NEW MEXICO EDITORIAL FORUM
By Max Bartlett and Jose Aguilar
One issue has generated little discussion during the heated health care reform debate: whether states should have the right to develop their own approaches to universal coverage.
The Health Security for New Mexicans Campaign wants to see language included in the national proposal that gives states flexibility to develop their own approaches to solving rising health care costs and growing numbers of uninsured.
The focus of current health care reform proposals is to create “insurance market exchanges.” These one-stop-shopping insurance exchanges must offer consumers -- primarily the uninsured -- choices of different insurance products, including some type of public option. A less than robust public option is in the proposal passed by the House of Representatives. The Senate is in the process of negotiating an alternative to the House version.
Unfortunately, the health care reform debate has skirted the issue of whether states can take a different path that reaches the same goals. States always have been laboratories for innovation. Women’s suffrage, civil rights, child labor and minimum-wage laws were developed in the states first and then became federal law. Why shouldn’t states be allowed to continue that role in health care reform?
If a state can develop an approach that is not based on the insurance market exchange model, an approach that still provides comprehensive health coverage for its residents and contains rising health care costs, why shouldn’t it be encouraged to do so?
The recently passed House bill contains no language enabling states to develop anything other than an insurance market exchange. The merged Senate bill now under consideration mandates that by 2014, states must set up an insurance market exchange and experiment with it for three years before requesting any waivers.
Why should states be forced to go through a long, expensive, complex and time-consuming process when they already may be working on approaches more appropriate to their circumstances?
In New Mexico, the Health Security Act offers a different solution from that based on an insurance market exchange. It is a “home-grown” solution that has earned enormous public support -- 146 diverse organizations are part of our coalition, and 32 New Mexico counties and municipalities have passed resolutions endorsing it.
The Health Security Act would enable New Mexico to set up its own health care plan that automatically covers most New Mexicans, provides comprehensive benefits and guarantees freedom of choice of doctor even across state lines.
Instead of creating a system of competing insurance plans, each with different provider networks, this proposal would shift the role of private insurance companies to provide supplementary coverage – as they do with the original Medicare program. Any individual, employer or group wishing to purchase additional coverage could do so. A non-governmental, geographically representative citizens’ board would be in charge of the plan.
Two separate studies have concluded that if such a health plan were established in New Mexico, health care costs would be reduced by hundreds of millions, if not billions, of dollars within five years.
Why is this so? Because this approach simplifies a very complex private insurance system with its hundreds of policies, different benefits, co-pays and deductibles, all of which affect administrative overhead of doctors, hospitals and clinics – and which, in turn, negatively affect health care costs.
In a state such as ours, with a small population, it makes economic sense for most residents to be covered under one health risk pool.
Coalitions in other states -- California, Minnesota, New York, Pennsylvania, Washington and Oregon, to name a few -- have been working on proposals that are not based on an insurance market exchange and are adapted to the particular needs of those states.
Acknowledging these developments, the National Conference of State Legislators recently passed a resolution containing a provision asking that states be allowed to create solutions that go beyond any federal requirements. New Mexico was counted as one of the resolution’s supporters.
In addition, New Mexico State Sen. Dede Feldman and others from the House and Senate sent a letter to our five-member congressional delegation, which included a request that states be given flexibility to develop their own comprehensive plans.
Health care reform should clearly encourage state experimentation. Aside from the need for state flexibility language in the national legislation, the Health Security for New Mexican Campaign believes states deciding to develop their own health plans also should have the right to access the same federal dollars as those states choosing to set up their own insurance market exchanges.
At this critical juncture, Congress needs to tackle this issue.
Showing posts with label public option. Show all posts
Showing posts with label public option. Show all posts
Monday, December 14, 2009
Tuesday, December 8, 2009
MISSOURI FORUM
By Timothy D. McBride
Despite the importance of passing health care reform, it appears that the general public has very little understanding of the scope and importance of these reforms, or how the wide-ranging positive benefits will have on average Americans.
Much of this is due to overheated rhetoric, a misunderstanding of the proposals by the press, purposeful distortions by both sides of the debate, and the complexity of health reform. For example, much attention has been paid to the so-called “public option” which the right wing has described as a “government takeover of health care,” and the left wing has described as the only provision worth fighting for because it will keep the insurance plans “honest.” Both claims overstate the significance of the public option since by all estimates, even if it survives, not many will sign up for it, and the plan will resemble private plans, not a Medicare plan.
