Introducing the Concept of Choice Into Our Health Care System

Public plan option. Three words in the health care reform process about which much has been said -- a lot of it meant to stoke fears. Amidst all of the mischaracterizations being thrown around, let's focus on the most important of those three words: Option.

As in choice.

As in something that isn't common for American families when it comes to their health care.

If your family has health coverage through your employer, that certainly brings some peace of mind. But there's still a good chance that only one insurance plan is available to you. If your premiums are high, if you can't choose the doctor you want or if your plan refuses to cover your pre-existing condition, there's little hope for improvement.

In recent health care reform listening sessions I held in New Jersey, a top complaint of families who already have health insurance is that their claims keep getting denied. Without any other real options available to them, even families that have health coverage are struggling to get affordable treatment.

Meanwhile, if you're not offered health coverage through work and don't qualify for Medicaid or Medicare, then you really have no health insurance choice at all. That's just not right.

Setting up a system in which more families have a real choice of health insurance would be tremendously empowering. We can shop around for our car insurance, property insurance and life insurance. Why should our choice be so limited when it comes to the most important insurance -- the one that protects our families' health?

Now, if your family is happy with your insurance as it is, you will continue to have it, even if there's also a public option. We have to be very clear about that. If you like what you have, you will keep it.

We're not against private insurance; we just want to make it more affordable. Let's not forget that between 2000 and 2007, the premiums for employer-based insurance rose five times faster than average incomes, and between 2008 and 2016, the premiums we pay are expected to rise more than 83 percent.

Choice in health care isn't just about allowing families to shop around. It's about making health care better through real competition for your business.

A public option would change the way insurers do business. It would keep them honest, in order to keep their customers. That means lower costs for everyone: for individuals, for families, for small businesses.

More options would get more people involved, bringing down the share of the cost burden any one family has to shoulder, and reducing the number of expensive emergency room visits that taxpayers have to pay for. In that sense it would promote not just public health care but public health. That's in everybody's interest.

If we do it right, I think we're going to see substantial savings from having expanded options -- savings for families and savings for our nation.

Amidst all the naysaying we've heard about health care reform, let's remember this basic truth about our nation's health care system and why we must reform it: Millions of Americans are prevented from accessing quality and affordable health care. It's not just the 47 million without health insurance. It's also millions more gainfully-employed Americans whose insurance just doesn't give them enough coverage, enough stability or enough peace of mind.

To hear some of my colleagues criticize bold ideas meant to expand and improve health care coverage, you'd think the current level, quality and expense of health care coverage is acceptable. You'd think that keeping insurance companies in charge of your health care rather than doctors is the way to go.

I know from my conversations with family after family that this just isn't so. It doesn't matter who you are or where your family lives -- if your child has a cough that won't go away, if your husband or wife has a swollen knee, or if you feel discomfort in your chest, you should never be put in the position where concerns about the cost of seeking medical treatment can affect the health of our loved ones.

The sooner we can fix health care, the sooner we can get our economy on a stronger footing, create American jobs that won't be shipped overseas, and help all our families rest a little easier.

The old saying goes, there is nothing more powerful on earth than an idea whose time has come.

With the right leadership in Congress, with President Obama on our side, and with the strong support of millions of Americans, we will make it absolutely clear, in the words we say, in the actions we take and the laws we make, that the time for health care reform has finally come.

Follow Sen. Robert Menendez on Twitter: www.twitter.com/SenatorMenendez

Comments

[billthinx]

I worked 20 years as a cost management consultant to blue-chip health care providers in the U.S. There is NO doubt that a single payer insurance system is the only way out of the mess we're in. National health insurance is the only way to approach cost control that will last. Promises made by industry types today are just words... as soon as their "crisis" is past, we will find all the same costs, no reductions as promised and lots of excuses and rationalizations for their inaction.

The "choice" you talk about is music to the ears of insurance companies who manipulate every word in every sentence to over-charge up front and then deny coverage and push payment back onto consumers. Every clinic and hospital in the nation has a big staff dedicated to arguing with insurers about necessary treatments, coverage, demands for more information, non-payment, etc. Those costs alone are huge.

