Dr. Marcia Angell, former editor of the New England Journal of Medicine, senior lecturer in social medicine at Harvard Medical School and author (The Truth About the Drug Companies: How They Deceive Us and What to Do About It), suggests a simple, less costly alternative to building a health care "public option" from scratch. Instead, permit individuals to buy into Medicare, a known quantity with low overhead costs close to 3%, with high rate of public support - polls show higher favorability ratings among those covered by Medicare than those covered by private insurances.
"The public would be happy with Medicare for all. Polls have shown that the public loves Medicare," observes Dr. Angel.
"Public option" remains an amorphous term that is variously defined and deconstructed by different stakeholders, like a Rorscharch Test. Truthfully, the concept of "public option" as currently written in proposed bills is a faint imitation of its original intent, writes Kip Sullivan of Minnesota Physicians for a National Health Program, who evaluated the "public option" features of the current House and Senate Democratic proposals, and concluded that they lack most of the criteria laid out by Jacob Hacker who originally defined the concept. Hacker envisioned a public program closely resembling Medicare, with a large enrollment of the non-elderly population. The Lewin Group's 2001 evaluation of Hacker's "Health Care for America Plan" affirmed reduced overhead and premium costs, and predicted that a lesser number - 2 million - would remain uninsured.
Nevertheless, of the following 5 original criteria that Hacker and the Lewin Group specified as critical to the success of the "public option," only one is met by current House bills.
Hacker's Original Five Criteria of a Health Care Public Option:• The Public Option had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only Public Option enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The Public Option and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The Public Option had to be given authority to use Medicare''s provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the Public Option had to offer.
Concluded Sullivan, the only one of Hacker's five original criteria met by current Democrats' proposed bills is the latter one, requiring the insurance industry to cover the same benefits the "public option" must cover. None of the other four criteria are met.
By marginalizing the single-payer model from the outset, Democrats have already backed away from making the best case for health care reform as means to economic recovery. Too many have tended to fold in the face of Republican/corporate distortions, willing to abandon even the principles of a strong public option.
The likelihood is that the influence of the insurance industry would distort the "public option" into "a dumping ground for the sickest while they cream off the young and healthy for themselves," observes Dr. Angell.
Even if skittish lawmakers insist on incremental change, Angell suggests that the age of eligibility for Medicare can be gradually lowered by decade, e.g., to 55, then later, to 45, etc.
Dr. Angell notes that the Medicare prescription drug benefit has been a bonanza for the pharmaceutical industry and should be changed to provide for negotiation of bulk drug rates. Provider reimbursements need to be improved and costly subsidies to private plans eliminated. Currently, the fee schedule "preferentially rewards highly paid specialists for very expensive tests and procedures. For the system to work, it would have to be a nonprofit delivery system," she says.
But changes can be made over time, as Thom Hartmann writes in an open letter to President Obama. For now, Democrats should permit individual enrollment in Medicare, and call it the public option. The Medicare billing structure is in place and Medicare recipients have full free choice of providers, in contrast to private plans that limit choice to in-plan providers.
Democrats, bypass the narrow prescriptions of the "Gang of Six" and the distortions and distractions purveyed by partisans. Implement a system that is known and favored by many as your "public option" -permit Medicare buy-in.
We're talking about INSURANCE, are we not?
Then why is the word INSURANCE neglected from the little coined term "public option"?
Language is important, and if it's INSURANCE we're talking about, then say the word (also, "health care reform" is every bit as generally and mysteriously vague).
Say Public Health Insurance, and since there already is Public Health Insurance, then we're just naturally drawn to talking about Medicare, and to simply expanding Medicare.
It's almost as if the private health insurance lobby came up with the term "public option" (stripped of the all-important word INSURANCE) to keep people from the substance of what we're talking about.
INSURANCE, Public Health Insurance.
Medicare, at a rate equal to or lower than, the minimum of health insurance premiums found in America today.
Watch the people, especially the young and healthy, flock to such a Medicare as that.
Lastly, in the matter of general "health care reform": this issue of INSURANCE, and Public Health Insurance, is important enough that it should be separate and distinct from other "reforms".
Notice how 'end-of-life counselling reimbursement', as a "reform" of sorts, has been attached to the issue of Public Health Insurance, and is being used to demonize it ("death panels").
Make Public Health INSURANCE a completely separate issue, and separate legislation, from other "health care reforms".
Seeing as how Medicare is already provided for people who qualify due to their advanced age, we simply allow other younger Americans to join also, at a cost that is determined to be equal to or even lesser than, the lowest health insurance premiums that private insurers offer anywhere in America.
Now, under that type of plan, and also under any "option", we'd fear that the thing would become a magnet for the sickly and the chronically ill, as a kind of 'fiscal back breaker' to the plan.
But the simple plan as described, would instead be a magnet for the many young healthy Americans who just want health insurance at a cheap affordable price, but in truth often go without it, because they rarely if ever need a doctor.
And that's a lot of young and healthy Americans described there.
They save their money by going uninsured, but they are apprehensive about it, and wish they had an alternative or 'safety net' just the same.
Medicare, at rock bottom prices: it would draw so many young and healthy dollar conscious Americans (who otherwise and with some apprehension, go uninsured), as to float this expansion of Medicare, and more than pay for itself.
The system is already in place, there could be a sliding scale for how much you should pay based on income, and the prescription benefit could be updated to give Medicare the ability to negotiate drug prices too.
It is really just WRONG that every American is not covered with health insurance. To think that we have been surpassed in health care by 37 other countries, many that we re-built only 60 years ago and others that we give aid to now, is shameful. To see so many people line up in Los Angeles for free health care, and so many still under-served, it's a sham.
The health insurance companies have been scamming the American people for decades, and it's time for it to stop NOW. We MUST NOT allow those corporations to continue to rule this country. They have bought the conservative members of Congress with their donations, and they are thoroughly in control of what services WE GET NOW. My life and my health are not for sale!
At least Medicare is a non-profit plan that does not cut people off in order to make a profit for ridiculously-paid CEOs. Both my in-laws were well served by Medicare in their 65+ years, and with very few problems.
I vote Medicare for all who want it!