• Yes.  Consumers need more choice.
  By Len M. Nichols, Ph.D.
  • 

  
  A public plan would provide an alternative to people who mistrust private plans. And it would help keep those plans honest by serving as a benchmark for costs, benefits and premiums.
• No way. It would mean worse health care for all.
  By Michael F. Cannon
  • 

  
  The government would inevitably end up giving the public plan unfair subsidies. Like all government attempts to meddle in the market, it would institutionalize waste and raise costs for everyone.

Comment [109]

Agree? Disagree? Let us know what you think. Please include your full name with your comment. Comments may be edited.

• <<
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• 11
• >>

• The debate about whether or not we should have a government sponsored health plan fails to address the fundamental problems that have placed us in our current situation. It ignores the fact that we are a country that faces a mounting tsunami of chronic disease and a wave of 77 million baby boomers entering the phase of life when health care needs and costs increase dramatically. Obesity, diabetes, hypertension, atherosclerotic cardiovascular disease are the major threats to our public health. First, our heath care system is currently constructed to pay for acute interventions and does not reward providers who care for patients with chronic diseases. Preventive care and maintenance of health are poorly reimbursed in the current construct. We do not distinguish between those providers, neither hospitals nor physicians, who provide higher quality care and achieve superior outcomes based on scientific evidence. Value based purchasing of health care would begin to address this disconnect. Bundling of payment for services related to an episode of care would help to align providers toward a goal of maintaining and restoring health. Providers should be encouraged to collaborate in the care of the patient, which requires an alignment of financial incentives. Zero sum competition is destroys, rather than creates value.

  It is important to note that health care is 2 words-health and care. We currently reward providers who provide care, but there is no consideration of the health component. Once we address this fundamental structural defect and rethink what we are paying for,we can debate whether public, private or a mix of the two is the best way to go.

  Posted 7 May 2009, 09:05 by Mark S. Soberman, MD, MBA, FACS

• Dear Sirs,

  the questions here should be – what is the key objective and how to achieve it?

  USA is probably the only Western developed country where citizens can be turned down by health insurance companies on the grounds of pre-existing conditions.

  It is often said that the wealth of nation can be judged on the basis of how this nation treats its worst off. It would appear that USA is not on top of the league in this respect.

  On the other hand, medical research and development is particularly successful at leading clinics in the USA.

  To claim that the competition between a government-back universal health insurance plan and private plans would be unfair is not enough. The US nation has to decide whether the current healthcare market is fair vis-a-vis American citizens. Maybe USA can do much better.

  Making healthcare affordable to everyone is a courageous goal. Universal health insurance plan might not be the only option, but certainly is a way forward. However, policy-makers should make sure that innovation will not be crippled.

  Jan Vyjidak

  Posted 7 May 2009, 03:56 by Jan Vyjidak

• The U.S. government (or a matter of fact any country) should not offer its own health insurance plan to people.
  A large pool of people’s money leads to frauds and potential misuse. Imagine a insurance kitty in the public domain so large, how will you manage corruption and equal distribution? What about the tax payer’s money? We are already in recession, and why should the intelligent earners suffer because of some who can’t afford healthcare.
  I feel if Govt insists on its coming into healthcare insurance, it should restrict itself only to primary/preventive and emergency care.
  All planned healthcare for secondary/tertiary/quaternary care should necessarily be in the private sector.
  Govt should actually devise better governance for the HMOs/insurance providers/Hospitals by being a sentinel to avoid frauds, misuse, undue delays in providing care, ceiling the premium caps to make insurance more affordable etc and to bring down the cost of healthcare as a whole so the premiums of insurance can go down. Govt should only look at those who are unemployed or below certain earning limits if they have to come into fray.
  BUT THE GOVT SHOULD NOT FOOL ARROUND WITH PRECIOUS TAX PAYERS MONEY. THE TAX-PAYERS POCKET IS ALREADY BURDENED.

  Posted 7 May 2009, 00:53 by Dr Akash S Rajpal

• It is nice to read the two opinion pieces but neither mentions any real world outcomes examples, only theory. Their whole discussion is on cost containment and firm micro-economics issues for an ineffective system whose outcomes metrics are getting worse and worse despite decades of ‘cost containment’ efficiency efforts of insurers’ MBA graduates that radically changed the supply chain, generating profits, but no appreciable improvements in health outcomes.

