The Baltimore Sun
September 7, 2001
“Business, industry object to $1 billion proposal by coalition” by Diana K. Sugg
“Leaders of a statewide coalition of labor, religious and civic groups are proposing an ambitious health plan costing up to $1 billion that would provide coverage for the state’s 650,000 uninsured residents. The strategy, already under attack by business interests, would require employers to provide insurance or pay a tax, expand a government health program for children and create a buying pool so the elderly could get their medicine cheaper.”
“One business group, the Maryland Business for Responsive Government, opposes the coalition’s plans, believing the new proposal is a veiled effort to install a Canadian-style health care system.”
“Experts who closely follow similar proposals nationwide called the Maryland scheme ambitious and well-crafted. They noted that the Maryland group responded to the public distaste for a Canadian-style, single payer system by coming up with a different approach.”
Robert Blendon, a Harvard professor and frequent source of polls indicating that Americans do not want a government-run health insurance program:
“They have done more work on this to make this politically palatable than many of the other proposals around the country. But I think they’re ahead of the curve.”
A description of the Maryland plan is available at:
Comment: 92% of Americans believe that it is important for the President and Congress to “deal with the issue of increasing the number of Americans covered by health insurance.” We are united in this goal, but we remain divided on the means to achieve this goal. Specifically, the major division is between those that support a universal, single-payer program, such as a Medicare for All approach, and those that support incremental increases in coverage. The opposition to a single payer approach continues to be reinforced by the work of Robert Blendon and others that indicate that Americans have adopted the anti-government rhetoric of the conservatives. Although the opposition is based on rhetoric rather than on an understanding of fundamental health policy, the reality is that the rhetoric has blocked all attempts at universal coverage. Thus we continue on the path of incremental reform, primarily by expanding public programs. Yet we now have more uninsured than we did at the time of the ill-fated Clinton attempt at reform.
Some of us believe that we should be following both paths to reform. We should be making every effort to educate the public and to change the political will such that a true universal, comprehensive, efficient, ethical, and equitable program can be enacted. During this process, we also should be enacting incremental reforms as temporary, urgent measures that will reduce suffering that exists today. But because these incremental measures ignore many important, fundamental issues of health policy, they should not be accepted as definitive reform.
Maryland’s “well crafted” program is somewhat unique in that they have merged both pathways into one. They have listened to Blendon and others and have rejected proposals that would have the appearance of a Canadian single payer system. They have accepted the prevailing concept that only incremental-type measures will have political support. They will leave in place the current, fragmented system of private sector health plans. They will expand the state children’s health insurance program. And then to fulfill the goal of universal coverage, they will create the Maryland Healthcare Trust, a program to cover the remaining uninsured. Thus they are proposing the politically palatable approach of incrementalism, but they are achieving universal coverage. Thus they have finally brought together all of us that are dedicated to comprehensive health care reform. In your fantasies!
They violated the first rule of negotiation. Even before they began, they paid a very high price by abandoning important fundamental health policy principles that must be in the forefront of negotiations as we design our health care system. Just a few of the issues they gave up even before they’re out the door include cost shifting, adverse selection, risk pool equity, administrative waste of private bureaucracies, cost containment, integration of fragmented programs, evidence-based expenditure controls, etc., etc. It is ironic that they chose to ignore their own study, done by The Lewin Group, that demonstrated that a multi-payer model would cost the citizens of Maryland over a half billion dollars more for their health care than would a single payer model (www.healthcareforall.com\Lewincov.htm). Perhaps the greatest defect in their proposal is that it will not contain health care costs, perpetuating the instability characteristic of our current health care model. As such, their proposal, even if enacted, cannot possibly survive intact.
Their proposal to cover the uninsured, the Maryland Healthcare Trust, was, in fact, very carefully crafted. As a stand alone product, it embodies many of the fundamental principles of a single payer system. In some ways, it improves on existing single payer concepts by introducing improvements in information technology, improved methods of cost containment and resource allocation, and including some of the beneficial measures introduced by the managed care industry but without the intrusion of the managed care plans. In fact, although the coverage under the trust would be limited to the uninsured, it is already being disparaged as a “Canadian-style health care system.” It is ironic that, considering all that they gave up before even starting, they are not going to escape the precise problem that they wished to avoid, being attacked as a socialistic, government run, rationing, bankrupt system like they have in Canada. They paid a terrible price to try to avoid the rhetorical lies that they will be faced with anyway.
There is another design flaw that will prove to be fatal for health care equity. They concede that both the Medicaid and the Children’s Health Insurance Program are significantly underfunded, and that funding will have to be increased in order for the program to succeed. Since these programs are for low income individuals and families, adequate levels of funding never will be provided. That’s “never,” with an “n.” Furthermore, the Maryland Healthcare Trust will be developed for the uninsured, another element with no political power. Consequently, the trust also will be chronically underfunded. It is likely that current trends, both in decreases in employer participation and in shifting of risk from health plans to beneficiaries, will move much of the “working families” into the trust. At best, mediocrity in health care will prevail, and Maryland will be locked into a deficient plan that will be highly resistant to revision because “everyone has health care coverage.”
When will health care reform advocates finally come together? When we agree that we cannot abandon health policy principles that will assure health care equity for all.