A Public Health Insurance Plan Option Is Centrist Reform

There is no reform without a public health insurance plan.

That is the message we as Progressives have to hammer home as the right-wing bullhorn tries to drown out the need for reform with cries of a government take-over of health care.

The problem is the for-profit insurance company takeover of our health care. Handing the private insurance companies 50 million more lives to cover with no benchmark on cost or quality, no ability to stop them from wrongly delaying and denying care, in short, giving them a monopoly over our health insurance coverage for working people is not reform.

Only giving people the choice of a robust national public health insurance option provides a tenable solution to our health care crisis.

Progressives believe the way to truly solve our health care crisis is to institute Medicare for all and get rid of the for-profit insurance companies altogether.

Conservatives fear a bigger government role in health care.

Giving people the choice between private insurance companies and a public health insurance plan allows both sides to get some of their preferred solution in reform, adding much needed competition to our health insurance system.

A public health insurance plan can let doctors deliver the care people need at a lower administrative cost, keeping insurance company bureaucrats out of the mix. Private health insurance companies can offer faster response to changes in medical practice and additional benefits, such as coverage of alternative therapies like acupuncture. Competing side-by-side forces both private and public plans to stay responsive to people’s needs.

Medicare shows us how private and public can work together. People with Medicare have a choice of staying in the original public Medicare program or getting their Medicare benefits through a private health plan.

Because they are competing side-by-side we can point to the public program and ask why the private Medicare plans cost an average of 12 percent more to cover the same people.

Without a public health insurance option there is no cost or quality benchmark.

Because public and private are competing side-by-side people with Medicare have a guaranteed back-up plan when their private insurance company decides to pull out of the program or merge with another company or their doctor drops out of their plan’s network.

Without a public health insurance option there is no guaranteed backup.

Because Medicare has such a large membership, it has leverage over large provider conglomerates to get better rates.

Without a public health insurance option there is no negotiating with the large provider conglomerates.

And lets be clear. Medicare’s rates may be lower in some areas than private insurance rates but the best evidence that they are fair is that 97% of doctors accept them. If they are low, doctors know how to get them raised. One only has to see what has happened year after year when the sustainable growth rate (SGR) formula for setting physician fees in Medicare Part B would have arbitrarily cut those fees. Physicians have threatened to drop out of Medicare and Congress has consistently overridden the rate cuts made necessary by the formula, which was written into the Balanced Budget Act of 1997 by a Republican-controlled Congress.

Because public and private are competing side-by-side people with Medicare can compare what benefits above the minimum standard the private plans offer and decide if they are worth the extra premium. And, if their private plan denies necessary care, they can find out under what conditions the public Medicare covers that type of care in order to appeal their plan’s decision.

Without a public health insurance option there is no transparency and no comparison with which to hold the private plans accountable.

Because Medicare has such a large membership, it can drive system-wide change. Private insurers usually follow Medicare’s lead when deciding whether to cover new treatments and technologies and in its payment innovations, such as the bundled payments Medicare uses for inpatient care.

Without a public health insurance option there is little ability to drive system-wide change.

The American people seem to understand this. They overwhelmingly support being given the choice of a public health insurance plan.

It is time for us to widen the scope of discussion on health care reform and move the center back to where it belongs: squarely on the addition of a robust public health insurance plan option.

08-13-09 By Monica Sanchez | Comment (0)