Thursday, June 04, 2009

Health Care Fantasy -- The Public Option

When I studied the actual plans for health care reform in the Congressional pipeline I was disappointed. It is clear that the insurance industry is so firmly entrenched in Washington politics that any noises from the single-payer people are as unnoticed as sneezes at a football game. I came away resigned to the idea that single-payer (obviously the quickest, most cost-effective way to reduce costs) will have to wait until American health care gets so financially obese that even the most selfish of Washington politicians can no longer be in denial. Something like how the UAW, after driving two of their three cash cows into bankruptcy, finally "got it."

The only bright spot I found was something called the "public option," a government sponsored insurance alternative to private insurance. The insurance industry is terrified of any such plan, of course, because even at its most fiscally irresponsible, any government plan would easily undercut the private sector because there would be no need to pay executive bonuses, profits to share-holders or, of course, taxes.

And that's just a change in paperwork. Imagine how much could be saved if the government actually got into the business of DOING health care on a more widespread basis than the already vast network of military medical professionals and the Veterans Administration's hospitals and local private-sector affiliates.

This morning Maggie Mahar posted news of a hopeful signal from the White House. Her headline was President Obama: “I strongly believe that Americans should have the choice of a public health insurance option”.

In a letter to Senators Ted Kennedy and Max Baucus that the White House just released this afternoon, President Obama spelled out his vision for health care reform, making it clear that he wants a public sector alternative to private insurance: “operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”
In his letter, the President also stressed that “reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care.” He then points to the large multi-specialty medical centers, where doctors work on salary, that HealthBeat has pointed to as models for learning how to provide more effective care at a lower cost: “ That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”

Go read the rest of her post. She will write a fuller commentary later.

Meantime, I was hit with a fantasy and left the following comment at her blog.

As Pacino might say, "HOO-Waaaah!!"

This is great news. After witnessing the casual manner by which the president tossed a few other things into the pile, then pulled back and let Washington politics have its way, I was afraid he might do the same with health care reform. Maybe not.

When I studied the actual proposals in the pipeline at the Kaiser comparison site I came away with the impression that the insurance industry had everyone in Washington by the family jewels. Proposals to "insure" every citizen, no matter how poor or currently ineligible, with tax money underwriting the whole enterprise, has the insurance companies salivating. Why should they care who they insure as long as Uncle Sugar picks up the tab? Actuarial tables don't lie, and the more public they are the better insurance companies look. ("Hey, all we're doing is figuring out a financially reasonable way to cover everybody. We don't make the charges. All we do is manage this grand new risk pool. Don't pick on US!")

I imagine a well-run, cost effective public plan, operated out of community clinics, VA hospitals and military dispensaries with paid professionals (yes, even PCP's and specialists). Such a system could still outsource lab tests, imaging, even CT's, and still deliver top-quality health care at a fraction of the costs of the current health care land yacht version of a gas hog.

The professionals would be in the loop for any new best practices as they develop and the drug companies could be brought to heel at the same time.

Compared to most community health care non-systems, the VA and military systems are models of fiscal excellence. It's been forty-five years since I was drafted to become an x-ray tech in the Army Medical Service Corps and I saw how that worked from the inside. I'm sure today's system is radically different and far better, but the basic idea was excellent: professionals were paid according to grade (officer ranks) but that was only the base. Added to that might be "professional" pay + "overseas duty" pay + "hazardous duty" pay + whatever it might take to recruit and retain needed services. No, it wasn't fee for service because that doesn't make any sense when patients have no means or "private insurance" for fees.

This is all a flight of fancy on my part. I expect nothing of the sort will come to pass, but I had to get it out of my system. It comes from seeing too many Michael Moore films. Now back to your regular scheduled programs.

Addendum, a few minutes later...

Little did I know as all this was coming together that a similar discussion was already under way at The Health Care Blog.

Should We Open the VA to All Comers?

Perhaps the idea is not as far-fetched as I imagined.

1 comment:

Hoots said...

Maggie Mahar's reply to mine at her place...


I am as thrilled as you are.

Obama is good at standing back, keeping quiet, and letting people flail about.

Then, in a quite, calm voice he says: "I feel strongly about the public sector option."

What he is thinking is this: "We won." We don't have to compromise on something I feel strongly about.

He is not going to buckle to please lobbyists.

And I don't think that he will let Congress water down the public option so that it isn't "too competitive."


Sure hope we're right.