2009.10.19 03:12:58

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Fact – over 46 million people in the United States don’t have insurance coverage. They include people who cannot afford paying the premiums, people who cannot find coverage because they have an illness or disease that precludes them from being covered, people who just lost their employment or are in between jobs and they cannot afford the expensive Cobra coverage, people who work for small businesses which do not offer coverage, people who work full time but are not offered coverage because of the nature of their job, such as a restaurant server, and people who are forced to have multiple jobs but each job is only part-time.

            In the proposals from both the House of Representatives and the Senate, there are plans to help such individuals. First, as a consumer protection measure, there will be much needed regulations to prevent insurance companies from “cherry picking” or selecting out only patients that are healthy, as in not covering patients with pre-existing conditions. If you have the money and belong to the uninsured group, you will be able to buy policies through a newly formed “Insurance Exchange”, which is like a shopping mall or marketplace for health insurance. The “Exchange” will be regulated by the government, which ensures minimal standards and rules so that these companies don’t cheat you.  Currently, the estimate is that, 83% of the population has some kind of insurance. With the formation of the Exchange where people can shop for coverage at an affordable price, that will increase to 94% of the population, meaning that more people will have insurance.

            Within the Exchange, there can be another type of Insurance plan that some people might choose instead of going with the available commercial plans. That is called a “Public Option or Public Choice Option”, which is a government-run insurance plan similar to the Medicare program that people over 65 years old have. Much of the brouhaha in the media that surrounds the Public Option has to do with the fact that it is a government-run program. The Republicans accuse the plan of being the beginning of a single payer system, and say that this is a slippery slope toward socialism and, by having an unfair advantage over the private insurers, it will ultimately drive the private companies out of business.  The Tea Party folks say that it is too expensive and it will contribute to the budget deficit. The House Bill “America’s Affordable Health Choices Act of 2009” H.R. 3200 has a provision for a public option. The Senate Finance Committee Baucus Bill does not have such a provision and 4 other Congressional Committees have a Public Option, including the Senate Health, Education, Labor and Pensions (HELP) Committee Bill. In addition to not having the Public Option, the Baucus Bill substitutes it with the alternative of having non-profit co-operatives as competition with private insurers. Most economists say that health co-ops are sheer fantasy, as they cannot possibly compete with the private sector giants to lower costs and win in the free market.  Because of the tremendous consolidation of the Insurance Industries over the last 15 years, most metropolitans in the United States are now dominated by just a few insurance cartels. For example, UnitedHealth Incorporated owns 29 health insurance companies or subsidiaries. Another example is Alabama, which is served by only one large company. The Greater Cincinnati has 2 large insurance companies that serve the majority of the market. The Greater Dayton and Miami Valley have UnitedHealth Care and Anthem Blue Cross and Blue Shield as the major players. The city of Philadelphia is the headquarters of CIGNA, yet, the 2 major insurance companies in that city are Aetna and Blue Cross: CIGNA cannot even compete in their own backyard, so you can forget about health co-ops. Most prominent economists, including the Nobel Laureate Princeton Professor Paul Krugman, believe that the Public Option must be part of Health Care reform to be competitive in the free market against the private insurers and to lower health care costs in the long run. The more recent Congressional Budget Office estimates that the House Bill HR 3200’s price tag would be lowered from approximately $1 trillion to $660 billion over 10 years if in includes the Public Option in its calculation of the costs. That’s $66 billion per year for a plan that would move toward universal health care for everyone. For comparison, the military budget is $600 billion per year on defense spending, and the Medicare program costs $500 billion per year to cover only people over 65 years old, which account for roughly 44 million Americans. If you ask me, in my humble opinion, $66 billion per year is chump change. For a health plan that promotes competition, drives down the costs, and helps expand coverage to Americans, we should all be for it, because we are on the right side of morality, of history, and it is a decent and good thing to have.

            Some lobbyists and anti-reform folks will say that the hand of the free market enterprise will wave and take care of the escalating health care costs by virtue of free competition. Over the past 10 years, the average premium for a family has risen to $13,375 in 2009 at a rate of 131% while the rate of increase for wages is at 38% and the inflation rate of 28%. This is a contradiction to the theory that free market drives down the costs. At this same rate, if nothing is done to change the health care system, the average premium for a family will reach $30,803 by 2019. That will be more than half the average annual income of a family in 10 years from now. That is just not acceptable and non-sustainable. Each year, the Wall Street Insurance Industries rake in over $200 billion in profits annually off the top. The free market has been very, very good indeed to the health care companies. This is why we need the Public Choice Option. Let your voice be heard in any which way you can, screaming, emailing, telephoning, so that your Congressman cannot be mistaken or not hear you, like our Minority Leader John Boehner. Representative Boehner, last month, went on the record saying that he has not heard or met anyone in his district that is in favor of the Public Option.  The last time I checked, more than 77% of the general population is in favor of the Public Option and 73% of physicians, recently polled, said that they are supportive of the Public Option. Could it be possible that tanning in a booth can be unsafe for one’s hearing or mind, Congressman Boehner? In contradistinction to Rep. Boehner, our esteemed Senator Sherrod Brown on Oct. 8^th, 2009, lead 29 other Senators in sending a letter to the Senate Majority Leader Harry Reid in strong support of the Public Option. We should all applaud Senator Brown for this bravery and join in an effort to contact Senator Voinovich (202-224-3353) to let him know that the Public Option is a good and decent thing for the society and humanity at large.

 

Donald Nguyen, MD, FAAP

Doctors for America

Health Care reform | Paul Krugman | Blue Cross | United Health Care | John Boehner | insurance companies | Senator Voinovich | Donald Nguyen | Doctors for America | Harry Reid | Public Option