No More Delays: Pass a Health Care Plan With a Public Option

I'll be upfront with you. I'm a candidate for the U.S. Senate. Last weekend I spent a good deal of my Saturday reading and drafting position statements and reviewing plans and releases for my campaign. Our young neighbors, both of whom work for a large, hip retailer, had a housewarming party at their condo. They invited my husband and me to join them. So, after knocking off way too late, we wandered across the courtyard.

Now, I realize I am not exactly the "Abercrombie" type and much too old to even pretend. As I tentatively entered their home, with its door wide open and people spilling out into the courtyard, I encountered a young woman, Meredith, age 31, who is a physical therapist in Columbus. Meredith is originally from the famous Cuyahoga County -- that of long-line voting fame, but which came through last year's presidential election with flying colors. (I ought to know; I'm the Ohio Secretary of State who succeeded in getting the resignation of all four of its board members, Democrats and Republicans alike, and helping the new board successfully reinvent itself.)

Meredith had been told by a friend that I would be there and had wanted to engage me on political issues. She was glad I supported marriage equality but she thought that maybe marriage wasn't the appropriate term for same sex marriages. I went through the "separate but equal" argument with her, while our mutual friend, a lesbian, stood by nodding vigorously in agreement with me. We talked about the unwieldy task of modifying so many statutes, state and federal, to create a separate status that was like married but was not. As the conversation spiritedly progressed, she said she did not believe in universal health care, that it just wasn't possible to provide health care to everyone. She had me hooked for what turned into a wild and fruitful discussion.

I said, "Wait, you're a physical therapist at a retirement residence. What do you mean you think it's not possible for everyone to get health care?"

She said, "I just don't think it's possible." I went into a litany of health care options such as Medicaid and SCHIP for people in need, as well as Medicare for people 65 and older. I talked about how it's the rich and the poor who have an easier time getting health care coverage, but that the middle class is squeezed -- underinsured and lacking health insurance if they lose their jobs. Her eyes started getting bigger.

She countered, "Health care will be rationed like socialized medicine like in Canada; it will be substandard; people won't be able to get the treatments they want or see the doctors of their choice..."

I shot back, "You're believing those deceptive commercials you see on TV that try to confuse the American public that health care reform will be like socialized medicine. With a public option, the government will not provide services, just pay for them -- like with Medicare." Her friend, a family physician, quickly interjected, "Yes, but they've cut reimbursement rates for Medicare, and it's making it really tough for doctors. I said, "Give me some time and I'll work on that," and I smiled.

Then I asked Meredith, "Do you think it will hurt your work as a physical therapist?" She really couldn't say. So on I went about the need for a public option, because some people would prefer a plan that involves less paperwork, less layers of administration, less comparison of medical bills to statements from insurance companies, statements that have to be saved for months just to get them to match up and to still try to figure what you owe before you start getting collection calls that you aren't even sure are right.

By this time Meredith was trying to insist that she really didn't believe those commercials. I challenged her, "You need to do more research. Search the Internet for answers to your questions, for varying points of view."

"I'm sorry Meredith's pushing you so much on these issues," interjected our friend. "No, this is great, let's keep going," I urged. "Why do you think insurance companies are fighting a public option?" I asked without pausing. "It's because they are afraid that people will choose the public option because the cost is less, and they assume their business will be hurt or fail, so they're fighting what they're afraid of, even if it may not happen." Meredith and her friend agreed.

"Do you like the fact that an administrative person sitting at a computer screen makes the choice of whether or not a service you provide is covered based on looking at a key for service codes?" I asked. "That's your livelihood controlled by someone who isn't even a medical specialist," I challenged. "What about those people who have preexisting conditions and can't get coverage?" I tried to back off and make sure I wasn't overwhelming her.

Just last week, I talked with a building trades official from Northwest Ohio who worked within his union to start a nonprofit corporation that charges $4 per member to administer a plan that negotiates fees for medical services with over 1800 providers in Northwest Ohio. This nonprofit is its own "public" option that pays the providers directly and is staffed by nine people -- that's right, nine people. He is such an enthusiastic evangelist for a plan that has been tried and works, that he is retiring as a union official at the end of this year to work full-time on expanding the coverage and availability of the plan. This plan now employs a nurse practitioner who offers preventive services to plan members. Hundreds of members continue to join, allowing for greater clout in negotiating reasonable fees and costs for health care services. This is how a public option would and should work.

