurance – at least when they first got sick.
In case after case, the insurance families bought in good faith failed them when they needed it most. Some were bankrupted by co-payments, deductibles, and loopholes that allowed their insurer to deny coverage. Others got too sick to work, leaving them unemployed and uninsured.
Now Congress seems poised to fulfill insurance executives’ prayers; make failure to buy their faulty product a federal offense. We’ve seen this brave new world in Massachusetts. Here, beating your wife, communicating a terrorist threat and being uninsured all carry $1000 fines. Our law has halved the state’s already low uninsurance rate – mostly by expanding Medicaid and similar programs at great public expense.
But reform hasn’t made care affordable for middle class families, or for the public treasury. A middle income uninsured 56 year old is now forced to lay out at least $4,800 for a policy with a $2,000 deductible before it pays for any care, and 20 percent co-payments after that. Skimpy, overpriced coverage like this left one in six Massachusetts residents unable to pay their medical bills last year.
Even among the insured, 18 percent skipped care because they couldn’t afford it. Meanwhile, as costs rise for subsidized coverage our state Senate plans to drop 28,000 people from the insurance rolls, and public hospitals and clinics have suffered draconian cuts as funds were diverted to shore up the reform.
First let me be clear that I am insured. I am 56 & own a small struggling retail store. My health insurance policy costs me $6000 a year. In order to have such a “low” premium, I have a deductible of $2500. I have almost no extra money after paying my basic bills. I can’t afford to go to the doctor although I have some real health issues. I fell last year and tore muscles in my leg. I need physical therapy but I can’t afford it. It is difficult for me to walk and it keeps getting worse. My quality of life has greatly deteriorated. I can see myself in a wheelchair in a few years. Blood was found in my urine 3 years ago. I took the tests I could afford but the cause wasn’t found. I can’t afford further tests. Maybe I will end up on kidney dialysis because I have an untreated condition. All I can do is to hope that I don’t. People in my situation who are under-insured are really in a bind. We are not poor enough for Medicaid or rich enough to have good insurance with a low deductible
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