What bipartisan health-care reform could look like

In response to John D. Ondich’s letter, “Put aside petty politics to fix U.S. health-care issues,” I would like to offer a few specific examples of what bipartisan reform to our national health-care system might still look like. As long as there are federal regulations of health-insurance companies in place (a Democratic idea), allowing people to buy insurance from across state lines (a Republican idea) shouldn’t be too problematic.

Regarding Ondich’s preferences (a Democratic one) for a public option such as Medicare to be available to all, I would support that option as well. To make this bipartisan, all one has to do is recognize that the Affordable Care Act (ACA) was based on a conservative, Republican idea first posited by the American Heritage Foundation in 1989 and supported by Republicans throughout the 1990s. It should also be noted that the state exchanges, mandates and government subsidies are still consistent with Republican goals. Consider simply how they are part of Republican Paul Ryan’s current plan for reforming Medicare. Perhaps we need to improve health care with a single front: exchanges for all, as long as those exchanges include a public option.

American health care is certainly large enough and complex enough for reforms to come from lots of different places, people, and even competing political ideologies and parties. There is no reason that health-care reform should, or is likely to, end with the ACA.

If we start with a common goal of making American’s health care better, cheaper, faster and fairer, we will see virtually no end to the possibilities of how that can be done. All that is required is the political will to make it happen. Political will starts with elected officials working together — and that begins with the people telling them to do just that.

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Comments (7)

  1. Submitted by Todd Hintz on 12/03/2013 - 04:34 pm.

    No no no no no.

    No, this plan will not work. And here’s why.

    The public plan can’t be AN option on an exchange; it has to be THE option. The ONLY option. Why? Because that’s how insurance works. Insurance works by having a pool of people pitch in money in case of a crises. You pay in today even though you don’t have an emergency today. The fee you paid instead goes to someone else whose had, say, a car accident. Tomorrow you may be the one with that accident and her or his premium will go to offset your costs.

    Pretty simple so far. But here’s where Mr. Schuster’s plan falls apart. With an exchange you take the pool of insured people, the American public, and divide it into smaller pools. That just drives up the premiums for everyone. You want that pool to be as large as possible so it drives down the average premium as far as possible. Currently we have exchanges that just allow in-state insurers to participate. Opening it up to other insurers will just make that coveted pool even smaller. They’ll simply pick the most profitable pools and dump the least profitable ones on the public option. In other words, they’ll grab the healthy people and leave the chronically sick and injured.

    What happens then? The public option becomes insolvent and people point at it and say “tsk tsk tsk… Government can’t do ANYTHING right” when the real issue is the program was stacked against the public option from the word go.

    Then people will say “gosh, if only we had anticipated that problem before we went down the road of creating these exchanges in the first place.” Who knew?!

    Now this isn’t to say there is not a place at the table for private insurance companies and exchanges. Just the opposite! The government option is there to provide a basic level of service. If people want additional benefits, access to luxury hospitals, or doctors who charge a premium for their care, then they can buy supplementary insurance on the open market. But basic health care should be a basic right, just like clean air, clean water, and electricity.

    An open exchange though? That’s a disaster of the first order.

    • Submitted by Dan Landherr on 12/03/2013 - 04:57 pm.

      Not understanding the size of the pool advantages

      Assuming people enroll randomly at some point an insurance pool becomes large enough that adding more people doesn’t really change it’s characteristics much. The pool regresses to the mean.

      At the moment the poor and the old are in the government plan (Medicare/Medicaid) and working people are on the market. Adding those people to the government plan just shifts the costs from the working person’s tax bill to their health insurance bill. Working people are paying the costs for the poor and the old either way.

      There are advantages in overhead by having everyone in the same pool but there are also disadvantages when it comes to innovation delivering services. In order to get costs under control we need to decrease overhead AND change how we deliver health care.

      • Submitted by Todd Hintz on 12/04/2013 - 07:38 am.

