Mandatory Health Insurance Is Urged
Los Angeles Times
December 20, 2004
Letters
Re “Mandatory Health Insurance Is Urged” (a proposal for an individual mandate)
Any proposal for mandatory health insurance in California that does not involve the creation of a single-payer system would serve only to increase taxpayer subsidies for private insurers. In light of California’s enormous budget deficit, the costs associated with moving the uninsured into the individual insurance market would be unsustainable.
The California Health Care Options Project found that all Californians could be covered under a single-payer program for less than we spend now. However,
it will take tremendous political leadership to counter the opposition of the insurance industry to a plan that would put it out of business.
If Gov. Arnold Schwarzenegger is sincere in his desire to cover the uninsured, he will fight to make California the first state to provide universal coverage.
Gerald Gollin MD
Redlands
http://www.latimes.com/news/opinion/letters/la-le-health20dec20,1,2569989.story?coll=la-news-comment-letters
Los Angeles Times
December 22, 2004
Letters
FOR THE RECORD:
Universal healthcare -A letter to the editor Dec. 20 incorrectly stated that
California could be the first state to have universal healthcare coverage. In fact, Maine started enrolling people in the nation’s first universal healthcare program last summer.
http://www.latimes.com/news/opinion/letters/la-le-health20dec20,1,2569989.story?coll=la-news-comment-letters
Following is a communication to the Letters Editor of the Los Angeles Times
(Dec. 22, 2004):
In your letters section today you included a “For the Record” stating that Maine has “the nation’s first universal healthcare program.” That is not correct.
Maine’s Dirigo Health program is a voluntary market-based plan. It was designed to provide small businesses with an option for coverage. In designing the program, they shifted from a 60% employer contribution for the family premium to a 60% contribution for the employee only, excluding the family. Because “groups of one” (self-employed) are viewed as higher risk, the program was capped at 4500 for groups of one. Offering a voluntary program that leaves many out is not the same as providing a mandatory program for everyone.
Maine’s intent is honorable. But they rejected a universal program and adopted the Dirigo Health program instead. Unfortunately, it will fall far short ofmproviding universal coverage.
A new report from The Commonwealth Fund on Dirigo Health:
http://www.cmwf.org/publications/publications_show.htm?doc_id=253634
The full report:
http://www.cmwf.org/usr_doc/dirigo_ib_benefitdesign_hp.pdf
Don McCanne, M.D.
Comment: On the surface, this seems like a petty issue. Maine’s Dirigo Health program has been widely touted as the nation’s first state universal health insurance program. The Los Angeles Times editors have apparently accepted this claim at face value. They have not responded to my challenge to that claim.
But the issue is of great importance. Others are looking at the “success” of
the Maine program as a model for reform for other states. It is important to
understand their process.
Another report on Dirigo Health just released discussed the opinions of those participating in focus groups and in-depth interviews. Only one group represented uninsured workers, whereas the other 15 represented business
owners, employers and representatives of the insurance industry. It is not
surprising that the results included the concepts that insurance brokers should be involved, the Chamber of Commerce should support the program, and that it should not be a single payer system. They want greater affordability and availability of coverage. They approve of state subsidies to make coverage affordable, but they are opposed to increased taxes to pay for it.
http://www.cmwf.org/usr_doc/LSPA_focusgroup_report.pdf
The plan developed, DirigoChoice, will be offered by a private insurer, Anthem Blue Cross and Blue Shield. Participation is entirely voluntary. For the $1250/2500 deductible option, the premium for a family is $11,160 per year (but will be adjusted for demographics). The employer’s contribution is $2,232, although the employer has the option to increase that. Premiums will be discounted on a sliding scale based on household income (e.g., a family of four with a household income of under $56,550, which is 300% of the federal poverty level, receives a 20% discount of the employee’s portion of the premium, making the employee’s share $7,142 or $595/month).
Thus Maine’s “universal” program is private insurance offered in the marketplace, and depends on the voluntary participation of the employer and the voluntary participation of the employee or individual at a premium that is typical for the health insurance marketplace. How could anyone label this as universal?
The Los Angeles Times should be ashamed that they have been duped into touting this as “the nation’s first universal healthcare program.” But double shame on them for failing to apply the same critical standards on themselves that they incorrectly applied to one of their contributors, especially when it is on such an important topic as health care reform.
The crucial message here is in Gerry Gollin’s letter. We should all make an effort to be certain that Gov. Schwarzenegger hears it.