We do not have the "best" health care system in the world as any learned person can discover. We face much higher existing costs along with lower quality outcomes in many categories of medicine. And costs keep rising. Many aspects of cost control could be addressed under a single payer system as every other advanced nation has demonstrated. As long as consumers can have choice of medical practitioners and treatment options covered, that's all that's needed. The political use of the word "choice" is a sop to existing vested interests and nothing more.

[JuliaRain]

Bravo.

[jmpurser]

EXCELLENT post! Always good to hear from someone who put in their time inside the sausage factory.

[JBCinSD]

Sen. Menendez, you are so right that heathcare reform's time has come. The best healthcare reform plan of all those I have read is in a small paperback: 
Healthcare, Guaranteed, by Dr. Ezekiel Emanuel (formerly of the NIH) 
It is the best of public oversight and private delivery. His Guaranteed Healthcare Access Plan:



1) guarantees coverage for 100% of Americans at the level of the insurance currently provided to you members of Congress
; we provide it for you - I hope you will pass a bill that provides the same security for us


2) gives everyone a choice of insurers, hospitals and doctors



3) changes the fee-for-service paradigm and focuses on high-quality, co-ordinated healthcare with emphasis on outcome; information flow in both directions is vital 



4) pays for itself from a dedicated fund that cannot be raided for other government programs



5) encompasses the framework for reasonable and timely dispute resolution



6) separates health insurance from employment, getting that function off the backs of businesses and eliminating the primary cause of labor disputes



7) ) achieves cost controls through eliminating redundant bureaucracies, fraud and excessive administrative costs



The plan is simple and comprehensive. This is the moment - let's be bold and get it right.

[larry278]

I 2d this. Thank you Senator.

[Mark Diaz]

Thank you for your opinions on health care. I appreciate what you wrote. Sadly, you can be bought (at some price) by HMO's, Insurance Co. lobbyists and others whose greed eclipses corporate resonsibility. Your words are nice, but until I can have a plan as good as yours (I'm uninsured) there is no justice. The election process is visciously corrupt. You didn't get swept into office on a wish & a prayer,and if you want to stay in office you have to raise, what?, $10,000 a week?

Necessity causes compromise, and sadly I have no trust that elected officials will represent the needs of the average citizen. Until we have universal health care (no opt-outs) we are a 3rd rate country.

France, Canada and the UK have reasonably passible systems.
We need to adopt something that WORKS!

That's my opinion.

[Debbie1996]

My real problem with this article is that it continues the lie that Americans just have to accept the insurance your employer offers. PLEASE SHOP for individual coverage. I know it is not a silver bullet and some people with preexisting conditions will not be able to get coverage. But it is CHEAPER for the many people, but they don't shop around like they do for property and car insurance. When I left my corporate job to join a small business, I was appalled at the coverage for my family of 4. $1,000-$1,500 a month depending on which plan I chose.

I shopped around and found an individual policy for $243 a month. Yes the deductible is high $5,000. But do the math - why pay $12,000-$18,000 a year so that you can pay $20 co-pays for Dr. visits that only cost $300 and 20% copays on major expenses. My max out of pocket was only $7,916 - that was all of my premiums for the year plus the deductible if I had a major event - I know it's complicated, but so many people need to actually sit down and run the numbers and compare.

The insurance companies are feeding on ignorance more than anything.

[kart125]

For all of this talk of reform, there is no plan for real reform. There is no plan to tame the beast that is medical practice. The only thing being offered is not reduction in health care costs, just drumming up "new" ways to feed the beast. If it takes a "co-op" or an "exchange" to make you happy then good luck with that as it changes nothing and is just another government boondoggle destined to failure. I give it 10 years before such a plan becomes insolvent and then we're back to square with nothing solved.
What is needed is not yet another dyfunctional "financing" plan or option, but actual healthcare reform vis a vis the providing of health care, not it's financing. But to do that would take actual work. It's much easier and gratifying to provide a pointless "government" "option" financing option - "I'm here from the government and I'm here to help" as the old joke goes.
The two biggest impediments is people don't want to just pay the doctor but try to hide that cost in "insurance" and the expectation the "insurance" is supposed to socialize those costs. If we just payed the doctors directly for regular treatment and let the insurance companies be insurance companies and only insurance, this would greatly reduce to cost and waste in financing medical treatment.

