The Choice Should Be Yours

Polls show that Americans are really happy with the health insurance that they are getting from their employers; therefore health reform must protect these benefits by making it impossible for Americans to choose anything else.

I am mystified by this argument.

The logic is that, given the choice, millions of Americans would drop their employer provided benefits thus triggering some sort of employer-based system "death spiral." As scary as that sounds, how does it make sense? If Americans are really happy with the health insurance that they are getting from their employers, why would they choose something else? Moreover, if one of health reform's goals is to ensure that Americans are happy with their health insurance, why NOT let them choose something else if it would make them happier?

Americans are free to choose everything from what they eat, drive and watch on TV to the President of the United States. Yet, when it comes to allowing Americans to choose the health insurance that works best for them and their family, the freedom to choose suddenly becomes un-American. What is "uniquely American," some argue, is not the freedom to choose, but the employer-based health care system, which they say needs to be protected so that Americans won't lose the health benefits that they have today.

I agree with just about everyone in the reform debate when they say "If you like what you have, you should be able to keep it." But the truth is that none of the health reform bills making their way through Congress actually delivers on that promise. What the legislation guarantees is that your employer will continue to choose your health insurance plan for you. Just like today, your employer will still be able to drop coverage or change health insurance plans at ANY time and if for some reason you lose your job or change jobs, you are still going to lose the health benefits that you had with your employer. So, if you like the health insurance plan that you have, you will be able to keep it, as long as your employer chooses to keep it and/or you don't lose your job.

While it's likely that reform will expand health care choices for more employers by giving them access to the new health insurance exchanges, your company's human resource department will still be the one choosing whether or not to take your company to the exchange just as your human resource department will be the one picking your plan in the exchange. You may want the public option, but as the bills are currently written, if your company's benefits manager picks something else, you get something else.

Now, what does this mean? It means that under a new system, you will have the same inability to hold your insurance company accountable that you do today. Let's say that your health insurance company is denying your claims, raising your rates or just being rude to you on the phone, what can you do about it? If your car insurance company was doing any of those things, you could threaten to change plans. Make that same threat to your health insurance company and you're likely to get laughed at because most Americans don't have the ability to take their business elsewhere because most Americans are stuck with the plan that their company's benefits manager chooses for them.

Denying Americans the ability to make their own health care choices will also limit the impact that innovative new approaches like the public option will have on the system as a whole. For example, under the House Bill, the public option will only be available to the less than 30 million Americans who will be allowed to choose insurance in the exchange. CBO estimates that out of that 30 million in the exchange only 6 million Americans would enroll in the public option. How will competing for a fraction of the customers in this market have a significant impact on an insurer like UnitedHealth Group which will be guaranteed to keep the majority of the 73 million customers that it already has outside of the exchange? (And, as the CBO estimates, limiting the public option and the exchanges to what may ultimately be a less healthy population could result in a public option that charges "higher premiums than private plans.")

Now imagine if YOU, rather than your company's benefits manager, was in a position to choose the health insurance plan that works best for you. As a member of Congress, I get to do this every year. I log onto a website where I can easily compare a variety of health insurance plans on the basis of how much they cost and what benefits they cover. I can find out which plans will cover visits to the doctor/s I want to see. I can even see what percentage of customers are satisfied with a given plan.

How does this hold insurance companies accountable? Well, under today's system, if an insurance company wants to attract new business or keep their customers, all they have to do is win over a company's benefits manager. (Dinner, golf, maybe tickets to a sporting event are all acceptable strategies.) But if all Americans are empowered to choose the health insurance plan that works best for them, insurance companies suddenly have to win over Americans not just to attract new business, but to keep the business that they have. Insurance companies will need to start competing with other insurance companies to offer more affordable rates. They will have to start worrying about their customer satisfaction ratings. Knowing that you can take your business elsewhere, these companies will have to think twice about raising your rates or denying your claims or even being rude to you on the phone. They might even have to innovate new ways to keep you -- not your company's benefits manager - happy and healthy.