  A single payer plan would be more efficient than today’s private insurers because it would not just be a ‘health insurance’ company like we know today, that pays providers only when someone gets sick enough to go to the doctor and buy drugs and makes its profits for itself when its simple-minded MBAs nickel- and-dime both highly skilled carefully educated healthcare providers, and patients and their loving devastated families.

  A single-payer could address systemic issues of prevention, lifestyle, food system pathologies, environmental pollution externalities, and stress management that no insurer would ever do because it kills their revenue opportunity to have healthy not sick people, and their ability to raise premiums every year on employers who really are making stuff that sells for real money in the US economy.

  A single-payer would also be able to more effectively pool risk across the national population in every age category using any financial tools available in the reinsurance markets to do so, that private insurers can’t use because they don’t have lifetime actuarial risk/reward to play with for each insured patient.

  A single-payer would be incentivized to create prevention as a whole new industry, and there are plenty of holistic practitioners out there who can offer these services for everything from addiction, diet, and stress reduction, to skeletal joint alignment and holistic ways to build and strengthen skeletal muscle throughout one’s life. The basis for paying for this would be reduced overall long-term costs over a lifetime, which would reduce healthcare risk and revenue opportunity for private insurers and traditional after the fact Western medicine! These innovations are happening in the UK today, which has lower infant mortality rates than the US does right now, and improvements in diabetes, heart disease, alcoholism and addictions in adults.

  They could also invest in early-detection through complex telematic monitoring system networks that would spot patients going out of range on metabolic vitals from their homes and broadband connections to prevent damage to organ systems before the patient feels sick enough to visit a doctor or ER, which is the first place we ring the cash register in today’s set-up.

  This metabolic and organ damage is the biggest cause of costly remediation treatments, pharmaceuticals regimes, and permanent loss of quality of life, with all the costly follow-on therapies, home-care, and loss of income associated. All these costs today add up to the insurers’ coverage limit only, which is well calculated for their profit margins, and then private families themselves get hit with quadruple wammy of income loss, quality of life loss, medical bills, and heartache!

  No insurer can take this on because the investment is too great, and too much effort for what is basically their cash management and cost containment business model which they are fighting real hard to keep just the way it is.

  Again, this innovation is happening in the UK today, because the incentives are there to make these investments for the entire population.

  These networks, like the Internet or the Federal Highways, are just not feasible for single-insurers in ‘weak’ competition conditions as exist today throughout the US.

  It maybe true that certain treatments would be best paid for by top-up plans for people who can afford them, to avoid queues for discretionary surgeries for example, or rationing for expensive surgeries for older people who may not qualify for everything they want late in life.

  But, in the long-run, we are experiencing terrible drops in our health outcomes metrics such as life expectancy, and infant mortality because the private system doesn’t want to cover everybody as it is, particularly the young who number now 100M Gen Y kids, who suffer now more than ever before from childhood onset diabetes, obesity, cancer, asthma and autism.

  These illnesses are brought on by negative externalities of food system pathologies and environmental degradation which is an external cost to the ‘degraders’, but will never sufficiently add up for private healthcare insurers to spend money to tackle them. A single-payer can tackle them much like Medicaid did for tobacco malfeasance and the huge external costs that accrued to both public and private insurers alike for those deliberately chemical induced addictions and resulting lung cancers. It wasn’t private insurers who tackled that, it was Medicaid/Medicare.

  Private insurers will also take money from a family for a few decades, until the kids are grown, and then raise the premiums on the couple who paid premiums all their lives just when they start to need remediation care (not preventative that was never on the cards throughout their paying lives), and heaven forbid a job loss puts them out of the system all together.

  Not to mention, the millions of children getting inadequate preventative care, who are our future workers and innovators, some even dying or being debilitated long before their productive lives should have been over because of inadequate preventative care, especially with so much diabetes, asthma, obesity, and stress today in children.

  Our two guys cite nothing from today’s healthcare industry trends. They harp on about marginal costs, but nothing about external costs associated with environmental or negative externalities from food system or CO2 emissions that rack up huge bills. They use no facts and figures or examples. They call themselves experts to write about healthcare, but write only in general theories like an undergrad econ paper. But, then again anyone inside the Beltway on the payroll of a tax-exempt partisan ‘think’ tank is an expert. I know. Their stuff gets touted out there all the time. I am not impressed McKinsey!

