- Did you know that "Mandated Health" is already a failure...?
- Which was the first state to enact a universal system?
- Who is Rube Goldberg and why is he designing my health care system?
If you said Massachussetts you'd be only half wrong...
Those of you who have been working on health care reform for many years likely came up with Hawaii. Yet you don’t hear much anymore about Hawaii’s universal system. Why is that? After all, soon after the enactment of Hawaii’s health insurance law, those lacking insurance dropped to 2 percent. Following "success" in Massachusetts, we are hearing about mandated plans from governors in California, Pennsylvania and New Jersey. Surely Hawaii should be touted as proof that Mandates work? Surely Massachusetts is well on its way to success...?
While Hawaii's "Prepaid Health Care Act" required employers to provide health insurance for employees working twenty hours per week or more, there is no such requirement to provide coverage for employees working less than twenty hours per week. On top of that increasing health care costs, insurance premiums, employer costs, prescription drug costs, long-term care costs, together with the growing number of uninsured individuals, and inadequate Medicaid reimbursements have led to uninsured over 10%... and unmangeable costs.
Ah... but that is old news. Surely the brilliance of bipartisan compromise (always a good thing, right?) in Massachusetts must have led to their mandated plan being a runaway success?
Uhhmmm... not in the real world, once they actually got down to the details reported reported the Boston Globe:
A state panel yesterday outlined for the first time the minimum requirements for coverage under the state’s new health insurance law, a package estimated to cost $380 a month on average for an individual.
Panel members struggled yesterday to balance affordability with protection from catastrophic medical bills and remained divided on many issues.
"If we’re going to mandate this, people need to see that they’re getting some value," said panel member Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology. But, he added, the premium is "bad news."
"I’m trying to think of something to get this number down," he said.
The minimum plan would limit annual out-of-pocket expenses to $5,000 for an individual and $7,500 for a family and include prescription drug coverage, according to the proposal by a subcommittee of the Commonwealth Health Insurance Connector board, which is implementing the new law.
As proposed, deductibles would run no higher than $2,000 per individual and $4,000 per family.
Advocates for the uninsured were stunned at the price, considerably higher than the $200 estimated by Mitt Romney when he was governor and first proposed universal coverage. A spokesman for insurers said the requirements were too prescriptive and could undermine the goal of universal coverage.
"For a large proportion of the folks not eligible for subsidized care, the bare minimum plan is flat-out unaffordable, not only because of the premiums, but the deductibles and out-of-pocket expenses," said John McDonough, executive director of Health Care for All, an advocacy group that supports the health law. "This is a significant disappointment. We think the Connector and particularly the insurers need to go back to the drawing board."
Eric Linzer, vice president of the Massachusetts Association of Health Plans, said the Connector committee’s recommendations were boxing insurers into a corner.
"There’s really a limited number of ways you can make premiums affordable," he said. "If the minimum credible coverage is too high and coverage is unaffordable, it runs the risk of not achieving universal coverage."
Romney won't have this Massachusetts miracle to fall back on. Requiring each person to purchase a private health plan (individual mandate), "works" only if the plans were affordable. Mass also decided that the plans must meet a reasonable standard of coverage. So what did they do? They declared that the plans would have to meet a reasonable standard of coverage and that they would have to have low, affordable premiums. And they decided to do this via fragmented risk pools and the existing plethora of private for profit insurers.
It was not as if this fundamental flaw in their proposal was simply overlooked. Many pointed out that you can have insurance premiums that are affordable, or you can have coverage that makes health care affordable, but you can’t have both. Health care simply costs too much. To be effective, the fragmented private for profit insurance pools must have adequate funds to pay reasonable health care costs. That means that the private insurance funds must charge high premiums to fund them. Simply declaring otherwise is not reality based.
California Gov. Arnold Schwarzenegger plans to copy the Massachusetts reform in shrinking the numbers of uninsured people by forcing them to buy stripped down, bare-bones policies.