Many are afraid of the government operating this kind of plan. But the truth of the matter is that accountability would be required and built in because, instead of the union's dues and investment earnings, it would be our tax dollars at work for us -- the burden spread among many with the advantages of volume and the political will of the Obama administration to adopt best practices in preventive medicine.

The Obama administration is not pushing for true "single payer" health insurance, where there is just one health care payment system for the country. Instead, President Obama pragmatically recognizes that people should have the choice of the public option or private insurance, if they have or can obtain private insurance. There are, however, 50 million people without any health insurance, many of whom are ready to accept and embrace what is, as I urged Meredith, a basic human right. Giving them a choice and making the federal government directly accountable for that choice is what the public option means.

For the long-term economic health of our country, the public option will jettison costs from employers and from us as taxpayers, who pay the hidden costs of uninsured and underinsured Americans' health care now as it is. You don't cure a headache by beating your head against a wall, but that's what we've been doing -- and it's getting worse. Glenn Beck can scream all he wants about how leaders of other countries come to the U.S. for our excellent care, but he doesn't talk about how some desperate middle class Americans take enormous risks going to other countries to get health care, under whatever standards of care may prevail there, because they cannot get it here.

We are the United States of America. We are still, to so many here and abroad, that "shining city on the hill." We must step forward, recognize that the free market, by itself, as applied to health care doesn't make us free, but rather imprisons us in a vicious cycle of suffering, inequality, disparity and grief. The public option is the first step to stem the flood of loss and resulting damage.

I know we can do this. Each one of us must search out the Merediths of this country and talk until we can't talk any more, and then keep on talking. This will only happen when ordinary Americans like you and me get off the couch, turn off the TV, read all we can read, write and email our Congresspeople, and talk to our neighbors and friends. President Obama needs us to support what is a gargantuan task. He proved we can do it with his election. Now let's do it again.

Jennifer Brunner is Ohio's 52nd Secretary of State. After taking office in January 2007, she implemented enormous reforms to Ohio's election system, resulting in a record number of Ohioans voting in a presidential election, and a record number of Ohioans voting for the same presidential candidate -- Barack Obama. She is running in the Democratic primary to replace retiring Senator George Voinovich, a Republican. In 2008, she was awarded a John F. Kennedy Profile in Courage Award, the most prestigious award bestowed on elected public officials.

Comments

[ompah]

There is nothing more important for the US government to provide than quality affordable health care for all Americans.
The real question should be "What can the US government afford AFTER they pay for quality affordable health care?
If our tax dollars can't go to affordable quality health care,what are we spending them on?

Charlie McCullagh
311 river rd
Red Bank ,NJ 07701

[johnashman]

Here's an option that would destroy insurance companies (people would be basically self-insured), drop prices by more than half, cause incredible competition, destroy the ambulance chasing, virtually eliminate paperwork and only needs the government to set up the rules of the game. But everyone appears to be too ideologically blinded to look at it because it's not government *controlled*, just government *set up*.

[hsr0601]

The House leaders reached a deal on Medicare payments: A "Pay for Value" reimbursement system that rewards doctors and hospitals that achieve the best outcomes at the lowest cost.

As a result, The House gained a lot of votes, a lot of people who were withholding support.

The federal Medicare program insures some 44 million elderly and disabled Americans at an annual cost of $450 billion, almost one-fifth of total U.S. health care spending.

Supporters of the agreement say it could save the Medicare System more than $100 billion a year and improve care, that means $1trillian over a decade.

No one can disagree with this best outcome / evidence-based system, and private insurance, too, will be greatly influenced by this change with the focus on value over volume.

THANK YOU !

[missdeb57]

You may be running for the senate, but you wouldn't get my vote. Health care has been a problem and a promise for many years. Do you really think that Obama has the right idea about anything these days, or ever? I am tired of the promises and none of the action. Don't touch what money i have left for your programs. Get rid of the garbage that you spend it on now. How many useless or overpaid programs do we have in the United States right now. How many politicians vote for things only when they can add something to a proposal that will help them? Get rid of the pork and maybe, just maybe, things that seem so unimportant to them after they are elected, re: health care, education, tax reform, unemployment, elder care, homelessness, etc., can be addressed. I do hope that you find the time to look into these problems if, and when you are elected. Until I see a nationwide effort to cut the pork, trim the pockets of the politicians, I refuse to believe that anything will come to pass that will help the American people. Please note: I did not vote for Obama, though I did vote. That is why I feel that I have a right to complain about the politicians and the politics of the US as it stands now.