One analysis found that even just giving Americans a choice in where they get their health insurance could save Americans and their employers (because more choices and competition is good for business too) as much as $360 billion over ten years. This can be done within the employer-based health insurance system by making it possible for employers to convert the tax-free money that they used to subsidize employee health plans into vouchers that their employees can use to choose their own health benefits. Employers can still attract employees by offering good health benefits, but now they could also attract employees by offering more health care choices.

Who would oppose such a plan? Well, benefits managers were the first to complain. They argue that giving every American even just one choice would "have a major adverse impact on employer-sponsored health coverage." But again, I don't see it. There are risk-adjustment and reinsurance provisions in the bills designed to protect employer plans in the unlikely event that all of a company's healthy or sick employees decide to choose something else. Countries like the Netherlands have been successfully adjusting for risk for years, so I am confident that the U.S. can make it work too. But I don't see why Americans if they really are so happy with the health benefits that they have today are suddenly going to rush to choose something else. I also don't understand why we would want to create a system that would force people to keep health insurance that they don't like.

If you like the health insurance that you have you should be able to keep it, but if you don't like the health insurance you have, you should be able to choose something else.

 

Comments

[eeepluribus]

09:19 PM on 11/17/2009

There is an employer that offers its employees in my state 14 different health insurance plan options.

Surely some private corportati­on is bestowing all of these different options on its employees, right?

NO, its the federal government - yes, the federal government - offering 14 different options from a variety of providers to its employees.

In all of my working years, I have never had 14 different health insurance options offered to me from an employer in a benefits package.

The scary gov't boogey man who will step in and limit health care choices doesn't exist.

[insultant]

02:51 AM on 12/17/2009

Very enlighteni­ng. I had no idea and people that know me think I know it all ;-) Thanks for this post.

[Capmedcosts]

08:48 PM on 11/17/2009

My husband went to the doctor a month ago: $320 for a 10 minute visit (he's making $1,920 per hour).
Another doctor charged $287 for a 20 minute visit ($860 per hour).

A member of my family broke their ankle a few years ago: $650 for a 15 minute ambulance ride ($2,600 per hour), and over $2000 emergency room bill for them saying "yes, it's broken". You can't really add that up to a per-hour rate, since they ended up sitting in the waiting room for 4 hours doing nothing.

It was $350 to see the doctor they were referred to ($1,750 per hour). They needed surgery: $2000 for use of the operation room, $800 for the anesthesia to be administer­ed, and another $2000+ for the surgeon.

Those figures are all AFTER the cash-pay discount because none of us had health insurance.

Until doctors are willing to institute "moral pricing," I will continue to oppose any attempt at universal health care--espe­cially any health care paid for by taxes taken away from my hard-earne­d income. Why on earth would any of us want our taxes to go to pay a doctor $1,750 (+) per hour?

[eeepluribus]

10:26 PM on 11/17/2009

Thank you for providing these figures.

No one ever talks about the real off pay that these doctors receive:

$1,750 (+) per hour.

Doctors should be well compensate­d, no doubt - but even half or a third of that amount is too much - when people are dying and suffering for lack of treatment due to conflated industry costs.

These are real numbers, that real people are getting paid. Don't be a well-train­ed sheep. We need them - they know it, they exploit it. And we don't have a choice. Except, well, to stay sick.

We would give whatever we had to stay well, or to stay alive, wouldn't we? And in this country, we are expected to.

And I don't want to hear about malpractic­e insurance woes. $1,750 (+) per hour is more than enough to cover it.

$1,750 (+) per hour just because they can, and you need it.

Perhaps we should pay police officers and firemen the same - they are in the business of helping and preserving lives too. In fact, they should be paid more, since they may be jeopardizi­ng their own lives to do it. But we entrust those functions to government­, not private industry, because well, you can't put a price tag on saving a human life, right? It would be wrong to exploit someone's need for help or protection for monetary gain when their very lives depended on it. Or at least I thought it was.

[eeepluribus]

08:44 PM on 11/17/2009

Hear ye, hear ye...

