Health Care Reform Needs a Public Option

Our broken health care system hurts everyone. Health insurance premiums are going up three times faster than pay, with many working families shouldering a growing share of those costs. They are paying more and getting less -- while being forced to fight with insurance companies to get the care they need and get their bills paid.

During the presidential campaign, President-elect Barack Obama spoke powerfully about the crisis. During his second debate with John McCain, he made it personal: "In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay for her treatment, there's something fundamentally wrong about that."

America needs to guarantee quality, affordable health care for all. Americans recognize that real reform must include a public plan as an option for families looking for health care that meets their needs, so that they are not at the mercy of insurance companies. A new report, released by the Institute for America's Future and the University of California Berkeley School of Law's Center on Health, Economic & Family Security, demonstrates that a public insurance option is vital to guaranteeing quality, affordable health care to all. The study finds that a public health insurance plan that competes directly with private insurers is essential to controlling health care costs, potentially saving the nation $1 trillion over ten years and improving the quality of care.

Per the study: Medicare, a public plan that most Americans appreciate, "already shows unique quality advantages over private insurance when it comes to reliable patient access to affordable care." Because of Medicare, seniors are "half as likely as non-elderly Americans with employment-based insurance to report common access problems, such as skipping a medical test, treatment, or follow up, and failing to see a doctor when sick."

Jacob Hacker, PhD, the report's author, provides vital new information that shows how a public plan can maintain lower costs while providing broad, guaranteed and quality coverage. "Premiums with a public plan cost about three-quarters the amount private insurers charge for the same set of benefits," says Hacker. "It's an essential element to any national health care reform proposal."

Hacker documents the good track record of public plans at reining in costs, while preserving access to care. In addition, public plans have pioneered key quality and payment innovations that have often set the standard for private plans. Just as important, he points out, public plans set a standard against which private plans must compete to drive value and can be a source of stability for people.

Public plans spend less on overhead and administration, less than 3 percent compared to 15 percent for private insurers. Innovative, effective solutions for our health care problems are driven by public health insurance. Private health care plans without public competition haven't kept costs down, or provided accountability or broadened access. Instead, as this new study documents, "private insurers have passed on costs while increasing profitability."

So it should come as no surprise that America's insurance companies are launching an all out effort to stop a public option from being included in health care reform. They know that having to compete with a public option will reveal private plans to be overpriced, inefficient and exploitive.

Americans want a government that creates opportunity and prosperity, supports and protects our families, and strengthens our communities. If there is anything we've learned from our experiences with the private health insurance market, it is that private insurers put profits before people. That is why we need to work together in the coming months and insist on a public health insurance option as part of any health care reform legislation enacted in Congress. We will have to fight the insurance industry to succeed. If we fail, we won't have the kind of change that America voted for in November.

Comments

[RaeDae]

I think if we had national health care, with deductions taken from everyone's paycheck just like they do with FICA, and having all employers pay on it too, it would be MUCH cheaper than what we have now, because no one would have to check to see if you are covered (your ID showing you were a citizen would be all you needed), no one would waste time trying to find a pre-existing condition to disqualify you from payment for services, and there would be no co-pays except a nominal fee for prescriptions, unless you were elderly or disabled or below a certain income level (in which case it would be free). The insurance companies would have to just stick to auto, home, and life insurance, and those who lost their jobs in those industries should be able to get retraining to do something else - like in the actual provision of services, because the minute we are all qualified to see a doctor, there will be a need for more medical professionals.

If we were all working on wellness, as suggested by Dr. Rick Lippin, we'd have less need for the doctors and be in better shape overall. If a person doesn't have the ability to read about health matters due to a poor education, then they are going to need the doctor, and that should be available to all, not just the rich. The only way to do this is through national health care.

[paurience]

I hate to be the wet blanket in the bashing insurance companies parade, but as much as I dislike the amount I pay in health care premiums for my family, I get really tired of people complaining about the fact that the insurance companies make money. Last I heard providing health insurance was a business. It used to be that businesses need to make money or they would go out of business (at least prior to AIG, Citi Bank etc.) I don't remember hearing about the big bailout of Aetna Healthcare. Probably because there wasn't one. I am not saying they are not making a pretty big share of money, but it's a business, they're supposed to. That is why health insurance companies don't like Gvt involvement. How do you compete with someone who has no profit motive and has the full resources of the US Gvt? You can't.

You want to address soaring health care costs? Get hospitals to stop charging $600 for an ace bandage. Get them to stop charging $2500 for a CT scan. Limit judgments against doctors for malpractice so they don't have to order 12 tests when one would likely give them all of the information they need. 11 tests so they can have a better protection against a lawsuit is ridiculous. All I ever hear about is insurance companies as the problem because that is the bill that most people see. Look at the rest of the system, not just the insurance companies.

