High-Quality, Universal Health Care Is Possible -- With No Premiums or Deductibles

[marmar]

via AlterNet:



High-Quality, Universal Health Care Is Possible -- With No Premiums or Deductibles

By Maggie Mahar, Health Beat. Posted July 16, 2008.

What's more, this new plan from Dr. Ezekiel Emanuel would rein in health care inflation and insulate our health system from lobbyists.



This article appeared originally as a two-part series on Health Beat.

Most plans for health care reform that stress "choice" give families the opportunity to choose from a menu of plans that offer insurance at different prices. In effect, families are "free to choose" the health care plan that they can afford. (More accurately, they are "forced to choose" the plan they can afford.)

Imagine, instead, a proposal for health care reform that guarantees free, high-quality health care for all Americans. No premiums. No deductibles. Under this plan, the government insists that all insurers offer the same comprehensive benefits to everyone, including: office and home visits, hospitalization, preventive screening tests, prescription drugs, some dental care, inpatient and outpatient mental health care, and physical and occupational therapy.

These benefits are more generous than Medicare's and more comprehensive than what 85 percent of all employers offer their employees. (Individuals who want to purchase coverage for additional services like concierge medicine, experimental drugs for serious conditions, complementary medicines or more mental health benefits could do so.)

If this all sounds too good to be true, you need to read Healthcare, Guaranteed: A Simple, Secure Solution for America by Dr. Ezekiel Emanuel. Published this month, Healthcare, Guaranteed offers a bold, refreshing plan for health care in America. The charm of the proposal is four-fold: It faces up to the fact that reform won't pay for itself, and it offers a funding mechanism that is fair and efficient and could deliver high-quality care nationwide. It regulates insurers, forcing them to concentrate on quality. Finally, and perhaps most importantly, this plan insulates our health care system from the lobbyists who, today, have far too much control over our health care system.

Emanuel has the background and experience needed to help draft a blueprint for health care reform. An oncologist who also has a Ph.D. in political science and now serves as chair of the Department of Bioethics at the Clinical Center of the National Institutes of Health, Emanuel is attuned to the ethics as well as the politics of medicine, and he understands the needs of seriously ill patients. ..........(more)

The complete piece is at: http://www.alternet.org/healthwellness/91609/

[dtotire]

1. Health Care Plan

His plan requires a 10% Value-added Tax. I have advocated the same, for some years. I wrote a letter to the Hartford Courant five years ago advocating it. We won't have Universal Health Care unless we enact some kind of consumption tax. It could be used to support a single-payer plan, or it could be used to subsidize private health insurance plans, if the public wanted to retain them.

[dtotire]

2. A Good Plan

One advantage is that the tax is rebated on all exports, which would make American business more competitive in World markets. Business would be relieved of the burden of providing health insurance for their employees and retirees. A disadvantage would be that the price of imported cars, televion, and other products would be increased by 10%, but this would lead to some of these product being produced here, meaning more jobs for Americans.

[marmar]

3. Nite kick.....

:kick:

[Cleita]

4. Any plan that includes for profit insurers is a plan doomed to fail the very

people who need health care, the sick. Insurance cannot by it's nature deliver true health care. Not only that it will cost more than extending an improved Medicare to all as outlined in HR676 a plan that is waiting for the House to debate it. This is what Don McCanne, M. D. of PNHP has to say about this plan.

Comment:

By Don McCanne, MD

Ezekiel Emanuel is certainly correct when he states that we must focus on health care costs as we expand health care to everyone. He is also correct when he implies that current political proposals such as electronic medical records, wellness programs, quality incentives, and disease management programs would not have any significant impact on controlling spending. But he is wrong when he implies that there is no reform proposal that would both control costs and cover everyone.

A single payer national health program is specifically designed to include everyone automatically, and to slow the rate of growth in spending, while shifting funds from wasteful administrative services to more beneficial health care services.