  Posted 6 May 2009, 23:49 by Brett Barndt

• Providing healthcare and anything to do with it is a state subject, and I feel governments all over should provide health insurance to all its citizens. Any abuse, or waste or lack of quality needs to be checked and audited. Dr. Ajay Sati.

  Posted 6 May 2009, 23:38 by Dr. Ajay Sati

• This is a moral issue. We have photographed distant planets, created the iPod, mapped the human genome, and much more. Do not tell me that we are the only developed country on Planet Earth that can’t provide health care to all of its citizens. The problems, of course, are the special interests who have a lot to lose and the fat cat politicians who never saw pork they didn’t cover in BBQ sauce and relish.

  I repeat: this is a moral issue and we have to solve it. Period. Amen.

  Posted 6 May 2009, 22:41 by K Nelson

• I live in Canada, a so called just society (a true oxymoron), which has socialized health care. The federal government has imposed the Canada Health Act, which outlines principles (most of which are unrealistic) to ensure there is a consistency of mediocre medical treatment country-wide. Provincial governments have the responsibility of providing health care to their citizens; the experience across the country is our present mediocre health care systems are economically unsustainable. Our just society has an answer to the problem, ration health care and underpay doctors. We now have a serious lack of family doctors. We also have a shortage of nurses, but for a different reason. The nurses are well paid, but funding of nurse care is also rationed. This means that those patients with sufficient finances seek out medical care outside the system. Those that do not have such financial resources wait and wait and wait. Having to get emergency health treatment (another oxymoron) at many Canadian hospitals is a nightmare. Can the system be improved? Yes, there are examples of sustainable health care systems that work very well in Europe, however, Canada has powerful special interests, like the U.S., that advocate against any kind of change, other than having governments throw more money at the present unworkable systems. Whatever happens in the U.S., don’t even contemplate adopting the present Canadian system.

  Posted 6 May 2009, 19:30 by Donald

• We must have health care coverage that is guaranteed for all regardless of employment, income, health status or age. Everyone must be covered.

  A public health plan option needs to be available. Only a public plan will be accountable to their members. The for-profit plans must be accountable to their shareholders. The insurance companies are afraid of a public option. They fear that the public plan will have a pricing advantage because the public plan will reimburse providers at somewhere around Medicare rates. In fact, the competition from a public plan can lower the reimbursement levels for the private plans. Plus the public plan could become the “insurer of last resort’ and cover the high risk and chronically ill while the private insurers cover a healthier population. So private insurers could benefit from a public option.

  The McKinsey Quarterly in 2008 reported that in the U.S. we spend $300 Billion annually on billing, claims, bad debt and charity care on the provider and insurer side. We could cover all 47 million of the uninsured in a very rich benfit package for $250-280 Billion per year. If everyone is covered there is no more bad debt and charity care for providers.

  We need a public plan to force cost control and guaranteed coverage not associated with employment. By enacting the following we can begin to get control on costs:

  • Pay the providers the full contracted amount and have the insurance company collect the cost sharing from their customer. For people covered by Medicare, the Social Security Administration could collect from the Medicare beneficiary. Under this arrangement, the insured person gets only one bill—from the insurance company. The patient would get no bills from providers. Providers could reduce their overhead spent on collections, billing, and no servicing of patients. Providers would have no bad debt. The insurance company and employer could collect from their customer by a link to the employee’s FSA, HSA, HRA or payroll.
  • If everyone in the U.S. was covered and the providers were paid the full contractual amount, there would be no bad debt at all and no need for charity care. So providers should be able to charge less.
  • Have all providers get paid on the same basis such as the Medicare rate. This doesn’t mean all would get the same amount. Providers could negotiate different rates, but the reimbursement methodology would all be the same. This would eliminate the need for the variety of claims and payment systems and reduce insurance and provider administrative expenses.
  • Have all insurers follow the same rules on claims payment. For example, payments on observation stays, supplies, assistants at surgery, etc. This would reduce insurer costs, claims system expenses, etc.
  • If everyone were covered, we could eliminate the duplicate coverage most of us have—being covered sometimes by multiple health plans, Workers’ Comp, several liability policies, etc. This would also eliminate the confusion and administrative expense related to COB and subrogation.
  • Have one national standard for technology assessment and coverage for new technology and procedures or an agreement that the findings from one would apply to all.
  • Have one national formulary for prescriptions
  • Have one centralized clearinghouse for credentialing.
  • Delay the expansion of any hospital until it has an electronic medical record in place. Minimize the duplication of services among hospitals.
  • Connect all neighborhoods and housing subdivisions with bike paths and greenways so people can walk and bicycle safely.

