It's in. It's out. Is it in again or is it out again? The public option in health care reform or the "government health program," depending on your perspective, is the "Wack-A-Mole" of health care reform.
In today's national health care reform debate, we seem stuck on an "all or nothing" approach to the public option which I would argue is not the right approach. Let's consider another incarnation of the public option, one that meets the original goal of healthy competition. The premise of a public option competing with commercial for-profit plans is a good one. A public option, with drivers other than profit, can raise the bar for quality and overall performance in competition with private plans. It can be done on a level playing field. It can be done without forcing commercial health plans out of business. And, it can be accomplished in a cost-effective manner.
How can I be so sure? In Los Angeles, we have been doing it for more than a decade (and sister organizations in 8 other counties). L.A. Care Health Plan is the largest public health plan in America with nearly 800,000 Medicaid, Children's Health Insurance Program (CHIP) and Medicare enrollees. We are a public entity governed by a stakeholder board, which includes representatives from safety net hospitals, community clinics, physicians and enrollees.
While fiscal responsibility is at the core of L.A. Care, profit is not. Since we have stakeholders and not shareholders, we concentrate on improving quality, driving innovation, supporting the safety net, and expanding coverage. In 2008, LA Care achieved certification by the National Committee for Quality Assurance (NCQA). We've developed innovative ways to align financial incentives across the system to drive quality improvement and address disparities, resulting in more timely prenatal care and adolescent well care delivery.
We have also made investments in safety-net providers that not only benefit our enrollees but others in our community who rely on the safety net. Examples include our investment of $1.5 million in accessible exam room equipment to better prepare safety net clinics to serve an aging population, and $7 million in oral health to fill in a gap in dental care. We've also been innovative in our use in aligning financial incentives among providers, and members to improve quality and address disparities, such as improving timely prenatal care and adolescent well care. We've even expanded health coverage to over 70,000 low-income children who do not quality for Medicaid or CHIP. All of this has been accomplished in the state with one of the lowest reimbursement rates of any Medicaid program in the nation.
Let's see here, an existing public plan model has a track record of expanding coverage, supporting safety net providers, realigning financial incentives, increasing quality, responding to consumer need and doing it all while containing costs. Isn't that what we are all looking for in health care reform?
The adage is if you know one health care market, you know one health care market. Provider organizations vary regionally in their infrastructure, contracting capacity, and ability to coordinate and manage patient care. Regions also vary tremendously in the availability of and access to specialty and tertiary care, evidenced by the wide swings in regional health disparities. That's why the public plan option must be nimble enough to respond to local market conditions.
It is important that policymakers broaden their search to include local public plans like L.A. Care, as well as cooperatives and not-for-profit safety net health plans that are already serving low-income populations through government-sponsored programs.
With about 64% of Medicaid market share in Los Angeles, we've proven that a public plan can compete with a private plan. L.A. Care has invested over $80 million into supporting community clinics and providing coverage to tens of thousands of kids who otherwise would be uninsured.
The plan must be nimble enough to respond to local markets and not force private insurers out of the mix. This can be accomplished by offering states incentives to create regional plans that are either public, not-for-profit, or cooperatives, and meet criteria to ensure they are accountable, transparent, compete on a level playing field, and serve the public's interest. It shouldn't be monolithic, national and have the ability to rate-fix.
Because it wouldn't be health care reform without a new acronym, let's call these entities "State-Designated Regional Health Consortiums" or SDRHCs. These localized SDRHCs can be an option offered to individuals and businesses through the exchange, and can also serve public programs outside of the exchange.
States should not be mandated to form SDRHCs, but should have a strong financial incentive to develop one. One idea would be for the federal government to offer an enhanced Federal Medical Assistance Percentage (FMAP) rate for a minimum of four years to states that create and/or utilize SDRHCs within the first year of reform.
SDRHCs should be required to have local stakeholder governance, which will ensure that the plan will reflect the needs and priorities of the region it serves. These organizations can be structured as public or quasi-public, private not-for-profits (under certain conditions), and cooperatives. The governing body should include representatives from consumers, government, safety net providers, physicians, hospitals, and other providers.
SDRHCs will operate under a set of open-meeting and conflict of interest rules that ensure transparency and oversight. These organizations will be financially self-sustaining, as the funds used to operate the plan shall be derived from enrollee premiums. While SDRHC's will receive some federal and state start up funding, it will be in the form of grants or loans. SDRHCs will have the same licensing, oversight, actuarial rate setting methodology, and financial reserve requirements as private plans. SDRHCs would be held to the same set of requirements for access and quality of care as private plans. However, because SDRHCs drivers are different than private plans, SDRHCs should be required to reinvest margins in the communities they serve. They should support the safety net, administer community grantmaking programs, or provide a return to the purchasers/consumers, thus improving the health of the local community.
SDRHCs should be required to offer contracts to all qualified safety-net providers under the same terms and conditions that the plan requires from other providers. Safety net providers include Federally Qualified Health Centers (FQHCs), community health centers, rural and Indian health services centers, disproportionate share hospitals, public and university hospitals, and rural and children's hospitals. The reasoning behind this requirement is that even with universal health coverage, there will still be a need for the safety net. Safety net providers will continue to be the main source of care for those who remain uninsured or are socially or behaviorally complex to effectively treat in private systems. These providers will also continue to see a significant number of those who have coverage through government-sponsored programs.
There are many successful models of these types of plans in different parts of the country, and particularly here in California. Let's not just give up on the public plan option - let's figure out a way to make it work by keeping the aspects of it that bolster the strengths of our existing markets and not those that threaten it.
- there are income limits as to who can participate (i.e. $56K/yr for a family of four),
-it is regional
-this organization is essentially a broker of government run plans(Medi Cal, Healthy Families, Medicare Advantage)
As far as the article goes, I see a few other issues:
-I really don't see how the "healthy competition" among health insurance companies has improved care. I thnik this is because the competition is for profits not providing care.
