By Hilary Corrigan
Coast Press Reporter
February 8, 2006
It’s an ambitious goal, Lewes resident Lloyd Mills admits.
Installing a long-term, universal health care coverage system in Delaware — probably with the state government collecting money through a new tax and serving as a single-payer entity — doesn’t sound like an easy project.
“We’re going to have to do it. There’s no choice,” Mills said, adding that health care has grown unaffordable for middle-class residents and such a cover-all approach remains possible. “There are countries that have done it.”
Mills is a committee member with the Delaware Health Care Commission, a state body seeking plans on designing a universal health care coverage system in Delaware. On Feb. 10, the group will consider proposalsfor such a blueprint and select an applicant to draft it by the end of summer.
“We’re embarking into relatively new territory,” said Paula Roy, the commission’s executive director.
But to Roy, it’s part of the stated mission to craft “basic, affordable health care for all Delawareans” that led the state’s general assembly to form the commission in 1990.
“Our job isn’t done until there are strategies in place to cover everyone,” Roy said.
The commission came up with a similar universal coverage idea a decade ago, but took a different action route, reviewing ways to tweak the existing health care system in order to cover more people.
“It’s come full-circle,” Mills said of a universal plan. “We’re tired of tinkering. Tinkering has gotten us nowhere.”
‘Same boat’
In Delaware, about 100,000 remain uninsured and just as many are under-insured, Mills said. That leads to emergency room visits after people who can’t afford pricey medical attention let health care problems fester. Most of those with insurance have it through luck, since their employers offer it, he said.
“We’re all in the same boat,” Mills said of health care coverage needs, but that stance hasn’t improved what he describes as a failing system. “I’ve given up the moral argument. It doesn’t get anywhere.”
Instead, he focuses on the current system’s costs, what he calls a “patchwork of revenue sources” made up of co-payments, deductibles, premiums and other charges.
“There’s no good reason why it should be as complicated as it is, except a lot of people get paid a lot of money for pushing paper around,” Mills said.
He expects the draft plan to replace that with a new health services tax based on citizens’ ability to pay.
“Everybody in and everybody paying a fair share of the cost,” he said, adding that a single payer system would streamline financing. “One person paying and one person receiving all the bills.”
Mills expects that someone to be the state, possibly contracting an experienced insurance company to process claims and collections.
Such logistics present the problem, according to Beebe Medical Center President Jeffrey Fried.
“The devil is in the details,” Fried said.
Jim Bartle, Beebe’s vice president of finance, likes the idea of streamlining the hospital’s current administrative and financial burden associated with billing, insurance forms and claims to many different payers who all use different rules.
But crafting a single-payer system would need to include the federal government’s Medicare and Medicaid programs for senior citizens and those with low incomes. In an area full of retirees, more than half of Beebe’s business comes from those programs’ users, Fried said, and any new state plan would need to align federal plans for a fair process.
“What’s the role of the federal government?” Fried wondered. “That’s the big issue.”
He also wonders about Medicare’s financial future as the large baby-boomer generation retires and taps it.
“What are the alternatives?” Fried said, adding that he would support a universal coverage system, depending on details. “I think it’s good that people are looking at alternatives.”
Processing
Roy expects to receive most applications to the commission’s proposal request, advertised last month, on the Feb. 10 deadline.
“What we’re all really after is a way to cover everybody,” she said of the goal.
A federal grant allowed the commission to seek proposals outlining what such a system would resemble and how to install it.
“We will at least have a roadmap,” she said.
She finds more people willing to consider the possibility now than she found even five years ago. A 2004 report from the commission outlined a single-payer system possibility, but this approach takes a closer, more detailed look at it.
“The question is whether the challenges can be overcome,” she said. “Is it possible?”