He concedes that reducing the waste of the insurance industry is “valuable,” but then he dismisses it as a “1-time savings.” Since it is a fundamental structural change in the health care financing system, it is not a one-time savings, but rather it is a change that shifts the curve of the health care spending down to a new lower trajectory - permanently. All of the other cost-saving features of the single payer model each have the effect of further lowering this trajectory.

Although he mentions that cost control will require comprehensive reform, his own model, which he developed with Victor Fuchs, doesn’t seem to address the cost issue that he says (and we agree) is so important. They would establish a voucher system for purchasing private insurance and fund it with a regressive value-added tax (VAT). They would control spending by providing only a “basic” plan for everyone, but allow individuals to purchase services or coverage beyond the basic plan.

Victor Fuchs and I participated in a panel debate at Stanford. I asked him if providing a walker would be a basic service for a patient with disabling osteoarthritis of the hip, whereas hip replacement surgery would be an option for those willing (and able) to pay for it. He emphatically insisted that hip replacement surgery is a basic benefit, even though it is an elective surgery. My point is that all reasonable beneficial health care services should be covered, and we should not be distracted by the fictional concept that there is an inexpensive, lower tier of services that would satisfactorily address the health care needs of all of us, with an opt-up for extra services. That lower tier includes most of our health care services and products (excluding vanity cosmetic surgery and the like), and it is very expensive.

Dr. Emanuel also states in his article, “…health reform proposals by presidential candidates or others should be critically evaluated primarily on whether they establish a financing structure and incentives for the delivery system reform that really control costs. If they lack a serious plan, they are not credible reforms.”

Physicians for a National Health Program (www.pnhp.org) has advanced a highly credible reform proposal. Anyone else?

http://www.pnhp.org/news/2008/february/focusing_on_coverage.php

[GreenPartyVoter]

5. Thanks for that second opinion

[Cleita]

7. Also, this plan is similar to the one that Massachusetts has and they

are already running into problems with cost because the privateers are costing the state too much because as for profits their administrative costs are too high.

[Cleita]

8. Here's a couple of articles on Massachussetts.

http://www.usatoday.com/news/health/2008-06-29-massreform_N.htm

http://www.pbs.org/newshour/bb/health/jan-june08/masshealth_04-28.html

Neither article addresses why the plan has become so costly. Could it be the private insurers who have been invited to feed at the government trough are inflating the cost of health care? Some say that they have to go after costs, but the problem is that the for profits will skim the cream before one cent goes to health care. That is why this health care plan is failing. There really is no room for private insurance in a single payer universal health plan and it is naive to think this can work.

[knitter4democracy]

6. I agree. We have to get the insurance co's out of it entirely.

For profit insurance companies will kill any plan. We'd have to get rid of them first.

[Xithras]

9. Perhaps, but the choice here is a bit simpler.

Even with an Obama presidency, a true single payer plan is at least 20 years out. A true push for single payer insurance, with nationalized medical facilities (as the pnhp plan proposes), would spark of a political war in this country that wouldn't fade with the passage of a single bill. You'd see lobbyists pumping millions into Washington, billions into a media blitz scaring people with threats of rationed health services, you'd see the healthcare industry financing their own candidates (probably Republican) to oppose the plan. Even if passed, it would spend at least a decade working its way through the courts to determine the constitutionality of prohibiting an entire class of business and nationalizing private property (you can count on THOUSANDS of eminent domain suits as medical facilities nationwide claim that the government is involved in a taking of facilities...that could add countless billions to the bill). At that point it's a crapshoot. The SCOTUS may very well find it unconstitutional, at which point it goes back out the window. Even if it is constitutional, you've now wasted at least 15, and probably 20, years getting to the point where you can start implementing the damned thing.

