Saturday, June 27, 2009

Time For A Bipartisan Commission

548 words

President Obama and the 535 members of Congress seem to have at least 600 different national medical insurance proposals, some of our leaders being of two or more minds on the subject. Analysts writing in the press push additional panaceas and utter platitudes in abundance. Mixed in with all this is propaganda from insurance companies' spin-doctors and from other corporations with major interests at stake.

Policy affecting one sixth of our gross domestic production should not be created by such a haphazard approach.

Agreement on major legislation does not seem likely in the near future. But it should be possible for Republican and Democratic leaders to create a process which could produce legislation most Americans could agree on during the second half of President Obama’s first term.

Congress should establish a bipartisan commission on National Medical Policy. Although the commission would hear testimony from representatives of the medical and health care professions and the drug and insurance companies, none of the commissioners should be representatives of these self-interested parties.

The main job of the commission would be to study all of the major countries that have national health insurance programs. It would analyze the respective advantages and disadvantages of these various national systems.

The commission would then be charged with drafting a proposal---appropriate to American circumstances--- that would to the greatest possible degree incorporate the strengths of these other systems while avoiding their weaknesses. Hopefully, a proposal would emerge from the commission that could command bipartisan support in Congress.

Our expectations for the commission should not be too high. Any possible medical system will have some defects, given the many conflicting interests and considerations. Services covered must be limited to some extent since medical technologies now exist that are too expensive to provide them to everyone who might benefit.

If the new system is a single-payer one, it will be necessary to raise taxes in order to pay for it. But this would be offset for the average person by elimination of the medical insurance premiums that we now pay, directly or indirectly in the form of reduced wages when our employer writes the check for the insurance. If the system is not a single-payer one, it will force people to make complex choices that may be beyond most of us, and may include mandatory purchase of private insurance that would be a tax in everything but name.

The commissioners must be willing to follow the evidence wherever it leads. If it leads, as I expect, to a single-payer system, the fact that this might put the private insurance companies out of business (they could still sell other kinds of insurance) should not be a deal-breaker. Life is tough. A country which has survived the bankruptcy of airlines, auto companies, and banks should not hesitate to put the insurance companies out of their misery if it is what the public welfare requires. Jobs would be lost at the insurance companies, but new jobs would be created administering the new system.

Over two thousand years ago, Aristotle compared the constitutions of the various Greek city states in his effort to determine an ideal form of government. It would likewise be intelligent for Americans to study the experience of others before coming to any conclusions about major medical reforms.

Wednesday, June 17, 2009

A thoughtful comparison of Medicare and private insurance

Medicare: comparing before and after

by Stephen Gregg

Tomorrow is my 65th birthday. I just left my private-sector health insurance roots behind and enrolled in Medicare. I'm both pleased and troubled by the transition. That split attitude was striking for me, given my long-standing philosophical and ideological commitment to "private" and "free market" views. How could I possibly view participation and dependency on a government-run Medicare program as an improvement?

Well, Medicare is a very sweet deal.

The Social Security Administration indicates my Medicare tax contributions over my working career have been $57,700. That seems far less than the costs my wife and I are likely to incur over the remainder of our lives. Surely, it will be convenient to allow politicians, lobbyists and organizations such as AARP to run the show, no matter the larger consequences. I know politics offers considerable protection of my interests. In large part, this is not a story about how the government has taken over yet another sector of our society, but how far the private sector has wandered from steadfastly serving its customers.

Turning 65 is a rare moment, allowing one to contrast before and after. "Before" meant buying individual private insurance for the past 15 years. Employer group insurance is far more benign financially. The dominant characteristics of individual insurance included:

--Volatile premium increases.

--Benefit designs loaded with popular fluff, while leaving me wondering whether coverage for the unanticipated and serious was there.

--Insistence on using predetermined provider networks irrespective of better or cheaper alternatives.

--Spotty administrative support. Changing insurance providers during those 15 years was always an iffy exercise.

The "after," of course, remains to be fully appreciated, but the initial Medicare signals seem favorable, bordering on a breath of fresh air:

--Stable premium increases.

--Ubiquitous access to almost any provider in the country.

--Assurance that the best price has been extracted (extorted?).

--Standardized supplemental insurance policies covering super-catastrophic and first-dollar coverage for just slightly higher premiums.

--A wide range of supplemental insurers.

--Ability to switch carriers, no questions asked, once a year.

--So far, decent public-private customer service throughout.
--Very little uncertainty as to whether I am covered for all the possibilities.

It's a challenge to argue that Medicare is an inferior alternative to a more responsive and dynamic private sector.

This is disturbingly superficial and self-centered, but it's where I fear many people are today. It's no one's fault in particular, and all of our faults collectively. Certainly there is near universal acknowledgment that the math of Medicare just does not work in the mid to long term.

But as disastrous as the future financial plight of Medicare is, it may prove to be secondary to political demands to reform a health care system that isn't meeting many people's needs.

Do I think the private sector has a grasp of all this? I don't see it. Perhaps you do. What a predicament we have.


Stephen Gregg is a retired Portland (Oregon)-area managed-care and hospital administration executive.