-I don't see the downside in forcing commercial health plans out of business. These health plans are for profit. As publicly traded companies, their primary responsibility is to shareholder not patients. They fulfill this responsibility through ever increasing net profits accomplished through either raising premiums or reducing payouts or both. These decisions are made by CEOs who are compensated in the million of dollars per year and incented by financial performance.
-"States should not be mandated to form SDRHCs" this would cause people who happen to live in states where lobbying is effective to suffer disproportionately.
IMHO, the bottom line question is: is health care a right or a priviledge? I happen to think it is a right and any government of the people has an obligation to protect it's citizens not only militarily, but also medically.
I realize the public option is not going to be without issues, but I have yet to see a better alternative.
I don't hear anyone talking about creating programs to get us to live healthier lifestyles. An ounce of prevention is worth a pound of cure. Doctors need to get more than 12 hours of education about nutrition. They need to be offered incentives to educate their patients about healthier choices. There should be incentives for people making healthier choices, although one would think feeling better would be incentive enough.
Regardless of what happens with health insurance reform we need to stop destroying our bodies and expecting the healthcare industry to hammer us back together with pills and surgery. It’s insane, it’s unsustainable and it’s back of all the problems where cost is concerned.
Another part of the problem is "feeling better" usually not only means physically but also mentally. Sometimes these contradict. An example would be a young girl who is anorexic because of self image issues.
I also think people, to an extent, allow themselves to convinced they have problems that really aren't as severe as they may think.
I realize I'm making a generalizations and there are plenty of health issues people face that are beyond their control.
I also happen to think changing from a reactive to preventative health care culture will take a long time.
But, as they do provide employment for a small number of citizens (but about five times as many as a public plan would), I suppose we should be magnamious and allow them at the table. However, given their actions concerning the Town Hall Debacles of this summer, I think they should be soundly spanked in some manner.
Our elected officials in Congress receive health care mostly paid for by us tax payers, yet many are trying to make it impossible for us to purchase an affordable plan of our own :
While many of us are struggling to afford medical insurance/medical bills.
While Congress people try to stop healthcare reform.
While Congress people accept large contributions from lobbyists to prevent health care reform.
Please sign these petitions - and by all means, spread the word! Thank you!
http://www.petitiononline.com/PubOp676/petition.html
http://action.firedoglake.com/page/s/keepthepledge?source=email&subsource=fwd
http://salsa.wiredforchange.com/o/5649/t/4951/content.jsp?content_KEY=2793&tag=pod_auto-email1
Consider this .... Obama/Geitner/Summers/Paulson helped the Wall St. mafia steal TRILLIONS via the financial crisis through all kinds of backdoor deals. Obama had ...
+ promised transparency - he has secretly given more than 9 TRILLION to Wall St.
+ jail time for wall st. crooks - Not a single investment banker, AIG FP employee, Citi/Goldman/ went to jail.
+ recovery of stolen money - Fuld, AIG FP, Greenberg, top execs at Goldman, Citi, Bofa have been raking it ... Not a single dollar has been recovered.
+, limits on bonus/stock options - Bonuses/Comps have doubled. One Citi trader made 100 Million.
+ cracking down on fraudulent rating agencies - Moody's, S&P, Fitch have been going gung ho after all the noise died down
+ elimination of dangerous financial products - Wall St. killed even talk of anyone trying to mess with their cash cow ... Want CDOs/CDSs ? ... there's plenty more where they came from.
Is Obama secretly killing the public option ? Is he batting for Big Health/Big Pharma just like he was in bed with the Wall St. mafia ?
I regret supporting Obama and have never voted Republican.
Enough of this publc option buy another name nonsense. Support the public option, because no matter what you call it they're still going to try and block it.
Bring it to a vote, and if it fails so be it. Then in 2010 and 2012, any dem, ANY dem who voted against it should face a primary challenge, including the president.
Enough of this trying to placate the right, they lost, badly.
People talk about the 'trigger'.
Well, I have my own 'trigger'. If there is not a strong public option passed, it will trigger me to vote out anyone who did not fight to the last breath for what I voted for: change. And yes, that includes voting for a change at the top, if Obama does not support and pass a public option.
2. Private industry is more efficient than government ? In our infinite wisdom, we got the government off the backs of business with deregulation and now we have an economic recession.
3. Among industrialized nations, universal health care is the rule and not the exception. If other countries can pay for it , why cannot we?
I rest my case
Why?
Why should one dollar of my health care expenditures become profit to an insurance company? WHY?
Let 'em sell annuities for profit.
To bring down costs you are going to need a very powerful public entity that has enough customers to be able to negotiate prices with drug companies, hospitals, clinics, etc., and that will make them a real competitor to the health care giants that presently dominate the landscape.
In short, we need to be able to bring down costs enough to force private insurance executives to cut back on their summer mansions from three down to two.
MARCH WITH US ON SUNDAY, SEPT. 13TH IN WASHINGTON, D.C. IN SUPPORT OF THE PUBLIC OPTION! If you are unable to make the trip to Washington, please check out this link for information about marches and rallies planned in major cities all over the country!
www.marchforhealthcare.com
www.democrats.com
We must get this legislation passed! Our economy hangs in the balance! The present system is completely unsustainable. Get off the couch, folks...and get out into the streets! The President needs our support and we need to let our voices be heard!
The problem is that 'incentive based' organization of said programs means that Texas or South Carolina (to give two die-hard red state examples) could choose to screw their residents at the state level.
With this in mind, there would need to be a federal option to pick up their slack if states were not mandated to provide their share of the public option.
Time to start really working for a 3rd party.