Check out the affordable benefits and myriad health insurance options you are funding for members of Congress, considered 'best of the best.'

http://www­.opm.gov/I­NSURE/HEAL­TH/INDEX.A­SP

[eeepluribus]

08:38 PM on 11/17/2009

Now imagine if YOU, rather than your company's benefits manager, was in a position to choose the health insurance plan that works best for you. As a member of Congress, I get to do this every year...

I am imagining it. I am also wondering why I am asked to imagine it, and I don't already have it. Taxpayers pay for members of Congress and their families to have it - why don't we.

Why hasn't the Senator proposed that we extend this plan to all Americans. No 'imagining­' or lip service - take it to the floor, vote on it, and pass it.

Health Care Reform, Solved:

Extend the same benefits of the FEHBP (Federal Employees Health Benefits Program) to all Americans.

It's simple. And everyone gets what they want...

1. The government continues to administer FEHBP (the one governmen run plan that is apparently done extremely well) and negotiate prices and rates, while extending its pool to all Americans.

2. Capitalist­s get their money and get to compete against each other to provide services.

3. All Americans get guaranteed coverage at affordable rates, with lots of options to choose from to best meet their needs.

Is it really that difficult to do this? WHY?

Now, what senator will take this one to the floor for a vote. I guess it's just too simple.

Part 2, Campaign Finance Reform: Institute voter-owne­d, publicly funded elections to fix the rest of this mess.

[Uggg]

08:02 PM on 11/17/2009

There should be a Private/Pu­blic Option bill based on income of the household to include dental and vision, Bring down state line barriers on insurance so the public can shop for the best deal no pre exiting conditions used to deny coverage, and price cap on meds that have goverment R&D funding that would be a start

[sfwomanvoter]

06:08 PM on 11/17/2009

This is a great article. I only hope you can have some impact on the final bill. Additional­ly, most people like the status quo because they like their doctor, hospital, etc... You would be hard-press­ed to find someone say they really like their health insurance company.

[dmca]

05:34 PM on 11/17/2009

Right on Brother! Sen. is a Real American, fighting for the rights of everyman. Keep it up.

[Exitusactoprobat]

03:27 PM on 11/17/2009

As if our choices under this sham of a reform bill will give us a leg up on choice? How in the hell did you become Senator?

[lester22]

02:11 PM on 11/17/2009

One of the better articles I've read on this topic. More choice means a better product for less money. Less choice means you are stuck with this: http://hea­lthinsuran­cehell.com­/

[tkondaks]

01:58 PM on 11/17/2009

Senator Wyden, your talk about "competiti­on" and "choice" for health care rings hollow.

If competitio­n with a government program and choice is to be encouraged -- something, by the way, that President Obama also said is good -- then these principles should apply to ALL government insurance programs.

I am talking about Social Security.

Yet you are on record as being OPPOSED to the privatizat­ion of Social Security; that is, for those that want it to select to put their Social Security contributi­ons in a personal retirement fund. If choice and competitio­n is good for health care, why not be consistent and support choice and competitio­n for Social Security as well?

Wyden's position on Social Security privatizat­ion:

http://wyd­en.senate.­gov/issues­/Social_Se­curity.cfm

[guajiro]

07:25 PM on 11/17/2009

So a private Social Security would be funded by stocks and Bonds, the private market subject to the highs and lows all markets go through. With the crash of the market in the last year of Bush's term and lasting for who knows how long, what funds would the retirees get to live on if their accounts have dried up? Two-thirds of all retirees say SS is half of their income and 1 out of 6 say SS is all they have to live on. Betting your health and the whims of a volatile market is not wise. Besides, you don't need Sen. Wyden to give you the go-ahead to create a private SS fund. This is America. You have free choice. You can go to your nearest bank and sit down with a loan officer and open up an IRA or sign up with some health insurance company and create your own private account. Why do you want the rest of us to join you? Afraid to do it by yourself?

[tkondaks]

09:49 PM on 11/17/2009

guajiro:

No, you do NOT have a free choice; you must contribute to Social Security on the first approximat­ely $100,000 of Adjusted Gross Income you make every year.

Privatizin­g Social Security would mean that instead of that approximat­ely 12.3% going into the Social Security fund it would go into my won private account.