Oh, and then you're going to have to figure out how to deal with all of the doctors who will refuse to play along and accept it. Many will quit when their salaries are cut, and you can bet that independent "Cash and Carry" healthcare facilities will pop up marketing to people who don't want to wait for the rationed and waitlisted government funded care. The government can try to legislate those away, but you're now talking about MORE protracted "illegal taking" lawsuits, and those probably will NOT be won by the government.

Or, you can strike a deal that keeps the insurance companies in the loop, accept that there will be some waste, and have something up and running in only a few years.

Healthcare in the United States is a two TRILLION dollar a year industry. If you think it's just going to roll over quietly while it gets legislated out of existence, you're kidding yourself.

[Cleita]

10. The trouble is that like supply side economics that plan already has proved

not to work in Massachussetts so why would we try it again? Arnold Schwarzenegger is trying to get this plan into California after he vetoed a single payer universal health care plan that Californians actually wanted and voted for. Here is an article about it that mentions how it's working in Massachussetts.

http://www.indybay.org/newsitems/2008/01/10/18471628.php

snip

For one, it cannot keep at least half of its promise, controlling costs of medical care, because not only does it not remove the private insurers that created the current nightmare, it actually gives them a central role in the new system. And let us remember that the extraordinary administrative costs to private insurers – up to 34 cents out of each dollar <7> – are for them no great burden, because they are easily offset, as such costs allow insurers to never pay more in medical care than they collect in premiums. Indeed, such is the purpose of the sophisticated system of co-pays, cost-sharing, deductibles, exclusion clauses, and eligibility criteria, whose goal is not to control the cost of medical care in order to provide more and better of it to more people, but to control the costs of running their profit-maximizing business, while leaving enough spare change to shower high level executives with generous salaries and compensation packages.

What is worse, ABX1 1 creates new eligibility categories -- the poor, the not-so-poor, the non-poor, and several levels within each category -- and imposes “fines” for misbehavior (e.g. failing to purchase health insurance) that will have to be enforced, all of which will increase administrative waste. And in its attempt to regulate industry, whether or not it succeeds, the legislation creates yet another layer of expensive bureaucracy that will divest resources from actual medical care.
Last, ABX1 1 will not control costs because it prevents Californians from using a major cost-containment mechanism: the purchasing power of large pools, which allows single payer systems like the Veteran’s Administration or Canadian Medicare to negotiate for best prices of medical goods and services through global budgets, fee schedules and drug formularies.

This failure to control costs will prevent ABX1 1 from meeting the other half of its promise: providing health care security to Californians. It cannot provide “health care security” because it does not guarantee a comprehensive package of medical services at prices that are affordable for prospective patients. Rather, it merely mandates individuals to buy a policy in the market, whether or not the policies they can afford truly meet their medical needs. And we should note that subsidies, likely to increase as more individuals become impoverished by rising medical costs and become “eligible” for them, are not gratis: they are borne collectively by all taxpayers.

If we are to go by the experience of other states, the prospects of ABX1 1, at least for those who would like to have the health care security and cost control of medical care that the legislation promises, are grim: a similar, individual mandate in Massachusetts is already running $147 million over the $472 million budgeted for fiscal year 2007, collections of fines from employers who fail to provide coverage are 80% below the original projections, and barely 7% of the uninsured who are not poor enough to receive subsidies have enrolled in any plan at all. Yet we should refrain from throwing the first stone: the cheapest plan that meets the mandate’s requirement for a couple in their fifties costs $8,200 per year, with $2,000 deductible per person, so “choosing” to not enroll in any plan, even at risk of being fined, is not unreasonable <8>. Nor is it unreasonable to request, as many have done, a “compassionate exemption”, which by April of 2006 was already being granted to approximately 20% of those who failed to comply with the mandate (about 60,000 individuals) <9>.

snip

When the privateers come in they treat all the new government money they are getting as a candy store and the states cannot contain costs because they are not the single payer. They are ruining Medicare with privatization and the joke of a prescription drug benefit given to seniors. Please the insurers have to go. All it will take is the will of the people and the legislators to make it happen.