[JuliaRain]

"If we just payed the doctors directly for regular treatment and let the insurance companies be insurance companies and only insurance, this would greatly reduce to cost and waste in financing medical treatment"

It's called Single Payer with extended health care benefits by private insurance. Canada is an example of this.

[kart125]

No,it's called "health care spending account" with private insurance. The point is to eliminate third parties, who only add cost, for regular and customary medical expenses. Rather than choosing the cheapest alternative - to pay the doctor directly for regular expense - we involve third parties that only increase cost and unneccesary overhead, simply because we want to delude ourselves that we're somehow getting health care "for free" if we're not the one writting the check to the doctor. Once we have direct payment for services and cut out the expense incurred by third parties, then we can discuss how to fund those who can't pay.

[kart125]

No choice? There is always choice. Just because the choices are not those you would wish to have does not mean there is no choice. Rarely in life do we have available the choices to us we might wish to have. If you don't like your employers health care plan you have a choice to seek other employment. Your employer does not offer health care? You have a choice to obtain individual coverage or to work for an employer who does.
I evaluate the health care options before taking a job - that's my choice. When I was out of work, I obtatined individual coverage - that's my choice. My current employer is continually changing it's plan in order to provide the most beneficial plan to it's employees whenever something better is available - that's their choice.
Claiming there is no choice or competition is a ruse to justify superfluous government involvment.

[JuliaRain]

And your post is a ruse to blame those who cannot get coverage.

[kart125]

No, my post is to point out that just because we might not have the choices we would like is not the same thing as not having choices. And the question is not how to make "choices" available to those who in fact have them but choose not to avail themselves of those choices. If you don't like the choices availble, you have a choice to increase the choice by getting more education or job training, etc. My point is, if you are unwilling to make the choices to get you what you want, how is that anybody else's problem?
Now that is not to say that there aren't gaps in the system that need to be dealt with. But being disengenuous about "oh woe is me, having someone else pay my health care benefits is not a choice I have so therefore I don't have choices" isn't road road to get coverage to those who need it.

[JuliaRain]

You guys see this?

A Model for Universal Health Care Coverage
http://www.huffingtonpost.com/gavin-newsom/a-model-for-universal-hea_b_221123.html

This is worth studying.

[JuliaRain]

Some health care reform is already happening in San Fransisco.

[jmpurser]

Studying? It's just cheer leading for President Obama's non-health care reform plan.

[JuliaRain]

What is wrong with looking at this as an example to expand on? I'm for SP. I don't know how you guys are going to get it in the USA, but learning from other nations and learning about how others are TRYING to reform is a good thing. As I've said many, many times.... Study other systems. Learn from their successes and their mistakes. Adapt a system for the US.

[Kirch22]

The keys words here are "if we do it right ". Given the history of the government with social security, Medicare and Medicaid and a host of failed social programs I think the government has shown public programs never "do it right". This is a flawed idea and will eventually wipe out private care for the middle class.

[RedStateDem]

Be afwaid. Be vewwy, vewwy afwaid!

[fedupwiththis]

Unless we can keep the Republicans out of the formulation you are correct. Social Security was running a surplus before Ronald Reagan and Alan Greenspan figured out how to get money out of it and into the hands of their corporate cronies. Medicare is not a "failed" social program. It has been underfunded and oversubscribed by people who don't need it. Medicaid has suffered the same fate as every other social program over the past three decades. They have been starved for funds so we could force feed the arms makers who produce weapons we don't need to fight wars we have no business fighting.

[jmpurser]

Social security, medicare, and medicaid are all massive successes.

[Primadonna]

Single-payer ... HR 676 ... support it.

[Chaimirija]

Given all the info coming out on these supposed options, you would think people would all be for SP

[jmpurser]

I've never talked to a supporter of the "public option" who actually understood what President Obama has been saying the plan would be.

They all think it's "medicare for whoever wants it" or else that the government is going to pay for any health care plan they want.

If we could better inform people I think Single Payer would see a surge in popularity.