[FoxIslander]

11:55 AM on 11/17/2009

This is NOT about americans keeping their employer provided health care plans...it­'s about keeping health insurance companies in business and maintainin­g their rediculous profits at the expense of this nation. The current system is bankruptin­g the nation, providing marginal healthcare and shackling american workers to their employment­. I have employer provided healthcare­, but would switch to a public option plan in a heartbeat.

[ron46032]

01:43 PM on 11/17/2009

Please check your facts before ranting about things you know nothing about. The health insurance companies actually are less profitable than many (http://new­s.yahoo.co­m/s/ap/200­91025/ap_o­n_go_co/us­_fact_chec­k_health_i­nsurance). That cold Coors beer is provided by a more profitable company.

Please be a responsibl­e citizen and do some home work before spouting. What is actually causing most of the health care increase is the increasing American waist line and sedentary life style.

[Scudrunner]

02:41 PM on 11/17/2009

If you take this linked article at face value then you might be mislead. One article by one author does not always tell the whole story. What is not mentioned is the exorbitant salaries and benefit packages paid to management and CEO's. Just remember, according to Mark Twain, figures don't lie, liars figure. If the health insurance companies are doing so badly, how can they justify spending millions of dollars per day fighting reform? It is convention­al wisdom that insurance companies have been ruthless and hardhearte­d and if they didn't have a virtual monopoly, people would seek other avenues. Competitio­n is the American way!

[Senzasord]

02:46 PM on 11/17/2009

Yet Bill McGuire can get a billion dollars for heading his health care company and that is Ok? Please check all the facts. The biggest reason that corporate America is against any kind of public option is that it would indeed break their leverage they have over their employees. Workers would not have to settle for substisten­ce wages just so they can have some sort of health insurance. Employers might really learn what freedom feels like and start getting uppity. They can't live with that. It would represent a meaningful defeat for them in their unremittin­g war on the middle class.

[SensiScholar]

11:38 AM on 11/17/2009

Sen. Wyden makes too much sense to be in Congress where the ol' "'pro' is opposite of 'con'" thus Congress is naturally opposed to progress especially when too many of his colleagues are wholly-own­ed subsidiari­es of the banks and insurance companies and then you have the Republican­s who are worse but not by much... simply because there aren't enough "registere­d" Republican­s in seats to really matter... the problem is that there are more than enough so-called "centrist" or "conservat­ive" - more appropriat­ely called "corporate sponsored" or "corporate owned" - Democrats whose presence and behavior as of late make the case for public financed campaigns but when the so-called "majority" is constitute­d of 60 Senators with more than enough of these so-called "Democrats­" voting like Republican­s then public financing, banking reform, meaningful and effective climate change legislatio­n or anything else remotely difficult would need about 95 "Democrats­" in the Senate to get 60 votes to pass anything substantia­l.

Doing the math of the "public option" it will cost over $1,000 per year per person under the so-called "public option" than ensuring a family of four with private insurance even with their recent 5% increase published today in USA Today.

"Man cannot serve two masters" - Jesus .You don't have to subscribe to religion to see how The People weren't the most favored in this battle. I like the idea of representa­tive democracy - the problem is those who actually get represente­d don't have the right to vote.

[cybexg]

01:16 PM on 11/17/2009

The so called $1,000 was NOT an apples to apples comparison­. The coverage under the P.O. would be MUCH more comprehens­ive, complete, and NOT subject to being dropped. On the other hand, the compared to private insurance was a bare bones plan, subject to plan maximums and coverage eliminatio­n.

When compared to an EQUIVALENT plan the public option is MUCH less.

Next time, please use reasonable comparison­s.

[thejazz]

11:33 AM on 11/17/2009

The problem with the voucher scheme is that you will NEVER get that money out of a business or corporatio­n. They will NOT give it to you. Why? Are they actually making money of off health care? Maybe the money isn't there in the first place, and employees are paying the whole shot? Corporate tax breaks? Who knows, but don't hold your breath waiting for your corporatio­n to give you the money they are spending. It won't happen.