When the reforms are phased in, 96 percent of American citizens will be covered by health insurance -- up from an insurance rate of 83 percent today -- according to Congressional Budget Office estimates. Contrary to fears that the legislation will lead to a government-run health system, 58 percent of the persons obtaining coverage will obtain coverage from private insurers, in a new Health Insurance Exchange. This Exchange will be much like the array of private insurance plans offered to Congress and the President today. The remaining persons insured under the plan would be low-income children and adults insured through Medicaid and the children’s health insurance plan.
In Missouri, over 800,000 persons are estimated to be uninsured today. However, the Congressional reforms would reduce the number of uninsured by over 604,000 reducing the uninsured rate to less than 4 percent (from a current rate of 16 percent). Over 270,000 persons would obtain insurance through the Health Insurance Exchange, another 200,000 adults through Medicaid, and 130,000 children through Medicaid.
Although much of the focus has been on the provisions that would expand coverage for the uninsured, little attention has been paid to other provisions which could have wide-ranging impacts on the health sector. For years there has been little attention paid to public health issues. Most chronic diseases (such as obesity) can be prevented through lifestyle and environmental changes. So the proposal would implement policy changes to encourage preventive health and wellness, encourage physical activity and good nutrition, enhance the public health system, encourage health promotion activities, and enhance access to behavioral health services.
Also receiving very little attention are significant provisions to enhance the infrastructure of the health system. Since the health reforms are estimated to lead to 36 million more persons obtaining health insurance, this could significantly strain the medical care system. However, significant new funds to enhance the health workforce for primary care physicians, nurses, physician assistants, social workers, and public health workers are found in the proposal. Funds are also included to resolve payment problems afflicting physician payment, at least temporarily.
The recession led Congress to pass significant stimulus spending which has made the public concerned about the rising federal budget deficit. It should be comforting then that the President has promised he will not sign a bill unless it is deficit neutral.
While it is worth noting that much of the costs of increased coverage is paid for by the previously uninsured themselves (if they can afford it), the remaining costs are covered by taxpayers. About half of these costs will be covered by reductions in Medicare spending, and a significant share of these reductions will come from reductions in a program widely recognized to be in need of spending reductions, the Medicare Advantage program. The remaining costs will likely be covered by tax increases, most likely on a combination of high-income taxpayers (as President Obama promised in his campaign) or on high-priced health insurance plans.
As health care reform continues to move forward we can take significant steps towards removing the scar of the uninsured that has long stained our country. The proposals are not perfect, nor will they solve the problem overnight. But we cannot let the perfect be the enemy of the good. We just have to get started on solving this problem.
--------------------------------------------------------------------------------Much of this is due to overheated rhetoric, a misunderstanding of the proposals by the press, purposeful distortions by both sides of the debate, and the complexity of health reform. For example, much attention has been paid to the so-called “public option” which the right wing has described as a “government takeover of health care,” and the left wing has described as the only provision worth fighting for because it will keep the insurance plans “honest.” Both claims overstate the significance of the public option since by all estimates, even if it survives, not many will sign up for it, and the plan will resemble private plans, not a Medicare plan.
When the reforms are phased in, 96 percent of American citizens will be covered by health insurance -- up from an insurance rate of 83 percent today -- according to Congressional Budget Office estimates. Contrary to fears that the legislation will lead to a government-run health system, 58 percent of the persons obtaining coverage will obtain coverage from private insurers, in a new Health Insurance Exchange. This Exchange will be much like the array of private insurance plans offered to Congress and the President today. The remaining persons insured under the plan would be low-income children and adults insured through Medicaid and the children’s health insurance plan.
In Missouri, over 800,000 persons are estimated to be uninsured today. However, the Congressional reforms would reduce the number of uninsured by over 604,000 reducing the uninsured rate to less than 4 percent (from a current rate of 16 percent). Over 270,000 persons would obtain insurance through the Health Insurance Exchange, another 200,000 adults through Medicaid, and 130,000 children through Medicaid.
Although much of the focus has been on the provisions that would expand coverage for the uninsured, little attention has been paid to other provisions which could have wide-ranging impacts on the health sector. For years there has been little attention paid to public health issues. Most chronic diseases (such as obesity) can be prevented through lifestyle and environmental changes. So the proposal would implement policy changes to encourage preventive health and wellness, encourage physical activity and good nutrition, enhance the public health system, encourage health promotion activities, and enhance access to behavioral health services.
