The next big health care crisis is now. HEALTH SCARE
The New Republic
December 24, 2001
by Jonathan Cohn
"As The New York Times reported last week, several major insurers, including Aetna, Humana, Cigna, and the UnitedHealth Group, are rolling out a new type of plan that fundamentally changes the way insurance works. Under the new schemes, which some call 'health savings accounts,' an employee would receive an 'allowance' of $2,000 or $3,000 to spend on medical care. If the employee ran up bills larger than that, he or she would have to pay them out of pocket, as much as $5,000, at which point the employer would pick up the rest."
"It's not too hard to see why this sort of insurance would appeal to the employer and to the insurance company: They'd both be spending less money. Employees who don't go to the doctor's office often would come out ahead too, at least in the short term. But if you happen to be one of those unlucky souls who has an expensive medical condition, the new accounts could spell disaster."
"In other words, the plans would take financial risk off the healthy and put it onto the sick--exactly the opposite of the social role insurance is meant to perform. The fact that so many of the nation's big insurance companies are introducing these plans suggests that, unlike medical savings accounts--a related idea hatched in right-wing think tanks that never really took off commercially--this new scheme has market appeal. Over time, it's not hard to imagine this style of insurance completely taking over, in the same way managed care swept through the market in the '90s."
"About the only consolation might be that this new system would probably prove highly unpopular. The funny thing about illness is that it's pretty democratic--it affects everyone you know at some time, and some people you know all the time. A health insurance system that made illness such a crushing financial burden would inevitably affect not just the working poor, but large chunks of the middle class. And that would eventually produce a political backlash, even if Washington didn't immediately recognize it."
"... for the last eight years, the Democrats have only nibbled around the problem of inadequate health insurance--a program for poor children here, a drug benefit for seniors there--and the Republicans, for the most part, have tried to avoid it altogether. But in the next few years, we are in store for another upheaval in American health care--and it might just shake up American politics as well."
<http://www.thenewrepublic.com/122401/cohn122401.html>http://www.thenewrepublic.com/122401/cohn122401.html
Comment: In this excellent article, Jonathan Cohn discusses the enthusiasm for reform of a decade ago, and the events since. He demonstrates trends that have moved us to the threshold of another great opportunity for reform. The expanding inequities developing before us can provide the contrast that we need to demonstrate the value of health care equity. This time, instead of trying to sell the nation private health plans, let's show them how we can deliver health care equity for all of us.
Jeff Huebner, M.D., Jack Rutledge Fellow of the American Medical Student Association, responding to the message on the ACP-ASIM request for proposals for health care reform:
I was interested in your closing comments after the ACP-ASIM post. Have you received any responses? You were absolutely correct that we must present our own vision. However, I believe it is vitally important for those groups that support single-payer to develop a plan for implementation (something that might pattern Canada's gradual, province-based implementation) over time, so as to not allow people to be scared of "sweeping, government" reform. Mobilizing support for the Tierney and/or Wellstone bills (gives money to the states and ERISA clearance to develop their own plans) might be considered initially.
It has been demonstrated through both public opinion research and through the history of both national and state initiatives that the public becomes easily fractured in their support when universal coverage or single payer is framed as a "large, government-based takeover" or that people will lose the benefits they're familiar with. I think this second concern (as The New Republic and New York Times articles in the past week demonstrate) has begun to dissipate and is easier to exploit right now, but the first concern is not.
For single-payer, then, to become an option during a national debate about universal coverage (which we do seem headed for again), the public must realize that health care DELIVERY will remain private (but be non-profit and publicly accountable), that people will have the option to see the doctor of their choice, etc. A discussion about the prioritization of health services resources also must be held. Focus groups should be conducted in order to explore how to frame the issue of single-payer with the public (I'm not sure if this ever has been done? Does anyone know?).
More importantly, I think those groups that support single-payer must develop a concrete, grassroots plan for how we will mobilize at least health professionals, as well as the public, in support of single-payer. By saying "mobilize," I think it implies a sequence of events, e.g., having a plan where people raise their voices (rallies, town meetings, etc.), write their representatives, and developing press "events" (via new reports, rallies, and more -- the single-payer feasibility stories have been a good start) that inject single-payer into the public debate. Continuing to support Maine's efforts (via contacts we have, volunteering to work for them, finances, etc), remains important. Transforming the white paper from the Physicians' Working Group on single-payer (<http://www.pnhp.org>http://www.pnhp.org) into a more digestible and supportable document for the public might help too.
These are not trivial issues. It will take a committed group of leaders, strategic planning, financial resources, and a willingness to build coalitions. A multi-year plan that recognizes the importance of educating and mobilizing activists and lays the foundation, so we are ready when the political landscape becomes fertile once again (which certainly is not right now) is necessary too. Only then will we be able to effectively advocate for the much anticipated "Medicare-for-all" bill.
The American Medical Student Association (long-time single-payer supporter) has funded the Rutledge Fellow to work full-time on this issue, and contribute toward a movement that would make "Everybody In, Nobody Out!" a reality. Any other takers?
To Holiday Cheers and Health Care for All, Jeff Huebner, M.D. AMSA Rutledge Fellow