Two difficult issues that stem from using private health plans as the model for reform include: 1) Can you mandate individuals to buy an insurance plan they can’t afford?, and 2) Can you allow insurers free rein on using premium dollars for their own purposes rather than spending them on health care? Let’s see how the Senate Finance Committee approached these.

Members of Congress are promising reform that will give us choices of coverage, just like they have in the Federal Employees Health Benefits Program (FEHBP). They will do this by establishing an FEHBP-like insurance exchange for the purchase of health plans.

In the debate on health care reform we hear that physicians are leaving the Medicare program because they cannot continue to accept the low fees paid by the government. Not true, according to this new GAO report. Physicians are more willing to serve Medicare beneficiaries and to accept Medicare fees as payments in full.

This paper (14 pages) brings together numerous credible studies on the quality of health care in the United States, as compared with other nations. Anyone reading this message already knows that the United States is paying enough for exceptional care for everyone, but many of us are not receiving it. On average, our health care is mediocre.

One of the more unique features of the health care system in the United States is that we spend far more on care even though our use of health care services is comparable to other nations. The difference is in the prices. Other nations use government regulation to improve pricing, but the United States persists in refusing to intervene in market pricing.

Much of the discussion on health care reform centers around financing reform, with goals of achieving universality and affordability. Effective reform that would actually accomplish that (i.e., single payer) would be a crucial first step toward the even more important goal of reducing the socioeconomic disparities in care. The record on disparities in the United States is shameful.

The health care reform proposal before Congress would increase regulatory oversight of the private insurers, mandate individuals to purchase their plans, and penalize those who fail to do so. The experience with auto insurance in California should provide us with at least a hint as to whether that is a rational response to the health care crisis.

Several readers found fault with Katharine Seelye’s dismissal of “Medicare for all” single payer reform as being too complicated, imposing a big tax increase on the middle class, and driving doctors and hospitals out of business because of low reimbursement rates. She also quoted Stuart Altman as saying it would be too disruptive, and Robert Moffit as saying that it would mean too much government intrusion.

This study analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) conducted by the National Center for Health Statistics (NCHS). This was a scientifically rigid analysis of a highly credible data source. The study concludes that the deaths of about 45,000 people each year are associated with the lack of health insurance.

According to this study conducted last month, 90% of insured Americans rated their insurance coverage either excellent or good. Yet when asked about specifics, only 14% of those rating their coverage excellent or good reported that they did not have any problems with paying their medical bills in the last 12 months and that they were satisfied with the elements of coverage listed above.