Also receiving very little attention are significant provisions to enhance the infrastructure of the health system. Since the health reforms are estimated to lead to 36 million more persons obtaining health insurance, this could significantly strain the medical care system. However, significant new funds to enhance the health workforce for primary care physicians, nurses, physician assistants, social workers, and public health workers are found in the proposal. Funds are also included to resolve payment problems afflicting physician payment, at least temporarily.
The recession led Congress to pass significant stimulus spending which has made the public concerned about the rising federal budget deficit. It should be comforting then that the President has promised he will not sign a bill unless it is deficit neutral.
While it is worth noting that much of the costs of increased coverage is paid for by the previously uninsured themselves (if they can afford it), the remaining costs are covered by taxpayers. About half of these costs will be covered by reductions in Medicare spending, and a significant share of these reductions will come from reductions in a program widely recognized to be in need of spending reductions, the Medicare Advantage program. The remaining costs will likely be covered by tax increases, most likely on a combination of high-income taxpayers (as President Obama promised in his campaign) or on high-priced health insurance plans.
As health care reform continues to move forward we can take significant steps towards removing the scar of the uninsured that has long stained our country. The proposals are not perfect, nor will they solve the problem overnight. But we cannot let the perfect be the enemy of the good. We just have to get started on solving this problem.
McBride is Associate Dean for Public Health in the Brown School at Washington University in St. Louis.
--------------------------------------------------------------------------------
Copyright (C) 2009 by the Missouri Forum. 12/09
Monday, October 19, 2009
NEW MEXICO EDITORIAL FORUM
By Jason Marks
Year in and year out, healthcare costs go up faster than the rate of inflation. This year, we will spend more than $2.5 trillion on healthcare in the U.S., which is over $8,100 per person. Even at that, more than 35 million of our fellow citizens are left without regular healthcare coverage through insurance or a government program.
Health insurers serve as a convenient target, getting criticized for denying care to those that need it most, creating too much red-tape for doctors and other providers, and for diverting too much of our insurance dollars to administrative overhead, profits, executive compensation, and lobbying. But since most insurers pay out 75 to 85 percent of premium dollars in medical reimbursements, the direct savings from taking them entirely out of the system is no more than 25 percent.
If like me, you are concerned not just with the availability and quality of healthcare, but also its affordability, then it is important to understand that we have to look beyond insurance reform and coverage mandates. We must also look also at our healthcare industries, by which I mean doctors, hospitals, pharmaceutical companies, and so forth. Most importantly, we have to look at -- and fundamentally change -- the current dynamic in which employers, insurers, healthcare providers, and last (and sometimes least) patients come together to deliver and pay for our medical care.
Neither health insurance nor the healthcare industries exhibit the benefits we expect from effective marketplace competition. As BusinessWeek Magazine recently reported, most health insurance markets in the U.S. are effectively monopolies or duopolies (one or two companies control the vast majority of market share). They found the same thing for hospitals. Insurance companies are unwilling or unable to extract significant long-term cost savings from providers. Healthcare providers seemingly feel the squeeze of “inadequate reimbursements” from insurers, but costs keep climbing, as do salaries and compensation.
This is where the “public option” comes in. The public option would be a single, nationwide health insurance plan that would be available as a choice for anyone who is currently uninsured, as well as many people with current coverage. It would co-exist with the current system of private health insurance, and no one would be forced to select the public plan. In fact, the only restrictions go in the other direction – public option advocates have agreed to restrict the ability of people with existing employer-based coverage to opt-in to the public plan in order to protect private insurers from the risk of losing too much business.
The public option plan can provide immediate savings to consumers who select it by doing away with some of the excess overhead consumed by insurance companies. There won’t be any premiums diverted to profits or outsized executive salaries. Moreover, government plans such as Medicare and Medicaid have proven to be more administratively efficient than their private counterparts. More importantly, a large public plan will bring competition and market discipline to every corner of the country. Frankly, the theory is that with enough enrollees, the public plan will be able to act as a price-setter, and not merely be a price-taker. The public plan will not be authorized to save money by rationing access to needed care.
Miracles of cost-containment, bringing us into parity with places like Canada should not be expected, but it’s very reasonable to expect that we can knock a couple of percentage points off the rate of annual medical inflation: What the President calls “bending the curve.” The savings would go beyond members of the public plan, as private insurers would be forced to respond with their own efficiencies. You wouldn’t know it from stories that cast the public option as yet another costly program demanded by “liberals,” but the public option is actually the most significant cost containment feature in the proposal being considered by Congress.
