A Better Way to Reform Health Care
I recently posted an article on the Huffington Post along with my friend, Regina Herzlinger of Harvard, describing how the Obama health care plan will decimate our economy. Many readers asked if I had a plan or if I wished to only criticize the president's proposal. In fact, I have introduced comprehensive health care legislation, the "Patients' Choice Act" along with Senator Richard Burr (R-NC) and Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).
We believe our plan will meet the president's goals far better than the president's own plan, or the plans being floated by the president's Democratic allies on Capitol Hill. Before I explain how our plan achieves those goals and outline some of the key differences between competing proposals, the American people should realize that there's remarkable agreement about the goals of health care reform.
Republicans and Democrats and conservatives and liberals all want a health care system that is more accessible, affordable and fair. I know this to be true because I've seen it first-hand. I've worked in the health care sector my entire adult life first as the owner of an optical company then, and now, as a practicing physician. The least partisan places in America are health care delivery areas - doctor's offices, emergency rooms, neonatal and intensive care units, and so on. The American people want a system that works, and so do the vast majority of members on both sides of the aisle.
Setting the right tone in the debate is more important because the stakes couldn't be higher for individual families and the future of our country. Getting health care reform wrong won't merely prolong the suffering of families, particularly low-income families, but will jeopardize our long-term economic health. What the American people need, and what policymakers have an intellectual and moral obligation to provide, is a rational debate based on competing ideas and solutions, not the recycled demagoguery of past campaigns. If we believe the other side is wrong we should put forward our best ideas and arguments in specific legislative language.
I'm willing to give the president the benefit of the doubt and believe the best about his motives, even if the political apparatus supporting his plan isn't willing to do the same. I'm also not afraid to say that I want the president to succeed because success will mean a better health care system. I am convinced, however, that if the president isn't persuaded to change course his plan will fail catastrophically, especially if he "wins" the vote in Congress. In fact, health care could be his domestic Iraq, but worse. It's one thing to declare "Mission Accomplished" but something else to truly accomplish the mission.
Let me explain how our bill accomplishes the mission:
Today there are three major barriers to access and coverage. There is broad agreement about two causes: cost and cherry-picking - when insurance companies deny coverage to people with pre-existing conditions. The other major barrier to access and coverage are failing government programs like Medicaid that provide access to a government benefit but not access to health care. Forty percent of doctors and hospitals refuse to accept Medicaid patients because the government's efforts to impose "affordability" have been an abject failure.
On the cost front, our bill gives every American a generous tax credit ($2,290 per individual, $5,710 per family) to purchase health insurance. We do this by ending the current discrimination in the tax code that gives people a tax break if they receive health coverage from their employee but no benefit if they are self-employed or unemployed. The rules governing our current, employer based, health care system were made in the 1940's when Americans stayed in the same job far longer than they do today. Ending the employee exclusion will end job-lock and put the individual and their doctor back in charge of health care.
This is a bold proposal that would dramatically reform our health care system. We address a number of questions related to this provision in our materials but let me address a couple of common questions.
Many people ask: How will a $5,710 tax credit help someone buy coverage when the average plan costs about $13,000? That's a fair and reasonable question.
Our plan works because the employees only pay about one-third of their plan's premium. For example, the average family's annual employer-provided health insurance plan cost about $13,000 last year, with an employer paying about $8,600, while the employee only paid about $4,200 in annual premiums. Under the Patients' Choice Act, that family would have more than enough to cover their share ($4,200) and have a significant sum left over for any additional medical expenses. It's true that the funds the employer provides would now be taxable income just like salary but the point critics ignore is that the typical individual and family will still come out way ahead under our plan.
The tax issue is controversial because the Obama campaign spent millions of dollars distorting John McCain's tax proposal which also called for ending the employee tax exclusion and replacing it with a rebate. Ironically, the Chairman of the Senate Finance Committee, Senator Max Baucus (D-MT) has proposed eliminating or capping the employee exclusion as a way to raise revenue. The fact that Senator Baucus was greeted not with a barrage of attack ads, but with assurances from the White House that his option would be "on the table," shows that the attacks against McCain were illegitimate and purely partisan.
The question the American people should be asking Congress about the way our current tax code treats health care is not whether we should change it but why on earth should we keep it like it is. The current rules are terribly regressive. Today's system discriminates against low‐income Americans: wealthy Americans receive $2,680 in tax breaks for health care while the poorest Americans only receive $102.26.
We address the second major barrier to access - cherry-picking - by making it profitable for insurance companies to not deny coverage. Our bill does this in several ways. First, we set up voluntary state-driven exchanges to facilitate real competition between private plans and give Americans - for the first time - a choice of health care plans. The exchanges would require all participating insurers to offer coverage to any individual - regardless of patient age or health history. Exchanges could also set up auto-enrollment so that a 24-year-old who shows up in an emergency room after a motorcycle accident would already be covered by a basic plan. Today, we all pay for those ER visits.