[thehoopoe]

Why is big business so uncreative? The whole premise of capitalism is that it is innovative and quick to respond to market demands. DOn't the insurers have any confidence they can adapt to a new environment?

No? Then maybe they aren't very good at what they purport to do. Or maybe they're crooks, not legitimate businessmen.

[weatherwaxx]

Thank you, Secretary Brunner!

I'll be voting for you for the Senate, but I sure hope you can get rid of the Diebold vote-fraud machines before you go. I saw my vote changed from Dem to Rep in 2004... and even though I re-punched the selections, who knows how it was finally counted?

Good luck, and thanks for a GREAT column!

[lj9283]

It will most likely cost a minimum of 1.3 Trillion if Health Care Reform is not passed.

In 2008 the costs for the 47 million uninsured was $87.4 Billion.

Project that out for ten years and assume no increase in health care costs and no additional uninsured and the 10 year cost would be $870 Billion.

Medical bad debt (not part of the uninsured) in 2007 was 25.4 Billion of non collectible money, an increase of 9.5% over 2006.

Project that out with a 9.5% increase each year for the next ten years and you have a total of nearly $433 Billion of bad debt.

$ 870 Billion + $443 Billion is over $1.3 Trillion in costs over 10 years if there is no health care reform.

Sources: Costs for the Uninsured - The Uninsured: A Primer (2008) - Kaiser Foundation
http://www.kff.org/uninsured/upload/7451-04.pdf

Health care bad debt (6/09) http://www.modernhealthcare.com/article/20090608/REG/90605999

[Mostro]

When in Chile the public option got strengthened by the good economic situation, thousands of people using private healthcare systems fled to the public one. Did this lead to a catastrophe? Far from it. It generated competence, the private sector started to offer better plans at a lower cost: people have options. It is a form of free and fair market applied to healthcare, with good results.

[weatherwaxx]

And that's EXACTLY what the in$urance industry is afraid of. Those who bleat most about "free market" really want a market controlled by the mega-corporations.

[claylandg]

No to Obama Health Care!!!!
Listening to him lastnight i got the feeling that if you are elderly than you are in deep trouble, he said something like this i can't remember the quote just write, but he said the elderly would have to make some tuff choices, life choice, to me he was referencing to after you get an age and your health becomes an issue that treatment might not be there for you that the government plan will wash it hands of you. I need for the president to clarify this point. i don't believe we should treat the elderly like this and just through them away when they are to old and deny them all the help necessary. If this is in the plan than i don't like it.

[weatherwaxx]

You can't even remember what you heard, but you're against it? DO YOUR HOMEWORK. I think what you heard was President Obama talking about what will happen if his plan does NOT pass. Bush and his industry buddies messed up Medicare--my in-laws had a terrible time just figuring it out.

Don't make your decisions on what you THINK the plan MIGHT be. Get the facts, and please do NOT believe what the insurance industry is telling you. Why do you think they don't want this? It isn't for your welfare, it's for their million-dollar bonuses that they get by refusing care.

[missdeb57]

The people who now are eligible for Medicare, etc, are those who have given many years through a lot of hard times to get where they are. Where are they? Hurting. My husband had to go back to work, even with a pension, to be able to afford the supplemental insurance he has. And taxes? Don't even go there. Let's get back to the basics of good health care, with out giving it to those who are not citizens of this country, who refuse to work because it is so much more fun to do nothing but sit on their couches, keep having children because they get more in welfare and food stamps, those poor souls who are addicted to alcohol or drugs that just need that next fix and just can't think about going to work because it will take time away from their addiction. Please stop talking garbage and get with a good program. Get rid of the politicians that refuse to do anything that doesn't benefit them. Make it so the politicians are reliant upon SS and Medicare, don't let them continue to collect huge sums of money on the backs of taxpayers. Sorry, Obama hasn't done anything thus far that makes me think that he really has any idea how to handle the matter either.

[rad21]

"Yes, but they've cut reimbursement rates for Medicare, and it's making it really tough for doctors."


Another distortion! Medicare reimbursements are pretty good.

Ask the doctors of McAllen Texas, who found the reimbursemnts so good, they provided a lot of medical services even when not really needed.

[Connolly1916]

It's making it tough for inefficient medical practices and hospitals that cling to outdated paper based administration. It's time for them to adapt or perish, and be replaced by modern, streamlined, hospitals, clinics, and practices that maximize their use of IT.