[Arthur954]

Your article , Mr. McEntee, is the best I have read on the subject. In my opinion, the US system cannot be fixed, instead we should let it shrink to a smaller size once a public system is in place.
A public health system could be implemented gradually :
--- select one state, for example Vermont. To find out about the working of public health, a short visit to Europe would be good.
--- the state in particular, could build a series of public hospitals with most of the services available, and any extra work or specialised procedures could be outsourced to the private sector, in a cost - competitive way. This would encourage new facilities that would compete with each other for the state business, offering MRIs etc at a good price.
--- the state would require that all parties doing business with them have all work ( bookeeping etc ) done in the US
--- The state in particular in which this experiment is conducted would have to find a way of making doctors work part - time at least for public health : a condition for a state license
--- The money would come from making it obligatory for all employees in the state to have the corresponding amount deducted from their paycheck, like in Europe

Once the good comments start coming in, the rest of the US will want the same thing !!!! I am sure
Lerts hope that Obama / Dashley GO ALL THE WAY

[TRex86]

Tres simple:
1. Merge Medicaid into Medicare and cover everyone over age 55 and up to 350% of poverty.
2. Make it a totally federally funded program (with income taxes and funny money).
3. Permit private purchase with income based premium adjustments.
4. Permit industry to opt out by paying into a "pay or play" pool, which applies to all businesses whether they currently offer insurance. (Defer the payments for at least two years--until the economy turns around).
5. Phase out the tax exemption for employment based insurance.
The immediate result will be taking huge expenses off of the back of corporate America and the states. Our industries will be more competitive. The states will be rid of their largest single expense. During the current economic crisis it will work better than direct cash subsidies. A key piece, however is the funding with progressive income taxes. In the short run funny money can be used as it is essential to throw vast amounts of newly printed money at the economy to prevent the Second Great Depression.

[Mixpixlix]

Affordable, accessible medical and healthcare (one for sickness, the other prevention) should be available to all.

As for cost, we all ready pay more than any first world country and get less. We rank 37th in the world regarding health care for our citizens.

Finally we have a perfect storm of a financial meltdown, growing unemployment, middle class people unable to pay their bills, including affording COBRA after being laid off. For the first time people, unions, big corporations, etc. all agree that our current healthcare system is bloated, self serving and puts profits over patients.

Medical costs got out of control for one basic reason: The powers that be believe that people would pay any price to get well. That's the rational for every increasing cost of tests and procedures though there's no real justification.

Why is it an MRI cost more now than three years ago, but a PC with double the computing power cost less today than it did in 2005?

Americans were sold and swallowed a lot of hogwash regarding why healthcare costs have escalated. I think it's safe to say, we've all had a belly full.

[rlfast]

I am an American citizen who lived in Canada for 25 years, and I have many friends and relatives who live there now. The public health insurance system in Canada is a tremendous success, the most popular government program of all. What we really need here in America is to be rid of private health insurance, forever. In the meantime, surely, asking only that a public plan be allowed to compete is entirely reasonable.

[wdw505]

that is why Canadian citizens come to the states for medical care, because that system works so well right?

[Mixpixlix]

Actually this is another myth.

It's a rare and wealthy Canadian who comes to this country for medical care. Usually for an obscure or new procedure not readily available.

I had Canadian neighbors who wintered in Florida. Their one concern was they'd get sick in the US and not be able to get back to Canada for treatment.

As the former middle manager Mom who after being laid off found herself enrolling her kids in a Medicaid program said (in effect): I used to look down on the people who needed these programs. I never dreamed it could happened to me. How could things have gotten so bad?

[Arthur954]

Every time the health care issue comes up, I start reading about a particular " Canadian story" ------------ does the US health care cartel pay people to spread Canadian stories on internet ?

[orangepetal]

Keep the private sector for 'extra' care. There will be limits to what the government can / will offer.
At least everybody will be able to walk into a doctor and get high quality care. Care management for chronic ailments, minimizing emergency room care and bulk purchasing of medicine for epidemic ailments should reduce the costs. Cutting out administrative fees and profit would lead to more savings. For the goverment to expect people to purchase healthcare, which blatently works against the consumer and increases at double didgets a year, will just lead to just more of the same. Unless you work for the government who generously increases wages anually. There should be no special interests at the table. Private healthcare can have its place for those who can and want to buy extra. Most Americans will likely buy some extra options. It will never be fair but it will IMO be fairer. All doctors and service providers could stay private, but no monopoly pricing.
IMO most Americans do not want more limitations they want more options. At least they are working on it in Washington, maybe we will get lucky.