Our exchanges are NOT based on the Massachusetts model, which is not working. Rather, we acknowledge the economic reality that single-payer advocates ignore: health care economics are regional, and that a one-size-fits-all mandate from Washington will fail.
We overcome the third barrier to access - failing government programs - by giving low-income Americans the means to buy insurance outside of the failing Medicaid program.
The Patients' Choice Act gives low-income families at 100 percent of poverty level an additional $5,000 to purchase coverage on top of their tax credit. In other words, a family of four at 100 percent of the poverty level would now have $10,710 to buy coverage under our plan.
Many on the left don't like to address the reality of failing government programs because it is undermines their case for the "public option." How can a system that turns away the poor 40 percent of the time by called a success and worthy of expansion? The American people should not have faith in the public option until members of Congress voluntarily enroll in Medicaid.
Instead of acknowledging the failure of government interventions many on the left like to demagogue greedy insurance companies. One problem with this argument is that the government already drives about 60 percent of the health care economy. We already have a system of price fixing and cost containment in place called Medicare that sets the prices that insurance companies and providers follow.
Of course, insurance companies are hardly perfect actors. As a doctor, I've berated many insurance company bureaucrats who thought they knew how to care my patients better than I did. Yet, it is misleading to claim half of the problem is the whole problem. Our bill deals with reality and the whole problem - the perverse incentives in government and the private market that are hurting families. Putting the individual in charge of health care is the only way to address these underlying factors that drive up costs and reduce quality and access. The third-party model lacks transparency and accountability and allows both government and insurance company bureaucrats to get between a patient and their doctor.
Our bill includes a number of other provisions that make our plan truly comprehensive. We emphasize prevention and disease management and change reimbursement rates so doctors can be paid for doing prevention. We eliminate widespread fraud and waste in Medicare and Medicaid, which is estimated to be $80 billion per year, and so on.
The point is that health care needs a new operating system, not a service patch to a broken system. Building a new "public option" on top of a failing system with an elaborate system of fines continues the 1960's idea that a little more government spending and intervention will fix health care. It's time for true innovation and change, not a Windows 1975 approach to reform.
Finally, a critical factor that sets our bill apart from the president's plan is sustainability. Our bill accomplishes these goals without spending any new federal money, or raising taxes. The problem in health care is not that we don't spend enough, but that Americans aren't getting enough value for their dollars. On a per capita basis, America spends nearly twice what other industrialized nations spend. Our responsibility is to make better use of existing resources.
The president's argument that we have to make an enormous new investment in a "public option" in order to save money down the road is speculative at best, and a recipe for fiscal disaster at worse. Every major health care program created by the government since 1960 has cost far more than originally envisioned.
In 1965, Medicare was supposed to cost $3.1 billion a year. Today, Medicare costs $455 billion a year and is headed for bankruptcy. SCHIP was established a decade ago as a safety net for poor children. Today, a family living at 300 percent of the poverty level is eligible for SCHIP.
Some estimates say the "public option" will cost $1.2 trillion but no one knows for sure. It's impossible to predict the havoc that would ensue if, for instance, the Lewin Group's study is correct and 120 million Americans lose their private insurance because private companies are driving out of business by the government plan. When faced with out-of-control costs, European countries with single-payer plans responded the only way they could - they rationed and denied life-saving care.
The president is using conservative economic arguments to sell his plan - it's about choice and competition, etc. - but he is putting forward a proposal that would have the opposite effect. Also, the American people should be concerned about the need for a government plan to keep the private plans "honest." In a free society, individuals keep the government honest, not the other way around.
The president has given Congress a firm deadline to pass a health care bill. In the next seven weeks all sides should put their ideas on the table and have it out. What is not acceptable, though, is delay and posturing. Organizing for America, the organization set up by the President's former campaign manager, David Plouffe, has asked Americans for donations to combat those who are allegedly spreading "fear and confusion" about the changes the administration seeks. I would contend that if the American people are fearful and confused the administration should look in the mirror. We are on the cusp of a major debate and neither the administration nor its allies on the Hill have put their ideas in clear legislative language.
Many on the left are obviously worried about a repeat of 1993 when their detailed plan was released early, roundly criticized then defeated. While hiding the ball might be a good short-term political strategy, a plan that can't survive public scrutiny does not deserve to become law.
I believe the Patients' Choice Act can prevail in a public debate. Even if our plan doesn't have the votes to pass in Congress, it does show the American people that it is possible transform health care without putting the government in charge.
I know that many on the other side have a different vision and philosophy. Yet, their stalling raises a difficult question. If they are confident in their plan why haven't we seen it? We're still waiting. More importantly, so are the American people.
