Waving the White Flag

Written by: CorinneAM on Apr 24, 2009 1:26 PM EDT

EJ Dionne writes in a Washington Post op-ed yesterday:

But negotiations over health care will involve give-and-take. What if including a robust public plan has the effect of dooming a bill that gets affordable health insurance to everyone? Should public-plan advocates block any bill that doesn't contain their idea, as originally conceived? Of course not.

This is precisely what EJ Dionne and most healthcare reform commentators (including, it seems, those who post here at BFA) want the debate to be about: Whether reform advocates, single payer ones specifically, should take an all-or-nothing approach, or whether they should work toward reforming the system as long as it doesn’t drive private insurers out of business.  For example, one possible compromise being floated is a new government-run insurance program that would come into existence only if certain conditions were met - if, for example, private insurers failed to rein in health costs by a certain amount after several years.

I’m using Howard’s flamethrower: Anything that doesn’t disrupt the status quo is a waste of time and money.  We don’t have years.

I agree with Dionne that single payer healthcare will not make it through on the first cut.  Failing that, what will I support? Everyone in, nobody out: A strong public option with intense regulation of for-profit insurance.  While the devil is in the details, that, I think, is the only way a hybrid system will work.

You will hear that features such as guaranteed issue (you can't be turned down for pre-existing conditions), community rating (they can't charge you more because you're sick) and premium subsidies (just like in Massachusetts) are important to reform.  Unfortunately, none of those measures control health care spending, and whether they result in increased access is open to debate:

ER visits, costs in Mass. climb

Questions raised about healthcare law's impact on overuse

More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.

Visits to Massachusetts emergency rooms grew 7 percent between 2005 and 2007, to 2,469,295 visits. The estimated cost of treating those patients - including salaries for caregivers, tests such as X-rays and CT scans, and medicines - jumped from $826 million to $973 million, according data provided to the Globe. […]

Several physicians and policy makers said the state information, along with other new data from Harvard researchers, suggests that emergency room crowding and rising costs will not be solved by providing people with health insurance alone, despite optimistic talk by politicians who advocated for the law.

What is needed, they said, are more primary care doctors and nurses, and a new payment system that encourages intense monitoring of patients with diabetes, asthma, and other chronic illnesses.

If we’re going to retain the for-profit insurance system it needs intense regulation to eliminate the micromanagement of medical care.  Insurance companies have been reaping billions in profits by denying people care and coverage. While the industry reps, like AHIP, have taken somewhat of a conciliatory tone, opposition remains to the idea of a government-run plan, arguing it would end private market insurance.

However, they may have no choice since private plans are losing members as more and more people lose their jobs.  Yesterday's Wall St. Journal reported that "the rising unemployment on health insurers' membership rolls reinforces what analysts and economists say is all but certain: that the number of uninsured likely has risen...adding urgency to the Obama administration's health-reform efforts."

Time is of the essence and we have one chance to get it right.

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