By Reed Abelson
The New York Times
October 20, 2007
It makes for a compelling stump speech. And the leading Democratic candidates for president are all saying pretty much the same thing: adapt the health care program that covers Congress and offer it to the 47 million Americans currently without insurance.
The (Federal Employees Health Benefits Program) gives members of Congress, along with about four million other active and retired government workers, a wide array of private insurance offerings with fairly generous benefits.
While health policy experts acknowledge that the federal employees’ program could be a workable way to reach some of the uninsured, they also say there is nothing about it that would help address what they see as an underlying reason for the growing numbers of uninsured: the nation’s runaway medical costs. And without major changes, they say, the model would be sharply limited in achieving the goal of universal coverage for all Americans.
To begin with, not everyone makes the $165,000 a year or so that members of Congress do. In fact, at least 100,000 federal workers — at least 5 percent of the active work force — do not have health insurance. In many cases, according to the union that represents the workers, they consider even the cheapest options within the federal plan unaffordable.
And despite the program’s federal imprimatur, the government currently plays only a limited role, preferring to let commercial insurers take the lead.
“This is a private-based solution, with all of its foibles,” said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology who is advising various Democrats about the federal program as a possible model. It would probably have higher administrative costs and pose more of a risk of private insurers trying to enroll only the healthiest people, Mr. Gruber said, than if the government were to provide the insurance directly.
And the officials running the federal program emphasize that theirs is not a government-run plan like Medicare, in which the government is the main buyer of health care and can effect broad changes in public health.
In order to make insurance affordable to a greater number of the 47 million who currently have none, experts say, the coverage might have to be much more limited than even the most basic federal employees option, and be designed to protect mainly against catastrophically high doctor or hospital bills.
“You don’t want to take them from nothing to a Cadillac,” said Professor Gruber.
http://www.nytimes.com/2007/10/20/business/20fedhealth.html?ref=health&pagewanted=all
Comment:
By Don McCanne, MD
So the health insurance program that covers members of Congress is the program that we should all have – except for those of us like the 100,000 federal workers who are not covered by their own program. What?
So to make federal coverage more affordable we would convert it into catastrophic coverage that still wouldn’t be affordable for most average-income individuals, and would expose many of those who are covered to financial hardship? And to do that we would sacrifice efficiency, equity, and the ability to effect positive changes in public health?
In this day and age, when it is difficult to tell the difference between a Cadillac and a Chevrolet, no one would propose ensuring a mode of transportation by offering a Chevrolet with its engine and transmission removed. Except maybe the leading Democratic candidates. After all, the shell of a Chevrolet is politically feasible, even if their owners are not able to show up at work.