By Ricardo Alonso-Zaldivar
The Washington Post
January 6, 2010
Congressional Democrats and President Barack Obama began work in earnest Tuesday on difficult issues still standing in the way of their national health care overhaul after months of tortuous debate. Topping the list: How to help Americans pay for insurance premiums.
Obama “… stated his intention to work with leaders to strengthen affordability … beyond what is in the Senate bill,” said a House leadership aide, who spoke on condition of anonymity because the meeting was private.
(House Speaker Nancy) Pelosi said she wants the final product “to ensure affordability for the middle class, accountability for the insurance companies, (and) accessibility by lowering costs at every stage.”
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010501560.html
Comment:
By Don McCanne, MD
From the very beginning of his political campaign President Obama stressed that his highest priority in health care reform was to make health care affordable. He even rejected universal coverage through an individual mandate, insisting that you can’t require individuals to purchase a private insurance plan that they can’t afford.
In his meeting with the Democratic leadership yesterday, during the final stages of the reform process, he stressed again that affordability must be further strengthened.
The question of affordability has often been framed as a balance between what is affordable for employers, for individuals, and for the government. But it is really individuals, collectively, that bear the costs of health care. Individuals pay for insurance premiums and out-of-pocket expenses. Individuals also pay for employer-sponsored health plans through foregone wage increases. Those who dispute that will have to admit that the cost of premiums that are not supported by lower wages would then be passed on to individuals as consumers of the products or services provided by the businesses. And of course the government is financed by individuals though taxes, either paid directly or paid by higher consumer prices for taxes collected from businesses.
Why is it important to acknowledge that the individual is the source of all health care financing? It’s simply because our entire national health expenditures (NHE) represent the financial burden for which individuals bear the collective responsibility, and it is that burden that must be made affordable.
Unfortunately, most attention was directed to making health care affordable for the government. Rather than doing that by controlling our NHE, Congress merely played shell games with the budget, shifting the flow of funds in different directions, creating only the false appearance of affordable reform that was fully paid for. Balancing a government budget on the backs of others has almost nothing in common with the concept of affordability.
What is most unfortunate is that President Obama, right from the very beginning, rejected the model of financing reform that would make health care affordable for everyone. The model he selected is the most expensive model and falls far short on effectiveness, equity, and universality. Where his model saves money is in policies that are designed to place more financial barriers between the patients and the care that they need – policies that are primarily business tools of the private insurance industry, especially the low actuarial values of the plans.
It has been proven repeatedly, through simulations and through real-life experiences, that a single payer national health program or a national health service are the only models that would actually slow health care cost increases while truly covering everyone through equitable financing of a universal risk pool. They are truly effective in controlling spending through mechanisms such as reduction in administrative waste, global budgeting for hospitals, negotiation of pricing, and budgeting of capital improvements. These are the least expensive and most effective models of ensuring that everyone receives the health care that they need.
Although Americans remain uncomfortable with the concept of a government owned and operated national health service, they are very receptive of the concept of an improved Medicare that would cover everyone. That would be affordable for businesses, for the government, and, most importantly, for the individuals who really are paying all of the bills anyway.
President Obama needs to sit down with the Democratic leadership and say, “Hey, it’s absolutely imperative that we make health care affordable, so let’s look at this single payer thing again.”