[hobbesian]

Universal single payer is the best of all possible systems despite the claims to the contrary. As a Canadian, I'm familiar with how friends, family and I have been treated here. Examples: my elderly mother; pacemaker, gall bladder surgery, hip replacement, rehab - all provided as needed with NO SIGNIFICANT WAIT TIME and COST = 0$. Close friend with bowel cancer: MRI's, surgery, all chemo drugs, provided with NO SIGNIFICANT WAIT TIME and COST = 0$. Close friend with brain tumor: all MRI's, neurosurgery, follow up rehab (years of it) and post surgery assessments - you get the picture. Sure, our doctors aren't all multimillionaires, Medicare CEO's don't get corporate jets ,and the accountants and lawyers involved in the health industry are underemployed. In the US, you have a battle for power and money where health is held ransom. Naturally the HMO's and the beneficiaries of your current system won't give up; they will twist every fact in order to keep their power. How do we know this? That's exactly what happened in Canada when universal was introduced back in the late 40's. The only difference was that HMO's in their current form didn't exist nor have the firm grip on our government the way they do yours. For god's sake, get universal passed, the HMO's keep bribing our neo-con politico's up here to chip away at our system. As an aside, Israel introduced universal decades ago, do you think they are onto something? Don't American deserve the same?

[bkbzipper]

All I know is there's got to be an alternative, a person who has to obtain insurance on their own is robbed... If you can't get into a group, your screwed they charge whatever they want. I want an alternative that doesn't go up $70 a month every renewal year, it's hard to keep paying for it, and harder yet if "something would happen" and I ditched it. For a family its as much as the mortgage... People need peace of mind, you get sick trying to just deal with insurance companies...

[jmpurser]

You're looking for Single Payer. Senator Bernie Sanders has a petition you can sign here if you're interested:
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Sorry about the video.

[kimleehan]

Questions, If we have both a private & public option would'nt the ones on the private option expect and demand much better healthcare than the ones on the public option? and would'nt a private option create a elite hospital system that would cater to only the well insured and not except the public option and not only that attract the best doctors?. If over 70% of Americans want public option than won't 70% of Americans go with the public option leaving less than 30% to go with private insurance, driving up the cost of private insurance.?

[jmpurser]

If the "public option" actually worked the way most of it supporters thought then there would be a lot of ramifications. Fortunately it's nothing at all like what most people think it is so there should be no widespread effect of having a "public option" except growing resentment for the Democratic party who sold us out.

[JuliaRain]

Luxury health care will never go away.

[MJinCanada]

One of the reasons some Canadians do go to the US is because our health care system won't pay for frills like boob jobs (except reconstructive surgery after cancer treatment) or nose jobs (except for someone who's near suicidal over her honker), and so forth. Nadia Suleman would have been referred for counselling right off the bat.

We don't really like the two-tier option some are pushing for here, because there are concerns it will take money away from regular health options. On the bright side, it would get the whiny jerks who think they should get a red carpet because they make loads of money out of the waiting rooms, and let the rest of us read the old magazines in peace.

[JohnIII]

Is the public option a voluntary program? Or do you pay for it regardless if you use it?

I'm OK with a public option if it is truly an option.

[jmpurser]

No, it's not an option. And it's not public. Either you're forced into it or you can't get it.

[Yves Papa]

This should be a public plan only. No private option.

[jmpurser]

That would be Single Payer and the president is absolutely against it and any plan that might lead to it.

It's also the best and proven solution to our health care crisis.

[freddiefreeloader]

Single payer would eventually be the end result if we get public option. The more people on private insurance the cheaper the rates, If over 70% of America goes with the public option than less than 30% will go with private option, driving the cost for private option so high no one but the rich could afford it. The Democrats know what their doing.

[Mikeeee]

"Senators who have spoken of ' Resevations ' about the Public Option Plan."
I'm confused. Has no one pointed out to these people that over 70% of the American people want a public option and that the Senators reservations are irrelevant, they are their working for the people.
Personally I don't care what a senators beliefs are about anything, (don't care if they think the earth is flat or there's a god living in the sky) as long as he/she does their job which is doing the peoples business in the way the people want it done.

[Sunflower114]

Thank you for pointing out that the Senators work for the people. You are dead on with that comment. I think we have some Senators who get that they work for us, but we certainly have a few who would prefer to impose their own will on us.