Something About the Public Option

Let’s face it: the battle for health care reform is really an effort to redistribute wealth.  There.  I said it.  And I condone it.  There is something about health care reform that is missing, like real reform.  Read this article:

We need to consider both parts of the formula for an efficient, fair and competent health care system to work: the users (patients) and the providers.  Both sides are beholden to the insurers, whose motives are not in sync with the needs of the patients or providers.  I hope against hope that this conversation is not moot as long as we have any remnant of our private health insurance industry in existence.  At least in this round of reform, we will still be left with the private insurers, the real fly in the ointment.

Nevertheless, with regard to this weak public option that will most likely be incorporated into reform, it might as well be thrown in the trash for all concerned parties.  To have a public option available to only those who are lower-income earners  would be a defeat before it is ever put into action.  By attracting only lower earners, the scope of the insurance will not be large enough, fairly competitive or adequately diverse to create a viable pool of insureds.  This weak public option would only be an extension of our already existing Medicaid program.  The neediest would get the worst possible health care.  This is a fact of capitalism.

A robust public option must be made available to all who desire to participate in such a program.  Otherwise, the public option will be a dumping ground for only the neediest of people with the most catastrophic illnesses requiring the most costly care.   Additionally, an unfair burden will be placed on individual employers to foot the health care bill.  This too, will have serious repercussions down the road for our economy.

If the public option is available for only the neediest, what effect will that have on our providers, i.e. physicians and hospitals?  Will they be able to retain the right to participate with only those insurance plans they choose to?  What about their participation in the Medicaid program?  Will they no longer have a choice in that matter?  Will they be required to accept all insurance plans, including Medicaid?  Besides the extremely low reimbursement rates of Medicaid, often not even covering the doctor’s own office expenses of time, medication dispensed and follow-up, the paperwork associated with filing Medicaid claims is overwhelming.  In addition, providers often have to wait months, if not a full year, before they receive the actual payment from Medicaid.  In the meantime, how are those providers meeting their payroll responsibilities, paying their utility bills,  making their monthly rent and keeping their malpractice insurance current?  Guess what?  They are not.  As a result, they will shut their doors forever.

Also, if these providers have no choice in participating with payers and therefore no control over their reimbursement schedule, who will fill our medical school classes seeing that the choice to become a practicing doctor does not include a decent wage?  More important, without a decent income, no one will be able to afford the debt incurred to attend medical school because one’s future earnings just will not cover those expenses.  Need I go on any further about the avalanche effects of a health care system that is not a single payer, government-sponsored program?

Will health care reform be just another noose around our medical providers’ necks?  A way to dodge the real issues of decent and reasonably priced care for all?  Me thinks the answer is “Yes”.  Unless we have ultimately universal, single payer coverage, there will always be an insidious class system inherent in our health care program.

The design of health care reform must offer equal benefits for everyone, while encompassing means-tested premiums.  Equal benefits with unequal fees is the redistribution of wealth that I initially spoke of.  Without equal access, equal care and equal reimbursement, our entire economy will suffer from these roller coaster effects.  The only true antidote is the single payer, universal plan.  Since there is no chance of that getting passed in this round of reform, the best we can hope for would be a precursor, i.e. a very strong public option.

We can hem and haw about the public option all we want, dither about the opt-out status of each state, talk about triggers, and try to pull the wool over our eyes about the extent and depth of the intentions and greed of private insurers.  Just today, Humana announced a 67% increase in profits for the first nine months of this year.  Do not be mislead by the much lower “net” earnings figures, as they are post-salary raises and bonuses.  Fifty to sixty per cent of those gross profits are going right into their executives’ pockets, not back into the system to pay for policyholders’ benefits.

I am no genius of public policy, but I do value the principles of foresight.  Where are these considerations for the future in the plans so far put forth?  It is a patch system we are offering when what is needed is an overhaul, a totally new model.  A weak public option will serve to create a permanent underclass of patients along with an exodus of providers.  This patient/provider double whammy of negative factors, these half-measured efforts, these useless tokens disguised as reform, spell failure for any health care improvements.   Until our lawmakers and policy wonks accept that health care reform is an entirely different animal than whatever it is we have now, every plan will fail.


Please visit my diary site at:  The ongoing comments and debate on that site are eye-opening and thoughtful.  Thanks.


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