        Open Market

        Dan, your argument falls apart with your opening sentence: people won’t be distributed randomly among all the available plans. Insurers will simply cherry pick the most profitable (as in healthy) clients and dump the expensive patients on the public plan. The alternative is they’ll simply offer plans that look cheap on paper, but are essentially junk when the customer tries to get a benefit out of it. That’s exactly what we’re seeing now, which is why Obamacare bans certain plans and why we have Medicare in the first place.

        You also inadvertently help make the case for a universal plan when you mention that working people are on the open market. The huge elephant in the room are the people who aren’t working, are self employed, or work for a company that doesn’t offer health benefits. The open market only services people who work for a large employer as the rest can’t afford the outrageous premiums.

        Here are just a few advantages of a universal single payer system that come to mind before I run off to work.

        -Less paperwork for the doctors and hospitals. They only have one plan to administer.

        -A network that includes all hospitals, clinics, and doctors. No more hunting around for a specialist that’s in network as all practitioners are in network.

        -Less overhead. Government run programs have a fraction of the overhead of private insurers.

        -No profit. This automatically takes the profit margin out of the system, which needlessly drives up costs.

        -It eliminates 2/3 of the bankruptcies in America.

        I’m sure with a little digging through the right tubes on the interwebs we can find a lot more compelling points to go with the ones above. But for now it’s time to catch a bus, earn a paycheck, and hope I don’t get sick even though I have “good” private health insurance.

        • Submitted by Dan Landherr on 12/04/2013 - 10:45 am.

          How do they cherry pick on the exchanges?

          Are you talking about health care as it was or as it is beginning next year? I don’t think plans can deny for pre-existing conditions any longer. There are subsidies now to make insurance more affordable. The poor have expanded Medicaid programs.

          I agree that single payer can reduce overhead. The plan you proposed would allow for supplemental insurance that would mitigate those savings by adding paperwork and bureaucracy. Unfortunately Medicare for all (pay for service) would also kill innovation in health care delivery. Hospitals must be incentivized to deliver high quality care for lower cost. Medicare for all would take the profit out of the insurance companies but not the hospitals. I’m not sure that profit incentives for hospitals are all bad but the current incentives are broken.

          • Submitted by Todd Hintz on 12/04/2013 - 01:41 pm.

            Reform

            I’m talking about health care as it was, is, and is being proposed in the opinion piece above. It’s ridiculously easy to get yourself out of a market you don’t want: just price the product higher than the next guy. I saw exactly that happen with my car insurance years ago. Every six months my premiums kept going up a little bit, even though I didn’t have any accidents or tickets. At first I just marked it up to inflation or market forces, but after a few rounds of this the price swing got to be so great that it prompted me to do a little shopping around. It turns out the competition was much cheaper. Why? Because my insurance company wanted to get out of the consumer market so they could handle just the more profitable business market. So they jacked prices until the consumer side of the business evaporated.

            The incentive side of the equation is easy to deal with. Currently hospitals and doctors are paid based on how many procedures they do. I’m sure everyone except the doctors will agree that this is a broken system as it simply encourages doctors to do more procedures, regardless of whether or not they’re in the best interests of the patient.

            Fortunately the solution to that is a slam dunk: switch to outcome-based medicine. What that means is the doctors are paid based on how well their patients get. If someone comes in with a disease or injury, can the doctor get them healthy and keep them out of the hospital? Too often these days doctors just treat the symptoms rather than the underlying condition, which means the patient just ends up back in ER next week when their problem gets worse.

            Now this isn’t to say that doctors won’t scream bloody murder about the new system. To them it means a new way of doing business and people hate change if for no other reason than it means a lot of work. It’s a whole new incentive program and they’ll be nervous about what impact it’ll have on their bottom line. But if we’re going to be serious about health care reform then, like universal single payer, this is a necessary item to the mix. One or the other is not going to cut the cake.

      • Submitted by Susanne Wissink on 12/04/2013 - 07:57 am.

        Reminds me of an old joke

        “Assuming people enroll randomly.”

        A physicist and an economist are stranded on a deserted island with absolutely nothing except a huge pile of canned food. The economist says, “Let’s assume we have a can opener.”

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