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A religious conversion: I don't think so

Fri, May 29th, 2009
Posted in Commentary

This week the American Health Insurance Plans organization (insurance trade organization), along with 5 other health care groups, notified the administration they were on board for healthcare reform. The one caveat they have notified the administration of is, there should be no public run or government insurance plan. They didn't have to fight against a one party payment system the politicians took that off the table before the medical-industrial consortium could get to it.

Medicare for all is, of course, a one party payment system with the advantage of dictating payments to all healthcare entities. Obviously, Medicare payment procedures are the most effective and efficient way to control costs. Costs are, after all the major reason to do reform.

You can talk about access to medical care. You can talk about the effectiveness and appropriateness of care. You can talk about statistics and rankings of care all you want but if the care was affordable there would be no impetus for reform.

The rest is beyond most of the politicians' ken. If the last 10 years have taught me anything it is that the best and brightest (especially when it comes to anything remotely connected with science) do not decide to go into politics.

There is so much still wrong with the direction this reform is taking one has to limit it to narrow bites so you can chew on it long enough to make any sense at all.

Let's just take on the public insurance policy controversy. This is apparently a deal breaker for most of those now promising restraint they could have had for the past 30 years.

The insurance people, and some politicians, who seem less concerned about 125 to 130 thousand people who, in good times, enter bankruptcy due to medical bills than they do for insurance companies, claim any government sponsored health insurance plan would be unfair competition for the for-profit insurance companies.

These are the same people who lobbied for or voted in Congress for supplemental payments for Medical Advantage Plans. These are the for-profit insurance plans that were to show Medicare how to save money because of their efficiency and innovation and ended up costing initially 11% more than standard Medicare in 2003 and upward ever since. This year Medicare will pay 17 %more than standard Medicare on average to these plans for each person covered. This year alone this will amount to 11.4 billion dollars more than if everyone was in standard Medicare. Corporate welfare personified. This has been going on for years. It was supposed to be "phased out" over ten years. The question is why does it take ten years?

The public plan will most likely finally give the for-profits some competition. I thought the free unfettered market guys were all for competition. Let them compete then. If they fail they fail and will not be mourned by those who have been paying exorbitant premiums for too little coverage.

Public insurance plans have a much better history of reining in costs. Between 1997 and 2007 costs and benefits in Medicare rose 4.6% per year while costs in private plans rose 7.3% annually. Medicare has pioneered quality controls and payment methods later adopted by the insurance industry. A public plan is necessary to provide a template of benefits and standards so that citizens can compare and make the best choice for their families. A reasonable benefit benchmark is sorely needed by the insurance industry.

The competitive edge the public plan will really have is that only hard headed free marketers will trust the insurance companies. The public plan will be portable and not tied to a job you may hate, that is outsourced, that time and tide passes by (buggy whips) or that some idiot runs and your job just goes away (GM/Chrysler).

You will be able to take the plan with you wherever you move in the U.S. and possessions.

You will probably be in the largest possible risk pool. When people find out it is run as efficiently as standard Medicare people will flock to the plan.

Two things have become clear with the developments of the past few months. The medical-industrial complex knows they have cooked their own goose and reform is likely inevitable. They hope to channel any changes into a veiled status quo. Failing that, each segment hopes to steer the reform so that others make all the sacrifices.

Secondly, they know Medicare is more efficient. More efficient not only in controlling cost (actually the only entity to partially control costs) but in paying physicians and hospitals rapidly in a transparent fashion. They understand a public insurance plan would be true competition for the first time in a long time. If no public insurance plan is included in the final reform it will be a betrayal to many people who voted primarily for healthcare reform.

Healthcare reform may still turn out to be smoke and mirrors.

Dr. Robert Sauer of Preston is a retired family physician. He can be reached at news@fillmorecountyjournal.com

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