Since our last stab at major health reform, we’ve added another decade’s worth experience to the decades that went before, all telling us that our current mix of insurance and healthcare arrangements is simply unable to control costs. Common sense demands that we try something different. The public option can bend the cost curve, while not disrupting the existing care relationships for people who are happy with their current coverage. It is an essential component of any healthcare reform package.
--------------------------------------------------------------------------------
Marks is a member of the New Mexico Public Regulation Commission, which regulates insurance through its Insurance Division.
--------------------------------------------------------------------------------
Copyright © 2009 by the New Mexico Editorial Forum. 10/09
Health insurers serve as a convenient target, getting criticized for denying care to those that need it most, creating too much red-tape for doctors and other providers, and for diverting too much of our insurance dollars to administrative overhead, profits, executive compensation, and lobbying. But since most insurers pay out 75 to 85 percent of premium dollars in medical reimbursements, the direct savings from taking them entirely out of the system is no more than 25 percent.
If like me, you are concerned not just with the availability and quality of healthcare, but also its affordability, then it is important to understand that we have to look beyond insurance reform and coverage mandates. We must also look also at our healthcare industries, by which I mean doctors, hospitals, pharmaceutical companies, and so forth. Most importantly, we have to look at -- and fundamentally change -- the current dynamic in which employers, insurers, healthcare providers, and last (and sometimes least) patients come together to deliver and pay for our medical care.
Neither health insurance nor the healthcare industries exhibit the benefits we expect from effective marketplace competition. As BusinessWeek Magazine recently reported, most health insurance markets in the U.S. are effectively monopolies or duopolies (one or two companies control the vast majority of market share). They found the same thing for hospitals. Insurance companies are unwilling or unable to extract significant long-term cost savings from providers. Healthcare providers seemingly feel the squeeze of “inadequate reimbursements” from insurers, but costs keep climbing, as do salaries and compensation.
This is where the “public option” comes in. The public option would be a single, nationwide health insurance plan that would be available as a choice for anyone who is currently uninsured, as well as many people with current coverage. It would co-exist with the current system of private health insurance, and no one would be forced to select the public plan. In fact, the only restrictions go in the other direction – public option advocates have agreed to restrict the ability of people with existing employer-based coverage to opt-in to the public plan in order to protect private insurers from the risk of losing too much business.
The public option plan can provide immediate savings to consumers who select it by doing away with some of the excess overhead consumed by insurance companies. There won’t be any premiums diverted to profits or outsized executive salaries. Moreover, government plans such as Medicare and Medicaid have proven to be more administratively efficient than their private counterparts. More importantly, a large public plan will bring competition and market discipline to every corner of the country. Frankly, the theory is that with enough enrollees, the public plan will be able to act as a price-setter, and not merely be a price-taker. The public plan will not be authorized to save money by rationing access to needed care.
Miracles of cost-containment, bringing us into parity with places like Canada should not be expected, but it’s very reasonable to expect that we can knock a couple of percentage points off the rate of annual medical inflation: What the President calls “bending the curve.” The savings would go beyond members of the public plan, as private insurers would be forced to respond with their own efficiencies. You wouldn’t know it from stories that cast the public option as yet another costly program demanded by “liberals,” but the public option is actually the most significant cost containment feature in the proposal being considered by Congress.
Since our last stab at major health reform, we’ve added another decade’s worth experience to the decades that went before, all telling us that our current mix of insurance and healthcare arrangements is simply unable to control costs. Common sense demands that we try something different. The public option can bend the cost curve, while not disrupting the existing care relationships for people who are happy with their current coverage. It is an essential component of any healthcare reform package.
--------------------------------------------------------------------------------
Marks is a member of the New Mexico Public Regulation Commission, which regulates insurance through its Insurance Division.
--------------------------------------------------------------------------------
Copyright © 2009 by the New Mexico Editorial Forum. 10/09
MISSISSIPPI FORUM
By Lynn Evans
The latest polls on health care reform find that most Americans support it, but they are also confused about what is in the proposals currently being worked on by Congress. No wonder. The amount of misinformation floating around is enough to confuse a rocket scientist.
If the American public is feeling left out of the debate on health care reform, it just might have something to do with the $1.4 million per day being spent on lobbying this single issue by the drug, health insurance and other health-related industries. In addition, according to the Center for Responsive Politics, the health care industry has given members of Congress nearly $24 million in campaign contributions this year, on top of the $170 million they gave during the last election.
The drug manufacturers’ trade association, known as PHARMA, has spent more than $92 million lobbying Congress this year and is about to roll out a $150 million ad campaign to cut the discounts on drug products that are being planned to help reduce spiraling health care costs. Having enjoyed the largess of the Bush years, these companies are willing to spend big to keep their profits flowing.
