http://www.prescriptionforchange.org/2009/01/cant_we_all_agree_to_agree.html
The wailing and gnashing of teeth over the impending demise of private health insurance has already started...even though no one is proposing to do such a thing. So, why the hysteria?
Remarkably, it all stems from a simple idea that everyone agrees on...a public health plan option (available to all, mandated for none) is likely to be cheaper than private insurance even if it pays doctors and hospitals just as much as insurance companies pay them today. Millions of people (mostly those of you without insurance) might choose that plan, and might well be quite satisfied with it. According to
the Lewin study at the heart of the debate, a public plan option will cost 10% less than private insurance, probably because it will have lower administrative costs (no TV ads, low executive pay, less claim-related bureaucracy). Now, that doesn't sound so terrible, until the Heritage Foundation talks about it like this:
The reason is that President-elect Obama has proposed (1) the creation of a new national health plan, run by the federal government and financed by the taxpayers; (2) an employer mandate enforced by a payroll tax; and (3) a Congressionally created national health insurance exchange in which the government health plan, subsidized by taxpayers and having special advantages, would compete unfairly with private health insurance. The result would be a massive crowd-out of private health insurance coverage, especially employer-based coverage.
There are a lot of loaded words in that paragraph, designed to obscure the fundamental agreement with partisan disagreements. Let's take these lines apart right quick and look at what the number crunchers actually said.
"a new national health plan, run by the federal government and financed by the taxpayers"--that sounds bad right off the bat. But a public plan funded by the taxpayers is not what has been proposed. Instead, the plan will be paid for by its enrollees. People who can't afford to pay premiums will be eligible for subsidies--whether they choose the public plan or health insurance sold by private insurance companies. Lewin offers a number of estimates for the price of this plan to its enrollees, depending on the rate it pays hospitals and doctors.
It details here how those prices would compare to coverage sold by private health insurance corporations--at least 10% cheaper, possibly a lot more.
In a market where health coverage is expensive and insurance contracts are drafted by corporate lawyers to protect insurance companies from your health claims, the public plan might well be both cheaper and simpler. And therefore more attractive to millions of people. Presumably, if the competing private companies could reduce their administrative costs and simplify their contracts, they could easily compete for that business.
"an employer mandate enforced by a payroll tax"--less freighted with ideological baggage, that part doesn't sound so bad, actually. Medium and large employers must provide coverage (most already do) or help fund health care by contributing to the system. Small employers (many can't afford to provide coverage) would be exempt from the payments but their employees could still get coverage. By allowing employers to just keep doing what they do now, Obama's proposal keeps much of the current employer-based health system in place. It just adds options that free people from job lock.
"a congressionally created national health insurance exchange in which the government health plan, subsidized by taxpayers and having special advantages, would compete unfairly with private insurance."--now we've really loaded our guns with birdshot and taken aim!
Apparently the big problem with the public plan option is that it is unfair to big insurance companies. We've already discussed the boogie man, "government health plan, subsidized by taxpayers," but what are the "special advantages"? Since Obama hasn't proposed mandating that everyone buy insurance, the public plan isn't a "default." Instead, the proposal studied by Lewin and criticized by Heritage only proposes that the public plan be one option among many and people must look through the options, pick one and enroll. Perhaps the public plan has the "special advantage" of benefits that are predictable and stable year after year, while private insurance companies change benefits, co-pays and prices. If people overwhelmingly choose the public plan, then maybe health insurance companies need to think about making their product less complicated and more attractive to consumers.
"The result would be massive crowd-out of private health insurance coverage, especially employer-based coverage"--this one requires some explaining. Lewin predicts that some employers will drop employee coverage when their employees have an alternative. Unfortunately that may be true, but if so, it will be true whether there's a public plan on the menu for those employees or not. What Heritage and others seem to advocate is the worst of all worlds, national health reform that feeds people who currently enjoy good, employer-based coverage into the individual health insurance market, where people pay far too much for uncertain coverage.
President Obama said a few words today that seem appropriate to this particular debate.
The stale political arguments that have consumed us for so long no longer apply. The question we ask today is not whether our government is too big or too small, but whether it works - whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified.
As President Obama sugests, we need to set aside partisan rhetoric and focus on the key facts upon which all sides agree—in this case, that a public health plan option is likely to cost a little less and help millions. That seems like a great place to start.
If we had access to quality food, we wouldn't need quality health care. We take pills to cure what quality food can do. Give americans quality food and water and we will all live to see 120. We are only as healthy as the water and food we eat. Plain and simple. It is not that deep.
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