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Miles J. Zaremski Headshot

The 'Phoenix' of Health Care Reform: The Public Option

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In recent days, now some sixteen United States Senators have stated they want the public option back as part of any health care reform. Considering the President's upcoming (February 25) Blair House conference on health care reform, such effort by these courageous Senators could not come any sooner. These efforts call to mind such pithy phrases as, "no risk, no reward," and "no pain, no gain," for it is what we need to see from our elected representatives in the Senate rather than feeling we voted into office spineless wonders.

The sixteen Democrats are taking the risk, the "pain" to ensure that competition can exist so that every single American has the opportunity to access and afford what it takes to be well and healthy. After all, premium increases are becoming stratospheric, i.e., Anthem Blue Cross of California reporting a 39% increase in premiums effective March 1 -- now stayed for two months due to the intervention of HHS Secretary Sebelius. And thousands of citizens are being dropped from the rolls of health insurance company insureds to make more profits.

But what I am reminded most from what this small group of Senators are now doing is the mythical bird, the phoenix. Mythology has it that this was the creature that had a lengthy lifetime, after which it burns, is reduced to ashes, and then resurrects itself. We recall the 1964 novel by Elleston Trevor, The Flight of the Phoenix, which became the basis for a 1965 film of the same name and then a 2004 remake of it, also with the same title. What these Senators are now proposing with the public option is health care reform's phoenix. Or, to put it another way, the final chapter on the public option has yet to be written -- reflecting on Mark Twain's observation in a note written in May 1897 after hearing about his obituary, "reports of my death were an exaggeration." That great "wordsmith", NY Yankee catcher, Yogi (Berra), said it best, "it ain't over 'till it's over."

The Blair House conference will bring together various leaders from both chambers. Whether this is all for show because it will be televised remains to be seen, though I wouldn't want to place any bets on it achieving any meaningful result. However, all of us who voted into office our current representatives to change Washington, particularly our health care system, may have been on some halucinogenic -- at least up to now. To reiterate, all we see are spineless wonders. But if this small group of Senators can achieve, however, what no pundit or media outlet has felt possible, then their efforts become our phoenix. Never underestimate the power of even a small group if what they want is what is right to do.

The template for reform is not hard to understand. It is captured by two simple words: accessibility and affordability. There are many objectives on which there is broad agreement. With regard to accessibility, insurance policies should not exclude pre-existing conditions; not allow cancellation of an existing policy owing to a medical condition; guarantee issuance and renewals; extend dependent child coverage to 26 years; and allow cancellation only premised on non-payment of premium or fraud in the procurement of a policy. Simple enough.

With affordability, there is agreement that policies should not set lifetime or annual limits on benefits; there should be reasonable limits for cost-sharing -- deductibles and co-pays with an annual ceiling; not allow pricing differentials based on sex; set reasonable restraints on age-related differentials; and create a national high risk pool to protect insurers from the few who incur extremely high cost medical treatments.

Of course there are quality parameters for which all would concur. Insurance policies should not require cost-sharing for basic, preventive care; should provide a basic package of covering basic health care needs; standardize forms to reduce paperwork and inefficiency in processing enrollments and claims; and furthering computerization of records without running afoul of privacy laws.

So, what the February 25 conference should focus in on are the issues where there remains debate. With accessibility, should we have the public option? Should the antitrust exemption be lifted? Should Americans be allowed to purchase policies across state lines? Affordability concerns would include whether tort reform really lowers overall health care costs; affordability credits and the financing of them for those who cannot buy health care coverage; whether to keep in place the individual mandate; and what to do about the cost of drugs for seniors?

What is left to decide are interim protections for Main Street while reforms are implemented, like placing limits on annual premium increases, and who is to pay for the new reforms, like no pre-existing condition will bar coverage. Given an individual mandate, it is hard to say consumers should also pay for these reforms too when insurers stand to reap $billions more in new premiums.

While we may see our phoenix in the form of Senators coming back to solidly support inclusion of the public option, our President must take charge, just like being the Commander-in-Chief ordering troops into battle to defeat the enemy -- only this time, the enemy is not some terrorist looking to destroy our country, but the forces depriving all citizens to their right to be well and healthy.

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