Looking just at the committees that have jurisdiction over drafting the proposals that will go to the full Senate, the health care industry has given in excess of $13 million to the members of the Senate Finance Committee and more than $6 million to the “Gang of Six” who have been working over the summer on the Baucus proposal. As might be expected, the most money -- about $3.6 million -- is roughly split between Senator Baucus and the top Republican on the Senate Finance Committee, Senator Chuck Grassley.
When the Medicare Part D legislation was before Congress, an equally obscene amount of money was thrown at the negotiators who then somehow came up with a program that pays drug companies money to run private money-making programs to help seniors buy their products.
Polls show that most Americans support health care reform that includes universal coverage, some kind of nonprofit option, and paying for the changes with increased taxes on high income Americans and employer contributions.
Most Americans understand that when 46 million of their neighbors do not have health insurance and more are losing their health coverage every day, and when a health insurance crisis is the No. 1 reason for bankruptcy filings, that health reform is needed now. Most people agree we need regulations to make insurance companies play fair and cover people with existing conditions, and that the goal should be universal coverage – especially for children. Most people would like to keep the coverage they have but are afraid that, if costs keep going up, no middle class families will be able to afford private insurance coverage that would meet their needs. So, most Americans support tax credits and subsidies that will enable working families who really cannot afford health coverage to get it.
People are very confused about the public option, and fear it will take away from what they have, rather than make the kind of coverage Congress gets, available to everybody. This might have something to do with private health insurance companies’ fear that the competition from a public option might force them to cut administrative costs and shareholder profits.
It’s time to take back our government from the Big Money interests who are muddying the waters of the current debate. We have an out-of-control system now and the companies who are benefiting financially would like to keep it that way, so they are spending a lot of money to kill reforms Americans want, and need.
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Evans is a Jackson health care activist and writer.
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Copyright (C) 2009 by the Mississippi Forum 10/09
If the American public is feeling left out of the debate on health care reform, it just might have something to do with the $1.4 million per day being spent on lobbying this single issue by the drug, health insurance and other health-related industries. In addition, according to the Center for Responsive Politics, the health care industry has given members of Congress nearly $24 million in campaign contributions this year, on top of the $170 million they gave during the last election.
The drug manufacturers’ trade association, known as PHARMA, has spent more than $92 million lobbying Congress this year and is about to roll out a $150 million ad campaign to cut the discounts on drug products that are being planned to help reduce spiraling health care costs. Having enjoyed the largess of the Bush years, these companies are willing to spend big to keep their profits flowing.
Looking just at the committees that have jurisdiction over drafting the proposals that will go to the full Senate, the health care industry has given in excess of $13 million to the members of the Senate Finance Committee and more than $6 million to the “Gang of Six” who have been working over the summer on the Baucus proposal. As might be expected, the most money -- about $3.6 million -- is roughly split between Senator Baucus and the top Republican on the Senate Finance Committee, Senator Chuck Grassley.
When the Medicare Part D legislation was before Congress, an equally obscene amount of money was thrown at the negotiators who then somehow came up with a program that pays drug companies money to run private money-making programs to help seniors buy their products.
Polls show that most Americans support health care reform that includes universal coverage, some kind of nonprofit option, and paying for the changes with increased taxes on high income Americans and employer contributions.
Most Americans understand that when 46 million of their neighbors do not have health insurance and more are losing their health coverage every day, and when a health insurance crisis is the No. 1 reason for bankruptcy filings, that health reform is needed now. Most people agree we need regulations to make insurance companies play fair and cover people with existing conditions, and that the goal should be universal coverage – especially for children. Most people would like to keep the coverage they have but are afraid that, if costs keep going up, no middle class families will be able to afford private insurance coverage that would meet their needs. So, most Americans support tax credits and subsidies that will enable working families who really cannot afford health coverage to get it.
People are very confused about the public option, and fear it will take away from what they have, rather than make the kind of coverage Congress gets, available to everybody. This might have something to do with private health insurance companies’ fear that the competition from a public option might force them to cut administrative costs and shareholder profits.
It’s time to take back our government from the Big Money interests who are muddying the waters of the current debate. We have an out-of-control system now and the companies who are benefiting financially would like to keep it that way, so they are spending a lot of money to kill reforms Americans want, and need.
--------------------------------------------------------------------------
Evans is a Jackson health care activist and writer.
--------------------------------------------------------------------------
Copyright (C) 2009 by the Mississippi Forum 10/09
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