12Nearly everyone agrees that the more than 50 million uninsured Americans are placing an enormous burden on the nation’s health care system. Understanding the pressures that uninsured citizens place on the overall health care system has prompted many advocacy groups to organize over the years. These groups generally agree on the desired outcome (health care for all, universal coverage etc.) but disagree on the particular means for achieving that end.
With health care reform, because of the complexities of current payment and coverage system, it is easy for some advocacy groups to try and advocate for an approach that, on paper, looks great and appears to have all of the answers. But these proposals often fail to take into consideration the impact they could have on the system as a whole and the providers of health care like hospitals and physicians.
On health care coverage solutions, this is the case. There are several groups who agree that the number of uninsured need to be reduced in America, but each of these groups has outlined vastly different methods of doing so.
The debate on this issue in Congress is shaping up to be, perhaps, the largest and most contentious battle this Congress will face this year.
Without a doubt, hospitals agree that when more people have health insurance both the patient and the hospital are in better financial shape. But the question that keeps coming back to the table is just how exactly would all of these different proposals work? And who, if anyone, has the right answer?
Below are samplings of the top health care coverage reform concepts outlined and supported by many advocacy groups. IHA invites readers to review the proposals listed below and share comments on which approach (or combination of approaches) would be the best solution to guarantee health care coverage for all Americans.
Single Payer:
A single-payer health care system is one, as modeled in some other countries like Canada, that would be the sole payer for health care as well as the sole provider for health insurance nationwide. Citizens would pay the government, which in turn would pay the health insurance claims. Advocates for a single-payer system like the Physicians For A National Health Program argue that that the advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.
Medicare-Like Coverage System:
Others advocate for an expanded “Medicare-like” or “Medicare For All” public health insurance option administered by the Federal Government. This type of program would be available to the uninsured and would use the existing Medicare program’s infrastructure. Potential pros would be that the current Medicare infrastructure is already in place and could be ready quickly to accept new enrollees.
State-Run System:
Another approach would give states the power to decide on methods aimed toward enacting universal health care coverage plans. One option would be for states to allow individuals to purchase coverage through the state employee plans, or provide comprehensive statewide health care reform as seen in Massachusetts.
Third-Party Administrators:
In the Senate Finance Committee Option Paper on health coverage reform, it was proposed that a public health insurance option be created where multiple government-run regional third-party administrators would provide coverage. These administrators would be required to establish networks of participating medical providers as well as payments for participating providers.
No Change:
Is there enough good (or potential) in the current system that could be used to argue against the need for massive reforms to the system?
IHA is eager to hear your thoughts and comments on the health care reform issue. Over the past several months, IHA and many other health care stake holders have been working with elected officials to help provide the hospital perspective on this issue.
Single Payer as Improved and Expanded Medicare for Everyone is the only reform that seems to be sustainable long term and ensures that we get everyone covered. that is the plan that gets my vote.
The idea that administrative simplicity will be achieved with single payer simply won’t materialize, as a federal system will require more bureaucracy to implement, will overwhelm the current system causing rationing of available supplies and care, and will ultimately increase costs. Medicare for all will not work without reform; it was just released last week that Medicare is going bankrupt, and sooner than anticipated.
A format that provides choice, allows people to keep their current coverage, but provides an option for the unisured is the most realistic way to provide services without causing costs to further skyrocket to accommodate a new system.
As a practicing nurse, I am compassionate to the needs of those with little or no coverage, yet I have seen firsthand how the current systems lack efficiency and do not always provide the intended benefits, so simply extending them is not the ideal solution.
Whatever plan is implemented needs to be done in a way that provides the maximum benefit for the minimum cost…not an easy task.
I think we should first (to rule out a state run program) take a look at how Massachusetts plan is working for them and what the outlook is? It is not good thus far. All of the other one’s involve government run programs. I think enough history is provided in the article alone to show how that system is working. I think things could stay the same with some education of comsumers. Why do we treat health “insurance” different than auto or home “insurance.” Well we don’t make claims on our auto or home unless it is necessary because our premium will go up. So what do we do (should we do) instead, we obey traffic laws and try to avoid making a claim. Homeowners insurance the same thing, can we fix it instead of making a claim. What do we do with health insurance “oh I have health insurance so I will go to the Dr. for the sniffles, or I can eat and drink whatever I want because my Dr can give me a magic pill to lower my HBP or Cholesterol.” We over utilize a system and complain because our premiums continue to rise. Why don’t we instead take some “self responsibility” and take care of our bodies, teach good eating habits, excersice etc and try to avoid running to the Dr. all the time. Does it remove it all together, no but it keeps costs down. Why do we have so many type II diabetics, it’s not a hereditary problem it is an overweight problem. We are trying to control the syptoms rather than attack the problem. With the nations philosophy on healthcare applied to the auto insurance world, we would essentially be driving around trying to get in accidents to be sure we are utilizing above and beyond our premium dollars. I think we should attempt to educate people about the importance of wellness and the understanding of insurance. Don’t replace something because the consumer abuses it, educate the consumer.