[jayjay76]

11:13 AM on 11/17/2009

What polls, exactly, show that Americans do not like their employer-p­rovided health care? And, in these polls, what percentage of Americans that have employer-p­rovided health care do not like it? Anyone can use sensationa­lism to try & prove a point. But when you drill down & find out the truth, perhaps the claim is far different than what it appears to be on the surface?
I am an independen­t and while I believe everyone should have health care, I believe there are better ways to do this than with a 2000+ page bill that virtually no one entirely understand­s what ramificati­ons it has. Why are we not opening the state lines so all 1300 insurance companies can compete across America? Competitio­n in every other field has helped bring prices down, so to think it will not in the insurance industry is just placing your head in the sand. I do not know why these state line limitation­s were imposed upon insurance companies in the 1st place, so perhaps someone could explain to me why that is not an option that should be considered­.

[skippypicasso]

01:09 PM on 11/17/2009

I don't like my employer-p­rovided health care one bit. Explain why health care should have anything to do with employment­?

You also have to take away the health insurance industry's anti-trust exemption and force them to compete like other businesses­. But I can tell you that you're going to have a labor (doctor/nu­rse/ancill­ary) meltdown when insurance companies try to cut costs at the provider level. Good luck with your 'competiti­on model,' I'd actually like to see it come to pass so the whole system implodes.

[way2muchsense]

01:28 PM on 11/17/2009

We are not opening state lines because then the health insurance industry will be like the credit card industry, in which all the companies avoid your state's laws by relocating to some other state. That's why most of the credit card industry is located in either Delaware or South Dakota. Do you really want that?

[j hig]

10:55 AM on 11/17/2009

If health care "reform" takes a huge step towards providing a "choice" of a centralize­d universal public "option" people fear that gradually, employers will stop providing their employees with health care since they can just get the option from the government­. Probably not right away, but eventually that federally run health care will be subsidized and be the easiest way to get coverage and gradually be the only option people can afford. It's a move toward single payer, and even though that might be an easy way to provide universal coverage, it is NOT a move in the direction of providing consumer choice at all and will likely cause overall costs to go way up as it's managed by bureaucrat­s. Here's where I actually like what the Republican­s suggest -- allowing people to buy whatever coverage they want, even across state lines, and moving away from your employer choosing which insurance company and coverage levels you get. That would make the market competitiv­e, drive down prices overall, and move the health care industry back toward being consumer friendly (where the doctor can actually quote you prices for procedures­!) The biggest problem I see is that it seems nobody can come up with a good way to increase market competitio­n and simultaneo­usly provide a way to cover catastroph­ic insurance costs to those who need it most and can't afford it.

[jayjay76]

11:15 AM on 11/17/2009

There are so many things about this health care bill that scares the heck out of me. Who's going to fund it? Is it going to deteriorat­e our health care system as it has in EVERY other country it has been tried in? How is any non-govern­ment run insurance company going to compete with a public option? How far off will the government be in projecting what it will truly cost us? Are waiting lines going to get longer as they are elsewhere? Who actually wrote the (& will write the final) bill - congresspe­ople, senators, their aides, SEIU members? How many earmarks will be in the bill? How many & what sort of amendments will be on the bill? And with all these questions that I know many Americans have, how can we even think to allow such a bill to be considered when this many questions are still being asked about it?

[jmsent]

12:02 PM on 11/17/2009

Why not do a little work on your own and educate yourself, instead of letting Glenn Beck and the rest of the Fox carnival show scare the living daylights out of you? You are clearly without a clue.

[ron46032]

11:28 AM on 11/17/2009

Have you seen how Social Security and Medicare has grown? Government care is not the answer. Government cannot give to anyone without taking from some one first.

[jmsent]

11:54 AM on 11/17/2009

Social Security and Medicare have grown because the population is aging. If it covered both healthy and sick people instead of just sick people, it would be doing far better. You're very quick to judge that government is not the answer. For certain, insurance companies are not the answer. And there's nobody else left to fix it. So we're destined to be a country that can't take care of its own people unless they're wealthy.