  Our country should not pass up this unique opportunity to make a health care system that is focused on health and guarantees coverage for all. We Americans enjoy free (i.e. taxpayer paid) libraries, parks, streets and other public services. Does it seem ironic that we can be denied health care services, but we can get free books, videos and music from our libraries?

  Posted 6 May 2009, 18:32 by Alan Mytty

• Why not start with the basics? The socialized medicine in France costs about 2/3 of our cost, and is ranked 1st to our 35th. In
  Europe, pharmaceuticals sell for 1/10th to 1/2 of the cost in the US. (I’m writing from Crete, and have bought Rx here.)

  U.S. health is not a system. It’s a disparate conglomeration of providers who act like cowboys. No discipline, no guidelines, just the ability to bill whatever they feel the service is worth.

  If this debate is about Orthopedists being worth a $1 million income, I rest my case. If its about value, there’s no opposition. One country should not bear the cost of Pharma R&D, physicians who go to school with their education subsidized by government subsidies do not deserve rock star salaries, and my health care costs should not consume 20% of my income.

  Some entity has to bring competition to the market. The current situation is too tight and tidy (see Eisenhower, Military Industrial Complex). At this moment, every individual policy for health insurance is underwritten. Which means that any individual with any risk cannot get/afford insurance. THIS TYPE OF DENIAL CANNOT PERSIST.

  In the rest of the civilized world, health is a right, like police and fire protection. It’s time that the US joined with our equals in sophistication and made it a right for our citizens.

  This is not a plea for a government sponsored alternative health insurance – it is a hope for universal insurance that is government sponsored.

  Human life and health is not a profit opportunity – it should be a human right.

  Posted 6 May 2009, 18:18 by Al Weigand

• The first question that needs to be addressed in the health care debate, I think, is what really drives medical costs? Doctors’ pay, chronic illness, aging population, medical liability insurance, drug product liability insurance and a lack of standards of good practice care are all major contributing factors. Fraud, out-of-cover patients, billing practices, medical records are smaller issues, but they seem to be the things the politicians and pundits from both sides of the aisle focus on.

  Doctors should be free to practice good medicine as defined by reasonable standards of care, and not be held to unreasonably high standards of care by ambulance chasing lawyers and malpractice insurance companies. A doctor should not need to order a brain scan every time a patient has a headache, but too much of the time the doctors order expensive tests and lab work, just to drive their risk of malpractice suit to the minimum. Its unreasonable and EXPENSIVE.

  Curiously, we had an ambulance chasing lawyer run for President last time, on a health care reform platform, and nobody called him to account for the $50 million in fees (paid by health insurance companies, and symptomatic of what drives health care costs) he siphoned off from the industry over a career. Very few doctors make $50 million in a lifetime.

  We need to back WAY off on our litigious tendencies, as we are shooting ourselves collectively in the foot. Standards of practice would help a lot.

  I also know many government employees are fully capable of delivering good quality medical services, just as they can be trained and equipped to do a number of important and difficult jobs. We all — private and public sector workers — come from the same educational system. It is just not true that all government activities are wasteful and bureaucratic. (Some are, to be sure.) Nor is it true that all private sector activity is efficient. The debate should quit demonizing “government”, and focus instead on what makes for good service delivery: qualified and trained personnel, good equipment and systems, clear standards of practice, manageable case load, compensation, performance incentives, etc. Those elements are harder to be implemented in a government setting, or even in a large bureaucratic private organization, but it is still possible.

  People should have access to basic health care, but if they want the most expensive health care in the world, they should be pay for it with their own money, and not beggar the rest of us taxpayers to pay their bills. Third party payers is another core issue. The king of Saudi Arabia had a cardiac surgery suite equipped C-130 fly around behind him wherever he went, but he can pay for it. It is not every US citizen’s birthright to be entitled to such extravagant levels of health care. Goods and services are scarce economic goods, not a civil right.

  We need to face the real issues driving health care before we decide how to “fix the system”.

  Otherwise the debate just becomes too much heated rhetoric and grand standing, with no real clarity or solutions being reached.

  Posted 6 May 2009, 18:09 by Geoffrey

• <<
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• 11
• >>

Commenting is closed for this article.