With premiums for family coverage now averaging $10,000 a year, the only way that states can make premiums affordable is to strip down the plans, which then forces policyholders to pay out of pocket when they get sick. High deductibles, co-payments and benefit reductions are destroying the financial protection that insurance should provide.
Half of U.S. bankruptcies are a result, in part, of medical illness or medical bills. Three-quarters of Americans who are forced into medical bankruptcy had health insurance at the onset of the illness that bankrupted them. Worse, suffering and death can occur when patients cannot afford the care that their private insurance does not
The big winners in the Schwarzenegger and Massachusetts health plans are private health insurance firms. The new insurance mandates will hand them billions in wasteful administrative fees that do not occur in government insurance programs such as Medicare. Private insurers will continue their cream-skimming, enrolling primarily the low cost, healthy workforce and their families, while leaving the costs of the unprofitable sick and elderly to the taxpayers.
State health programs are interdependent on federal programs such as Medicare, Medicaid and the Veterans Affairs' system, and are regulated by federal laws. The states alone cannot enact the structural changes that would be required to cover everyone and control costs. They are limited to building on the existing system by tweaking it to nominally expand coverage to the uninsured.
Total dollars are not the problem. We already are spending enough on health care to provide high-quality, comprehensive services for everyone. But our inefficient, private-sector insurance bureaucracies have failed and need to be replaced with single-payer national health insurance. Every other developed nation has covered its citizens through some form of non-profit national health insurance.
Here's the part I don't get: With all the actual programs out there... the various real world systems in place throughout every other country in the developed world, why do some in the U.S. keep insisting on inventing new and untried Rube Goldberg systems of care?
Only by including the healthy and wealthy in the same universal pool... Only by tapping the saving available by moving from the combined 31% overhead & profit extracted by the for-profit sector to the 4% of the public sector (e.g,. Medicare) ...can we provide universal care without increasing overall costs!
- Only Single-Payer, such as the easy to explain, understand and sell "Medicare for All" makes economic and social sense
- It is easily understood. people have heard of Medicare and it has wide support.
- Uses single existing bureacracy to administer. Don't need to create something new, just expand existing.
- Actual expansion is less than people think since if measure is acutal health care use, visits to doctors and hospital, then over 65 and/or disabled is proporationally more than general population; and same agency CMS, also already administers federal part of Medicaid which takes care of lots of kids.
- Simple description, eligibility for Medicare is now at birth instead of at 65.
- Still have competition at the DELIVERY side of the equation.
- No it is not "socialism" or "communism."
- Hospitals, doctors, health centers, clinics, even regional provider groups (e.g,. Kaiser, Puget Sound or other HMOs in the original sense of the word), still compete to attract patients, deliver care on the basis of quality, patient satisfaction, convenience, whatever.
- People still have choice. They still choose which provider to go to, who gets there service.
- The percent of costs going to care goes from 69% (current private sector) to 96% (current Medicare), which more than pays for making the coverage universal. I want 96 care not 69 care!
- Because have single nationwide pool, there is no skimming of the health & wealthy. True spread of risk. True purpose of insurance.
- Because one insurance bureacracy it is simpler, and easier and cheaper for everybody... for the patient (people) and for the providers (doctors, hospitals, etc.)
- Make every other business except health insurers happy by relieving them of the burden of health care.
- Separates care and insurance from job, employment and employers.
Spread the word...
Here is what you can do now:
Rep. John Conyers has reintroduced HR-676 this year. The bill garnered nearly 80 co-sponsors in the last Congress, more than any other reform proposal, and at least three of the newest members of Congress made support for single payer national health insurance a key issue in their campaigns. Senator Kenneday has been the Senate sponsor in past years. 225 Unions including 17 State AFL-CIOS have endorsed it, as have many other civic and religious organizations.
Ask your congressperson to sign-up as a co-sponsor of HR-676!
You can look-up your elected officials here
Just do it!