[SeriousBlack]

Nice right-wing talking point. Completely false, but nice.

[Arthur954]

Very well Mr. McEntee, a good article.
I am an American citizen living in Spain, where there is a national public health care system, and believe me --- IT WORKS !
--- there is unlimited health coverage for all citizens
--- for people above 65, medicines are free. You have a health card, you take it to the pharmacy, and when they insert the card in the computer, your medications appear on the screen and they give them to you. For those younger than 65, medications cost very very little. There are agreements with the pharmaceutical companies so that many medications are generic ( no brand name but same active components ) so they cost a lot less.
--- your health records are all computerized.
--- future doctors begin to study the career of medicine right in their freshman year in college, and the state universities have practically free tuition. When doctors graduate from medical school, they start working for the public health system, and then move up and move on to either private practice or, as many doctors do, work for both public and private.
--- sometimes you have to wait a little, but it is usually reasonable.
--- many procedures, specialist consultations, etc are subcontracted to the private sector, in a cost - competitive way.

. Everyone is entitled to public health care, and some people also are willing to pay for a private health insurance, to wait less, etc.
The taxes that we pay in Spain are

[Arthur954]

The Taxes that are paid in spain for this public health care are VERY REASONABLE.

[lj9283]

(The details below can be found in the Kaiser Family Foundation’s publication "The Uninsured, a “Primer” Key facts about Americans without health insurance")

Discussions on Health Insurance coverage never seem to talk about what I consider to be the elephant in the room, the current costs for medical services for the uninsured.

It is projected that in 2008 the costs for medical services for the uninsured will be $87 billion dollars.

Of those costs $30 Billion will be paid out of pocket by those who are uninsured.

The remaining uncompensated costs will be covered by Federal (26.5 Billion), state and Local (17.2 Billion) and Private Dollars (14.5 Billion) :

Of the uncompensated care monies (57.4 Billion), Hospital will receive $35 Billion, Community Providers will receive $14.6 Billion, and Physician will receive $7.8 Billion.

While federal dollars cover a much of the costs of caring for uninsured patients in community health centers, that share has declined between 2000 and 2007 from 56% to 48%. Less than $1 billion out of $26 billion of federal spending for uncompensated care will go to community health centers this year

$87 billion of unmanaged health care dollars will be spent this year in medical services for the uninsured.

Shouldn’t we be talking about how to better manage $87 billion?

[newpotusplease]

I want to know what AFSCME is going to do about the lack of due process for University of California Whistleblowers

http://cloudminder.blogspot.com/

[drricklippin]

PUBLIC VERSES PRIVATE IS NOT REALLY THE KEY QUESTION.W­E NEED A MAJOR FUNDAMENTAL OVERHALL OF A VERY FLAWED,ECONOMICALLY UNSUSTAINABLE, "DISEASE CARE" SYSTEM!

The economic sustainability of our US Health care system (and most other developed nations with an aging demographic) will require nothing short of the boldness and creativity that we are applying to the global environmental crisis

In this nation the uninsured have been immorally denied basic services- sacrificed at the alter of the free market-while the insured (most of us)have been both duped and swindled into purchasing medicines and medical services that we do not need at best and harm us at worst.

We need a sustainable prevention based health care system-both individual(health behaviors)and more importantly institutio­nal(public health) to replace our bloated and corrupt "disease care" system

We need to begin to dismantle a $2.2 trillion dollar, and growing, disease care industry that, if not checked very soon could be the financial ruin of this nation.

It will be painful but it must be done

Dr. Rick Lippin
Southampton,Pa

[orangepetal]

Your website is very interesting, I favorited it and will visit.
It is funny you mention the harm of modern healthcare, it is an issue overlooked. You connect a healthy spirit to healthcare. I'm not sure if I would connect it to healthcare but it is essential to a rich life. I love how you connect art and culture too.
I agree with your comment. I am surprised at how you do not connect food to health. it seems to me the obvious place to start. Maybe you did, and I just did not see it.

[RightWingMarine]

seniors miss fewer tests and medical appointments, could that be because they are retired and don't have a work conflict to get in the way?

If the gov is going to be providing free health care to everyone then why not drop the medical coverage we have now and get on the govt gravy train? This is something for nothing right? Nobody has to pay?

[newpotusplease]

everybody is paying right now - we are paying right now for the uninsured

please read up on the subject

[RightWingMarine]

In an ideal world we would only pay for ourselves. It's not my fault someone else decided to live an unhealthy life and got sick, why should I have to pay for their treatment?

We should end all medicaire and medicaide today. There will still be charity hospitals that will serve the poor but now there will be less in taxes being taken from one poor person to subsidize another poor person.