By Rep. Pete Stark
The Hill
June 3, 2008
Recent surveys indicate that a majority of Americans share a strong hope that the next occupant of the White House will work with the Congress to address this issue. As we have learned from past attempts, the best-laid plans of any one party, interest group, or industry are insufficient to achieve the goal. Success will require negotiation and compromise from everyone. Our private profit, non-profit and public programs must work in harmony to bring about needed change.
We are still full throttle at Senate Finance Committee
By Sen. Max Baucus
The Hill
June 3, 2008
On healthcare reform, Sen. Chuck Grassley (R-Iowa) and I will convene a bipartisan summit at the Library of Congress on June 16 called “Prepare for Launch: Health Reform Summit 2008.” It will be an opportunity for senators, representatives and health policy experts to dig in to prepare for health care reform in 2009. Federal Reserve Chairman Ben Bernanke and genomic research pioneer Dr. J. Craig Venter will address attendees. We will take up issues like state-based reform efforts, employer-sponsored coverage trends, rising healthcare costs, demographic shifts, insurance market reform, the role of public programs and delivery system reform.
http://thehill.com/op-eds/we-are-still-full-throttle-at-senate-finance-committee-2008-06-03.html
Comment:
By Don McCanne, MD
Those of us who have long been advocating for health care reform are encouraged by the the window of opportunity that has opened with the change in political climate. There is a high probability that in January, Barack Obama will be president, we will have a strong Democratic majority in the House of Representatives, and Democrats may even constitute a filibuster-proof majority in the Senate.
When President Obama calls on Congress to begin the process for reform, what response can we anticipate based on the views of highly credible Democratic veterans of the legislative process?
Rep. Pete Stark calls for resuscitating the system. He calls for opening the process from a position of compromise that includes the for-profit and nonprofit private insurance industry. Sen. Max Bacus doesn’t even go that far. He calls for incremental steps that are so small that they would be overwhelmed by our backwards slide from our goals of reform.
Based on the statements of several politicians, it is likely that the early initial measures will be passing the children’s insurance bill (SCHIP) that Pres. Bush vetoed, and undoing some of the damage done to Medicare by the Medicare Modernization Act.
Soon after, negotiations should then begin to craft legislation for a “universal” system of health care coverage. On one end of the debate would be the Stark/Hacker/Obama model of public programs plus a choice of either private plans or a public Medicare-like option. On the other end would be the Wyden/Bennett/McCain model of competing private plans, with or without an individual mandate to purchase insurance.
Where will the compromise process take us? There is considerable support for a public Medicare-like option that theoretically could serve as a vehicle for eventual transformation into a single payer system. For that same reason, there is very strong opposition from Republicans who perceive it as a program that would take us down the road to socialized medicine. The public option supported by progressives would be very expensive because of its comprehensive benefits and the impact of adverse selection. If such an option were included in the final legislation, Republicans and conservative Democrats would see to it that it would be an underfunded, bare bones program designed to encourage individuals to remain in the private insurance market. It is even more likely that the public option would be discarded in the negotiation process, primarily because of the complexities of another welfare program that wouldn’t serve the public well.
It is recognized that lower-income individuals cannot afford to pay health insurance premiums. Although a cumbersome system of premium subsidies could be devised, it is much more likely that Congress would rely on expansions of our existing underfunded welfare programs: Medicaid and SCHIP. The decline in access due to a lack of willing providers is simply a price you pay for the process of political compromise.
Medicare would likely be left alone after the initial damage control measures were enacted. It is likely that Medicare funding will not keep up with medical costs in an attempt to delay the financial train wreck predicted by many. Lower funding would result in a decline of participating physicians.
What about the rest of us? Easy. Simply reform the private insurance markets. Require that insurers offer coverage to everyone, regardless of preexisting conditions. Require that plans provide coverage generous enough to prevent financial hardship for those who do have health care needs. Prohibit the sale of innovative underinsurance products that would leave sick people financially destitute, while shifting their costs to the rest of us. Require that higher-income free-riders either purchase private coverage or contribute to a public pool. Prohibit the private insurers from wasting money on administrative excesses, keeping their costs at 15 percent of the premiums (while doing nothing about the administrative burden on providers).
Fine. Then have the private insurers get out their sharpened pencils and give us the very lowest premium prices possible for products actually meeting these standards. (Hint: California’s CalPERS, the third largest health benefit purchaser in the nation, offers PERS family plans at premiums ranging from $13,998 to $23,163.)
Talk about train wrecks. The private insurance industry cannot possibly offer plans with affordable premiums that provide reasonably comprehensive benefits for all risk categories.
So what will be the political compromise? Congress would never provide enough taxpayer subsidies to make these plans affordable (likely well over a half trillion dollars). They can’t mandate individuals to buy insurance they can’t pay for. They could provide partial subsidies, but the experience in Massachusetts, the experience with tax credits for trade-displaced workers, and the experience of state high-risk pools demonstrate that comparatively few individuals participate in these plans, even with fairly generous subsidies. Okay, so we can’t cover everyone with private plans, but, again, that is the price of political compromise.
Wait. We could do something else. We could get rid of the private insurance industry and adopt a single payer national health program. Presidential candidate Obama has already indicated that a single payer program would be a much better system of financing health care than our current fragmented system of a multitude of private and public plans.
We can have single payer if the people ask for it, but first they must understand why private plans will never work. John Geyman explains precisely why in his new book, “Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It.” Order your copy now, if you haven’t already. You’ll need it in the coming months as we debate reform.
“Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It:”
http://www.commoncouragepress.com/index.cfm?action=book&bookid=396