Loading comments…
Want to reply to a comment? Hint: Click "Reply" at the bottom of the comment; after being approved your comment will appear directly underneath the comment you replied to
I'm just wondering if our elected officials would take a drastic pay cut and then subscribe to their "health care" plans. It's easy for them to get the health care that they receive when we are paying for them. What do they have to worry about?
Sen Coburn's plan makes sense to me, I have to say. I think it could work.
And I appreciate his clearly laying out the plan and how they're planning on financing it, whereas I'm still waiting for these details from Obama and the Congress.
Man, you are a riot! For a second, I thought you were serious! Good joke, very, very good joke. Coburn making sense? Pal, you belong to SNL, with Sarah and the Cheney girl.
Really? I wasn't joking.
I'm all for health care reform, and I like to keep an open mind and consider ALL solutions to a problem so that the best may be chosen, and I hope our elected officials would do the same.
Maybe you could explain what exactly you think WOULDN"T work about Sen Coburn's plan, (so that I can learn from you, too). Could you please do it in a polite, respectful way?
majority of the people do NOT like what the capitalist health care has to offer, OK?
get on with the program, and deliver to the people
a PUBLIC UNIVERSAL HEALTH CARE NOW!
call it socialist or communist.
we do NOT care!
Maybe you should check out how that old communist health care system worked in the Soviet Union.
Did you?
Maybe you need to look to Canada and France and the UK.
Well, I'm not for communism.
But do you know what the secpond largest communist economy oi the world is.. the U.S. Military..
Sometimes, capitalism does not work. Police , fire and military protection our government run enterprise
Actually the soviet system did work. Have family who are russian doctors (which are some of the best on the world). Given an economy a fraction the size of ours... there was heathcare.
Like us they spent way too much on military and not enough on things that mattered.
In our case we spend way too much on the militray (52% of world budget) and healthcare
Regards
So price gouging isn't the problem, the fact that we can't afford the price gouging is? Strip congress of their tax payer provided health care NOW and let them acquire health care in the same we we are forced to do so.
Not just Congress, how about the adminstrative branch. I don't want to pay for Obama's cancer treatments to cure his lung cancer caused by his smoking habit. That's high dollar stuff !
Congress will not give up their healthcare or their pensions, just watching while ours get more and more screwed up.....
So, for those of you who asked, no, he doesn't have a plan for health care reform. He has the GOP "free market" plan which is what dug this hole in the first place.
If you're interested in real health care reform then check out universal single payer health insurance run by the government. This is not the generally misnamed "public option". This is a real proven solution to Americans health care needs. The only drawback of this plan is it doesn't provide billions in profits to the health insurance vampires or massive political bribes for congressmen.
I see it the way you do, jmpurser. This is another rube golderg contraption added as a carbuncle (the "Coburn Carbuncle") on the existing health "insurance" monster. See also "triggers" (Olympia Snowe), see also quaint and cute "co-ops" a la Kent Conrad.
SINGLE PAYER NOW! President Truman proposed it in 1947 (when Europe started their single payer plans), Senate killed it then, and we CAN'T let them kill it again.
http://www
Coburn's real cure to health insurance is to give every body loaded weapons and let them shoot it out at high noon. This guy is worthless.
Secondly, where in your proposal is the competition needed to cut costs? Isn't "competition" and free markets the keystone of all rethuglican logic in regard to economics? Think about this Senator, what if we outlawed private companies from providing health care entirely and installed a "pay as you go system" instead? Just like at the grocery store, you pay the cashier for the products or services you just received. How much do you think health care would cost when only about 5% of the entire population of the US could actually pay the current cost but everyone still needed the service to survive? According to right wing logic, either nearly every hospital/health care worker and the services they provide would have to drastically cut their prices to a level that average people could afford to pay, or go out of business because their isn't enough population remaining to support the industry. I'm sure you worked hard on that bill in order to impress your campaign contributors. What you need to do is work hard on a bill that isn't transparent to voters . . .
I fought for four months with Blue Cross to get them to approve helping me to pay for blood pressure medicine my md prescribed. Now that I was kicked off the plan due to being laid off, I pay for it myself. The cost is $84. per month. My co. pay with my former job was $40. What the heck? It's not like this was some super high priced prescription. They couldn't kick in $44? We were paying $700 a month for insurance for two people under the ex-employers group plan. Maybe my blood pressure will go down a bit now that I am not having to fight with the insurance company!!
HuffPost's Pick
If you are paying $84 a month for health care, get on your knees and thank God.
You misread the post; they were paying $700 a month for two people.
The $84 refers to a single prescription.
Often, a doctor can choose an alternative medication that's less expensive. Perhaps you've contacted your doctor about that already, but in case you didn't you may want to try that route. I'm sorry you got laid off, best of luck finding a new (and hopefully better) job.
