Taming a medical monster
By William H. Albers
Peoria Journal Star
September 24, 2006
In 2004, the Illinois Legislature enacted the Health Care Justice Act (HCJA). A 29-member task force was appointed to gather information about the uninsured and to issue a report by this December. The committee hired a consultant to recommend solutions. Public hearings have been held. Six proposed solutions have been submitted. The committee, which meets Tuesday, is now attempting to reach consensus on a plan to recommend to the Legislature.
Any solution must satisfy at least three major criteria. First, there must be universal, affordable coverage. Second, cost containment should be built in. Third, coverage should be comprehensive and fair.
Possible solutions for the uninsured take several approaches. Several attempt to increase the number of individuals covered by private insurance, including an employer mandate, individual mandate, tax incentives, health savings accounts (HSAs), purchasing cooperatives and vouchers. All of these would increase health care costs.
Other plans would seek to expand enrollment in Medicare or Medicaid by lowering eligibility requirements. Finally, some propose a single-payer system, similar to Canada’s, in which a government agency receives funds from individuals and employers, and reimburses providers for care.
Six proposals have been submitted to the task force. The consultant, rating each on a point system based on essential ideals, ranked single-payer the highest. It is the only solution which meets each of the criteria. Because of low administrative costs and simple reimbursement policies, a government-managed system can cover all citizens for no more than is now being spent on health care.
This alternative is highly controversial because it would eliminate private insurance. Not only would it be opposed by insurance companies, but others oppose it philosophically. “I do not favor national health insurance because it is not the American way,” one elected official recently said.
Unregulated private insurance has not and will not solve the current problems of excess cost and 46 million uninsured. Health care is unlike any other commodity in our economy. Demand is inelastic and society tells us that everyone is entitled to the same care, regardless of the ability to pay. However, private insurance, because it needs to generate profit, tries to exclude those at high risk, thus limiting the pool and reducing payouts.
The old and the poor are covered by public plans, but many middle-class working families are unable to afford private insurance (premiums for a family of four exceed $10,000 annually), and many others with chronic conditions are denied coverage and fall into the ranks of the uninsured.
To reach consensus, the task force may recommend a compromise. A hybrid proposal has been drafted which includes an employer mandate (employers above a certain size must offer health insurance) and an individual mandate (all individuals must have health insurance; those who cannot afford it may receive subsidies). Any proposal using either mandate will reduce the numbers of uninsured only if there is also an insurance mandate (insurance companies must expand the risk pool by offering insurance at the same rates to all).
The ideal solution to our health-financing problem is a federal single-payer system. Realistically, that is not going to happen for a while. A state-by-state approach is not optimal. There could be 50 different systems.
The Legislature must seriously consider the final recommendations of the task force and pass legislation. Any action which reduces the number of uninsured in Illinois (currently about 1.8 million people) will improve the health and well being of our citizens. This problem has been ignored by our leaders for far too long, and Illinois now has a chance to lead the way.
William H. Albers is a pediatric cardiologist and professor emeritus of pediatrics at the University of Illinois College of Medicine at Peoria.
http://www.pjstar.com/stories/092406/OP__BB0EJLGN.059.shtml
Comment:
By Don McCanne, MD
Once again, the single payer model ranked the highest based on the ideals of a universal system. Yet the voices still clamor for a compromise merely to protect the private insurance industry that has failed miserably in achieving the ideals we are seeking.
Compromise!? Why do we insist that the insurance industry must be allowed to continue to compromise the health and financial security of the people of our nation?
Are we a nation of dimwits!?