by: Alex Blaze
of the Bilerico Project
The push for health care reform started this week, and now there's a cacophony of voices speaking on the topic. It's all well and good for me, since I get off on that sort of thing, but it also means that there are going to be a lot of people putting out ideas for health care reform for the sole purpose of derailing it.
In the end, what private insurance companies and the congresscritters they bought and paid for fear the most is a public option that actually works. They pretty much know that the private insurance industry, as it operates now with huge executive compensation, large profit margins for investors, cold-hearted denial of payment to any patient they can manage, excessively high rates, and bureaucratic inefficiencies, would never survive. And you don't just have to believe me, Senate Minority Leader Mitch McConnell said as much on the teevee this weekend:
Wallace: Well, let me ask you about what seems to be a part of their plan, although I think we both agree that it's not very specific at this point. The president says that he wants a public health insurance option to compete against private insurance options. Is there any public plan as just one of a series on the menu that you could support?
McConnell: Well that would me a government plan that would inevitably put the government between you and your doctor and there would be no more private insurance.
McConnell: Because the private insurance people would not be able to compete with a government option.
HA! HA! HA! HA! HA! Silly Senate Minority Leader, you're not supposed to admit that the public option you're against is way cooler than the insurance people have now!
But it's going to be hard to deliver on this promise. The health care industry is, of course, against anything of the sort, and lots of people do have great health coverage as it is. Republicans know that good government health care means further electoral defeat for them as people realize that they've been lying all this time about how people simply can't come together and do amazing things like insure themselves through a tool like the government.
And other health care industries - like pharmaceuticals - don't want a government plan that can negotiate prices with private companies. I mean, if the government did that, then how would all of Eli Lilly's middle management afford mansions in Carmel, Indiana (oh yeah, I know how you all live)?
Then again, if they keep up this talking point, it might happen sooner than we think:
But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare's, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.
Although the numbers are disputed by public plan advocates, the Lewin Group, a health care consulting firm, recently projected that a plan paying Medicare rates would prompt 119 million of the 172 million people who are privately insured to switch policies (while also providing coverage to 28 million of the 46 million uninsured).
Hey, unnamed critics, you know what's actually unfair? Being denied a life-saving treatment because some private insurer bureaucrat is under pressure to "control costs."
Anyway, this is make it or break it time, as they say. There's more political will now than there's been in a good few decades to change our health care system, and if something less-than passes, it'll just placate people for another few decades. There's so much working against real health care reform, and so much riding on it, that we can't just pass anything under the rubric of "Do something!" We actually have to get something good passed that will change the way we deal with health care in America.
That's why the Progressive Caucus has lined up behind their version of the public option. No triggers (Olympia Snowe's (R-ME) plan to kill the public option) that require even more people to be murdered by spreadsheet before a viable public option gets created. And no weak plan that doesn't allow the government to negotiate with health care providers. Sorry, the casino's over, folks. And no tying the hands of the public option by saying it can't be subsidized in the same ways private insurance is.
- Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.
- Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.
- Be available to all individuals and employers across the nation without limitation
- Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.
- Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.
- Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.
- Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.
- Receive a level of subsidy and support that is no less than that received by private plans.
- Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.
In conclusion, the public plan, like all other qualified plans, must redress historical disparities in underrepresented communities. It must provide a standard package of comprehensive benefits including dental, vision, mental health and prescription drug coverage with no pre-existing condition exclusions. It must limit cost-sharing so that there are no barriers to care, and incorporate up-to-date best practice models to improve quality and lower costs. All plans, including the public plan, must include coverage for evidence-based preventive health services at minimal or no co-pay. All plans, including the public plan, should be at least as transparent as traditional Medicare.
Sounds good to me.
Eventually we're going to have to rally around something, and it's good to see the Progressive Caucus flexing its muscle. Their plan isn't a watered-down compromise, it's the best plan for Americans at this point.
Even if we only wanted to reform the private industry, there isn't any way to really enforce that other than with competition from a public option. The insurance industry will do whatever to get out of any reforms, so it's better just to circumvent them and give people a real choice.
Because any health care plan without a strong public option is just kabuki.