[weatherwaxx]

Using the example of dishonest practitioners who game the system isn't exactly a good reflection of genuine doctors who have to negotiate the paperwork set up to thwart the crooks.

[hsr0601]

Aside from the savings created by the prevention and wellness program, medical IT, foreseeable potential stem cell effect, and massive job creation, ending subsidies for the private insurers and payment reform and so on could be enough to meet the goal of deficit-neutral.
Public school, public insurance policy, and public clean energy act are the natural parts of life in the free nations.

Thank You !

[AsISaid]

Jennifer Brunner is an excellent public servant. She's smart, savy, and very strong-willed politically. And, by the way, she's a very nice and engaging woman. She's a self-made politician who worked her way through the system. She didn't show up one day and decide she wanted high office. She's paid her dues and done an excellent job along the way. Ohio needs her in the Senate.

[honestthoughts]

Here are the ideas:
1. Require all insurance companies to offer service to any customer that wants it and that the highest premium charged be no more than 100% more than the lowest premium charged. This would require companies to compete for business by keeping premiums as low as possible while insuring everyone. It would also incentivize patients to become healthier.
2. The government currently does not allow customers to sue the HMO's. This is ridiculous and anti - free market. The right to sue is essential and would ensure that high risk customers still get good service.
3. Give the same tax benefits to private plans as are available to employer plans. No wonder most people have their insurance through their job when there is a tax advantage to doing so. We could also allow churches and civic groups to purchase plans. This would give people more options outside of work.
4. HSA's: Most people can afford the first $1,000 a year or so in heath care costs.
5. A bold proposal: Eliminate Medicaid and Medicare. Provide a health stamp (like a food stamp) to the poor to help them buy private insurance. This must not be a direct subsidy to the insurers, but must go to the customer and allow them to choose. This eliminates the way these government programs dump on the private sector through inadequate reimbursements. Wealthy old people could afford the private insurance themselves because of the premium restrictions noted above, which would prevent gouging.

[weatherwaxx]

NO.

Insurance for-profit will ALWAYS funnel huge amounts of tax-care $ to the multi-mill­ion-dollar bonuses for industry execs who deny healthcare.

GET THE PROFIT MOTIVE OUT OF HEALTH CARE.

Take the insurance industry's control of our health.

When you have corporations colluding to set the cost of insurance, the notion of 'choice' is smoke and mirrors.

Your "bold" proposal.... yeah, it's bold. But I can think of a lot of other words that aren't as nice... "snake-oil sales pitch" is the cleanest.

Which insurance company do you work for?

[honestthoughts]

If we go down this road, at best we will have a health care system that operates like our public school system. The US public schools continue to cost more and more and the quality gets worse and worse. Of course, every election season the next group of politicians promise to run the system better. Won't happen. Why? Because public schools do not have to provide good service to get paid. Most people are so overtaxed to pay for public school, they cannot afford private school. And because public school is "free," private competition for middle and lower income families is not feasible.

I'm not sticking up for our current health care system, but it could become much better with some free market reforms as opposed to gov't taking over more control. Why haven't we seen these reforms? Because most Republicans only pretend to be pro free market. The reality is that big business does not like the free market because it forces them to be efficient and to focus on serving customers or go out of business.
Ideas to follow in my next post

[RepugsOut08]

I don't understand why you can't see that single payer is just the largest insurance pool possible. Large insurance pools always bring down the cost of insurance. Comparing single payer to the school system is a false argument.
A better comparison would be the police and fire depts. No one thinks police or fire dept. protection of life and health should be anything less than a right, and woe be to any politician who'd try to force Americans to buy expensive and capricious insurance for those protections.
Opponents of single payer just love to pick out some government entity that they think epitomizes incompetence. The DMV or the Post Office for examples, and now the public school system. I challenge anyone to go to Canada or England and find a person there that would give up their health care system or trade with ours.
My family has visited Canada for decades, and we always ask everyone we have contact with how the like their heath care system. Not one Canadian has ever spoken negatively of their system, and just laugh or look incredulous if you ask them to trade with the US of A.

[weatherwaxx]

As long as health care is all about profit, it will NOT be in patients' best interest. Medicare was one of the most efficient, effective government programs ever, until Bush messed it up -- Gingrich, Speaker of the House, promised the insurance industry that the GOP would see to it that Medicare "withered on the vine" so the industry could soak up healthcare money.

If you trust the insurance corporations... god help you if you get sick.

[pianoteacher]

Great post! Good luck on your Senate run.