I lost a brother in 1999. One of the prescriptions prescribed by his oncologist cost $1,299.00 for a 7 day supply. It didn't take long to max out the drug benefit on his insurance policy.
Betsy, I'm sorry for your heartbreaking loss. One of my brothers had cancer in his 20's and he, like your brother, exceeded the total yearly benefit. Luckily we were able to make deals with the drug companies at that time, and work out other arrangements. It's very difficult emotionally and financially.
I want my health care taken forever out of the hands of people working for profit motivated insurance companies. Those companies promised the Congress and the American people 15 years ago that if we would just let go of the notion of government imposed reform, they would bring about those badly needed cost cutting measures, and make access to health insurance more affordable. In fact, they've done NOTHING in all that time. What was bad then has only gotten exponentially worse.
It is time to remove profit from all aspects of basic health care. I have no objection to anyone making a decent living, but Murphy's First Law of Greed states that there is no such thing as enough when money is involved. It's time for these greed monsters to be relegated to luxury and vanity medicine, quite profitable, and get them well out of basic care.
I'm tired. I've been without health insurance for 11 years, denied due to a prior condition, with my savings slipping away, my ability to work being compromised. You'd better believe that my vote goes for single payer, and that if the legislation that is eventually framed does not include the competitio
Health care is a right. Health care is a basic right.
Hear, hear! I'm with you, Jeany. What Coburn, Conrad, Collins, Nelson and their ilk fail to realize is that the vast majority of Americans DON'T CARE if the insurance companies are driven out of business. They have come to understand that the health care insurance market IS NOT, AND NEVER HAS BEEN A FREE MARKET, but a monopoly by the insurance companies on a service that is a fundamental necessity for every person in America.
The terror of the "centrists" that these companies will be driven out of business is, however, a mere extension of the fear-mongering that has become so common in American politics. In fact, many of the European health care systems are hybrids of public and private options, including France and the Netherlands, both of which deliver far better results at far lower costs than ours. France comes in at #1 to our #37 position on the quality of health care delivered. Wouldn't it be terrible if we emulated that performance?
Coburn's plan is a fraud. Health care, as you say, is a RIGHT. It is NOT a legitimate profit center.
It is imperative that health reforms begins with not railroading people in the court system in the matters of mental health care.
Take the case of Ray Sandford of Minnesota that just happened recently.
Read Ray's tragic story at the website: http://www
Just recently on June 10th in his recommitment case, the same day as his trial, Ray was recommitted without the court accommodating his new lawyer to attend and that his new lawyer was not allowed to testify on Ray's behalf.
Does that sound like a kangaroo court or what? - it sure does to me
I say to Judicial Officer Steven D. Wheeler - what you did is not fair, more like
railroading Ray Sandford in my estimation. I can have my opinion and I just gave it to you.
Where are Ray's rights?
Ray does not want electroshock. Again Ray Sandford has been shafted in a court system that does not care about Ray.
Obama and the top brass need to deal with this now.
How many other Ray's are being railroaded out there?
The court system in my estimation failed Ray Sandford big time.
This is a legal issue, a moral issue and of one human rights.
Doesn't America believe in a fair justice system for its people?
In Ray Sandford's case, apparently not.
No need to petition Obama for intervention, he's just another one of the lawyers that have totally block the average citizen from participating in our Democracy. Thomas Jefferson warned us in his writings to not let the Lawyers take control, at the last count 1 out of 3 members of Congress hold a law degree. Nowhere in the Constitution is a legal license required to hold elected office.
Three questions for Senator Coburn (and his cohorts)
1. What is the prime motive for private health insurance companies? (Answer: Profit).
2. How do private health insurance companies make a profit? (Answer: least coverage for greatest premiums).
3. As a Senator, how do you like your taxpayer funded health insurance? (Answer: he'll have to answer this one).
The day this man gives up his goverment insurance payed for by the goverment is the day i stop fighting for single payer.
All employer-based plans should be taxed. Gays with domestic partners on these plans are already taxed. The revenue to the gov.would be huge.
In Germany the Federal Court has just told private insurance comp. they must insure all people, including the old and sick, they can't just cherry pick. Would our SC do the same.
That's the problem with a private health insurance industry. You can't "just" regulate them. You've got to pass laws and fight them out in court on a class and individual basis. It's criminally stupid to base you health care system on such folly.
All it is is the government pays, the insurance industry profits, and the people are right back where they were before.
Years ago it was the HMOs to take care of the problem, then we had Medicare part D with more profit for the pharmaceuticals and insurance industry and very little for some Medicare patients. Set up for private gains and enough to bankrupt Medicare.
They had years and years they could have reformed the system but did nothing. No difference now, the private profits are the only thing that counts, they will do everything they can to get a lobbying job once they leave the government.
Without a government provided public insurance for the middle class nothing will change. Coburn and his ilk will see to that.
You must be logged in to comment. Log in or connect with