Great analogy! It is absolutely true that one of the reasons for rising health care costs is the failure of many people to assume responsibility for their own health. I am as guilty as the next person of wanting to go out to eat, not wanting to exercise, etc. But we have to do those things in order to stay healthy, and the unhappy fact of the matter is that there are no magic pills to fix things. We have made many advances in pharmacologic therapies, but any medication has potential side effects, and even if it helps to manage a problem, rarely is it “fixed”.
When considering options, let’s take a look at people/consumers complaints.
1. Premiums are too high.
a. Use it like insurance. When you apply for auto insurance they look at your background and can choose what to charge you and whether or not to cover you. Companies can’t choose what to charge you based on your usage, but if they did I bet you would think twice before you ran to the Dr. for something. If you are on a group plan they have no choice but to accept you reagrdless of your choices. I think everyone should have access to coverage, but if they could base your price on your health/usage I feel that people would make some different choices.
2. There are loop holes in the coverage
a. Know what you are getting into. Speak with someone you can trust. Use someone to obtain your insurance (individual) that has access to multiple carriers. Many plans are just as good or better than that offered by an employer, and once you are accepted you can’t be turned away because your health deteriorates, contrary to what many people think. Once again educate yourself.
When insurance is provided to everyone at the same price through the same plan and is less expensive than it is currently, where will they get the money for that program. Directly from working legal citizens of the USA. What about the people who don’t pay taxes or don’t work? Yeah we pay for theirs too. We are currently paying into a system that won’t be around for younger people to utilize, what will happen when the same people get a hold of this system? We must think long term for our children/grandchildren’s sake. Address the problem, we have a weak unstable economy what will happen when citizens who want the most technolgically advanced healthcare can’t get it because we don’t have the money to fund the new studies? Doctors move and change professions because they are getting paid the Medicare going rate, and can’t keep their offices open? What about the insurance companies, brokers etc go out of business in the insurance capital of the world? (Des Moines, IA) Who will people contact with claims issues, the government, I’m sure that will be easy to get through to, when everyone in the nation is calling. The only benefit would be that they will be hiring for people to answer the phones, which is good, considering all of the people who will be out of work.
As a health care benefits specialist with over 15 years of experience assisting individuals and employers select and enroll in the best coverage, I support smart reform that will lower costs and improve access. That means, for example, providing tax credits for individuals who need to purchase their own coverage, thus reducing the overall cost and reducing the number of uninsureds. I also support tax credits for employers who wisely choose to implement wellness programs for their employees, so we can deal with the demand side of the equation.
Regardless of which path reform leads us, we must preserve the role of the number one consumer advocates we have–the health care benefits experts who help their members both before and after a sale! A website or–God forbid–the government, could never replace their expertise.
BTW, no state will be hurt worse than Iowa by a public plan based on Medicare reimbursements. Medicare is what is killing the priviate sector today–because providers (especially in Iowa) do not get reimbursed enough to cover costs for Medicare patients–so they shift costs to private payers. Most reliable estimates suggest that every person with private innsurance pays an additional $1,500 per year just to cover Medicare shortfalls. And if a public option is based on Medicare, most rural hospitals would have to close…not a future we want.
Health Care should be a right and not a priviledge…and health care dollars should NOT go into the pockets of insurance companies and their shareholders. Currently health care providers are spending significant amounts of money for staff who are responsible for dealing with the specific hoops each insurance company requires them to jump through. Single payer is the only way to make significant change. Will some individuals (those few with excellent insurance) have less access than they do now? Of course. But other developed nations with single payer have more positive health outcomes in general (ie., lower infant mortality rates), and as a country we need to look at what’s best for our population in general.
Before we go to a single payer – I’d suggest everyone talk to individuals from Canada who are unable to get in for elective hip surgery for very extended periods, or are unable to start chemotherapy for months, and can not get a colonoscopy in a timely fashion to make a prompt diagnosis in order to receive prompt care. Health care in Canada has a lot to be desired.
The true cost of Medicare is not reflected in the off-quoted 3% administration fee. Further, all provider types and hospitals, clinics, ASC’s etc have been the method of holding down costs while politicians gin up the benefits to get re-elected. It is true that health care costs are too high, but the current administration’s proposal will not lower costs. Further, statistics do not accurately reflect reality. For instance, where does 50 million Americans without health insurance come from. This figure includes illegal immigrants, and so it would be more appropriate to state the number of individuals rather than citizenship status. Additionally, another 50% have health insurance sometime, i.e. they are in between jobs and so lack health insurance for 2-6 months. Perhaps longer now in the current economic climate.
