By James Clark
Health News Florida, Feb. 16, 2011
As a former state director of social services (South Carolina), health policy chief in Florida’s Agency for Health Care Administration, and assistant Secretary for programs in the Department of Children and Families, I find the current debate on health care reform has failed to fully inform the general public. The discussions have mentioned the “elephant in the room”: the cost of the current delivery system, and then have gone downhill.
Heated rhetoric about the special interests that benefit from the quagmire of competing interests, including the insurance industry, pharmaceutical companies, hospitals, over-specialized physicians and nursing homes, only have confused the public trying to understand the debate. Invective and rhetoric regarding “socialized medicine, big government and insensitive Republicans who want to abandon the poor and deny care to persons with previous health care issues or who have too little money to buy insurance” have increased the tension.
Medicaid started out fifty years ago as a small effort to help those who couldn’t afford health insurance, and grew into the biggest item in the state budget, and in the recently enacted health care reform package will grow even larger. Medicare expenditures have grown to such a level that they cannot be sustained without significant tax increases.
Employers have not been able to afford to provide health care as a benefit and insurance and provider costs have continued to rise. With expanded Medicaid coverage some employers will find it preferable to deny lower wage employees health
insurance in favor of the promised expanded Medicaid system.
Most states are broke and won’t be able to afford the expansion even with federal matching funds. A few state legislatures have attempted to deal with the issue. California passed a single payer law that was vetoed by their governor. Vermont has a governor and legislature willing to try it out and recently met with the federal officials to obtain waivers to try a new single payer approach. Massachusetts implemented Governor Romney’s expanded health care initiative and is now considering a single payer system.
Florida recently elected a governor with a background in health care delivery and a self-paid campaign that frees him from obligations to the insurance companies or medical provider interests. He wants to cut spending and reduce bureaucratic regulation and it may be time for Florida to take a second look at single payer coverage.
It might also be time to expect the able-bodied Medicaid recipients to repay the taxpayers with hours of public service equal to the value of their free medical care. Mayor Giuliani required public assistance recipients to clean the streets and parks up to the value of their financial grant. When I interviewed these folks I found that they had no problem in repaying the city for the benefits they received.
The largest cost in the health care budget is that of administrative costs. Administrative expenses are greater in America than any other country.
In Medicaid and Medicare there are over 7000 different billing codes, and multiple levels of eligibility. Some Medicaid recipients are also elderly and we operate two overlapping systems to provide service to them. In addition, the amount of funds paid to providers differs from state to state and what is covered differs from state to state. The “non-system” would make a great “Saturday Night Live” skit if it were not so tragic.
Doctors are plagued by complex rules and procedures to be reimbursed and the degree of fraud in the system is fueled by the complexity. A single payer system would address this issue.
There is a “window of opportunity” with the budget restraints now faced by the states. We can reduce the bureaucracy, take care of the issue of tort reform for medical liability, provide universal health care, address pre-existing conditions, eliminate the excessive profits associated with rising insurance premiums and most importantly of all accomplish it without raising taxes.
There would no longer be a profit motive or insurance premiums and American families could keep the $12,000 a year now spent on insurance premiums. Hospitals and doctors would no longer be dunning folks for dollars they don’t have and then spreading out the costs associated with the non-insured among the insured.
William Hsiao, an economist who analyzed the Vermont proposal, said it would reduce expenditures in Vermont by 25 percent! Doctors and other providers might have to earn a bit less but levels of remuneration would still be greater than all others with advanced degrees currently earn.
This is a difficult issue; however, our legislators and our governor have a unique opportunity to reduce the bureaucracy of health care, reduce the cost of health care and return some savings to the taxpayers. Let’s “get to work” and show the folks in Vermont how to do it.
http://www.healthnewsflorida.org/analysis_opinion/hnf_entry/single_payer_health_insurance_is_it_time_for_a_second_look