Friday, April 10, 2009

More on More Healthcare

A friend of mine who is a doctor who is working very hard with a group called Physicians for a National Health Program sent me this information on the universal healthcare information that I wrote about before. Doctors from all over the country are working very hard to encourage the administration to consider an effective healthcare policy that would serve all Americans. The information that she sent me is this:

Health Policy Q & A with PNHP Co-founders Drs. David
Himmelstein and Steffie Woolhandler

Should PNHP support a public Medicare-like option in a market of private

PNHP should tell the truth: The "public plan option" won't work to fix the health care system for
two reasons:
1. It foregoes at least 84% of the administrative savings available through single payer. The public
plan option would do nothing to streamline the administrative tasks (and costs) of hospitals,
physicians offices, and nursing homes. They would still contend with multiple payers, and hence still
need the complex cost tracking and billing apparatus that drives administrative costs. These
unnecessary provider administrative costs account for the vast majority of bureaucratic waste.
Hence, even if 95% of Americans who are currently privately insured were to join a public plan (and
it had overhead costs at current Medicare levels), the savings on insurance overhead would amount
to only 16% of the roughly $400 billion annually achievable through single payer.
2. A quarter century of experience with public/private competition in the Medicare program
demonstrates that the private plans will not allow a level playing field. Despite strict regulation,
private insurers have successfully cherry picked healthier seniors, and have exploited regional health
spending differences to their advantage. They have progressively undermined the public plan –
which started as the single payer for seniors and has now become a funding mechanism for HMOs,
and a place for them to dump the unprofitably ill. A public plan option does not lead toward single
payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable
ones in the public plan.
Would a public plan option stabilize the health care system, or even be a major
step forward?

The evidence is strong that such reform would have at best a modest and temporary positive impact
– a view that is widely shared within PNHP. Indeed, we remain concerned that a public plan option
as an element of reform might well be shaped in a manner to effectively subsidize private insurers by
requiring patients to purchase coverage while relieving private insurance of the highest risk
individuals, stabilizing private insurers for some time and reinforcing their control of the health care
Given the above, is it advisable to spend significant effort advocating for
inclusion of such reform?

No, for two reasons:
1. We are doctors, not politicians. We are obligated to tell the truth, and must answer for the
veracity of our stance to our patients and colleagues over many years. Ours is a very different time
horizon and set of responsibilities than politicians'. Falling in line with a consensus that attempts to
mislead the public may gain us a seat at the debate table, but abdicates our ethical obligations.
2. The best way to gain a half a pie is to demand the whole thing.
Is fundamental reform possible?
We remain optimistic that real reform is quite possible, but only if we and our many allies continue
to insist on it.

As a lay person (not a doctor, not an economist, not a social worker, case worker, nurse, insurance underwriter or any other person of experience except patient and consumer of medical services), I obviously don't know how all of the issues play into one another, and I have absolutely no idea how to navigate the healthcare maze of billing, treatment, referrals, etc., and I don't really understand the interplay and differences between Medicare, Medicaid and private insurance.

I will say that this information gave me something to really think about in terms of whether or not to support the idea of accepting a step on the way to universal healthcare, or to hold out for the best possible scenario. Here is the response that I sent to my friend:

Thanks for this information. I guess I'm one of the majority who has been hoping that this would be just one step on the way to true universal healthcare. I understand the logic of not settling for less than what would fully address the true need out there, and that in the long run it would cost less to only reorganize once. My thoughts also, however, go toward the knowledge that many taxpayers are skittish about universal healthcare. They don't seem to understand that their tax dollars wouldn't just be paying for the healthcare of the masses, but of their own as well. Some I talk to are already convinced that universal healthcare (or socialized medicine as they term it) will be inferior to what we already have. They are afraid of long waits, untrained staff and refusals of needed treatments and medications. How do we assure people that there will be safeguards against their fears coming true? It amazes me how many people I know who feel this way. I don't get it. Thanks again, I'll post the information you sent me on my blog, to help get the word out and to let people see multiple sides of this vital issue.

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