The infant mortality rate was mentioned but other countries do not count all premature births as an infant, and therefore skew the prevalence. The U.S. also has one of the highest rates of teen pregnancy which is often associated with an increased infant mortality. If true comparisons are reviewed, health care outcomes are not more positive in other countries, but we pay a great deal more because of our access and utilization of PREMIUM health care. For instance, the U.K. recently closed 19 NHS hospitals because of lack of funding, and the major oncology service merged with a private cancer hospital. They are trying to keep up with the U.S. and outcomes will decline when the U.S. no longer drives progress.
So if one presumes health care costs are too high because providers are charging too much, then punish the providers by reducing payment (reimbursement). The Medicare system has already attempted to do this, but while politicians increase benefits and seniors increase utilization even as the number of seniors increase, the cost has never been constrained. Further pediatricians, internists, family practicioners, nurses and other providers are finding it increasingly difficult to have reimbursement which doesn’t keep up with the cost of running an office and paying employees. Thus rural medicine areas with minimal or no diversity of payors (only have Medicare) cannot continue to remain in small or solo practices or provide call.
Health insurance could cost significantly less is it was utilized as INSURANCE (which is intended to cover rare or infrequent occurrences), not every provider’s visits. Numerous non-partisan health studies have proven unequivocally that with an individual does not pay part of the cost of care, access is greatly increased, i.e. over-utilization.
The government has a tremendous role in what it does best–prevent fraud, insure the poor are receiving care, and provide transparency. Consumer protection should be enhanced, individuals should be able to purchase health insurance across state lines and the mandated state benefits that drive up premiums eliminated. If individuals were given tax preferential treatment, with tax credits for low income, we could gradually phase out employer sponsored health insurance which would allow it to be PORTABLE and then you could “fire” your health insurance company rather than asking for your employer to appeal to the company, which it is unlikely to do.
The issue is very complex and I do not type fast enough to address all the facets. I will say however, that my participation in the health care system in the military, as a nurse and a physician both in academia and private practice, affords me an inside viewpoint most people don’t have. With a sister living in the U.K and friends in Canada, I know that our country can come up with a better system rather than emulating the failed policies of these single-payor countries. We have all the talent and ability to have a system that is accessible to everyone, affordable, portable and encourages personal responsibility for wellness through premium reductions and other “carrots”and will still let us innovate and develop technology and cures that we have not even begun to dream.
I have not heard any comments about commercial insurance. I think they are part of the problem with health care issues. The contract with a hospital for reimbursement at a certain percentage so the hospital raises rates to make reimbursement more. Meanwhile the patient is paying 20% of the whole amount and insurance is paying only a percentage of the 80% they will reimburse for. Then the uninsured is paying higher prices for medical care. (The same goes for Medicare) There should be some control over the commercial insurance companies. You pay a good premium and the coverage is always less and less and the deductables (which are foolish anyway) are more and more.
I am worried about government controlled health care because the regulations are made by people who are not out with the working class citizens. It is easy for someone with an income of $1 million dollars to make regulations for incomes less than $100,000.
And how many senators and representatives are aware that there are providers that will not see Medicare or Title 19 patients.
Sincerely,
Elise Kukuzke
Imaging Manager
Marengo Memorial Hospital
Marengo, Iowa 52301
First, we need to consider whether Medicare is fair to Iowans. The answer is no. Iowans receive less per patient benefits. So, for Iowa, expanded Medicare is NOT the right answer.
Everyone needs to be covered, but people should not be forced into coverage they do not want. Whatever happens, consumer-driven healthcare plans should be a part of the mix.
So far this whole debate has focused on trying to fix a perceived problem from the back side. What needs to happen is to evaluate all of those things that have contributed to arriving at this point. We need to start with the entitlement mentality and scrap the idea that healthcare is a right. There is no constitutional authority for spending tax revenue on healthcare of any kind. We need to look at the reams of regulations that govern our daily lives and ask the question; “Does this provide value to the delivery of health care?” We need to look at TORT reform and patent laws and frivolous law suits and FDA rules and OSHA mandates. All of these things that politicians have done have created the environment for sky high health care costs. We also need to hold people accountable through the use of high deductibles/co-pays etc. If ALL people are required to pony up some of their hard-earned money to pay for their over-utilization, they will think twice about abusing the system. If we insist on an entitlement, then needs test it. Why should we pay 3/4 of the medicare premiums for the Vanderbilts or Kennedys? They can afford to purchase private insurance. Finally, in regard to the single payer system, this government has proven that it cannot efficiently administer a 3 billion dollar “cash for clunkers” program and we want to trust them to efficiently administer a sytem in charge of more than a trillion dollars?? Ludicrous to say the least.