Thursday, December 18, 2014
The New York Times
December 18, 2014
How the High Cost of Medical Care Is Affecting Americans
By Elisabeth Rosenthal
The Times designed a questionnaire with CBS News and conducted a
national poll this month.
Americans are eager for relief.
There seems to be widespread agreement that medical prices are
burdensome for American patients, and new solutions are needed. But will
the answer be a market-based approach involving greater price
transparency? More regulation, focusing on price? A government-sponsored
single-payer health system, like that in Canada? Or allowing younger
people to join Medicare, the popular health insurance program for
seniors? Many readers surprised me by saying they could not wait to turn
65. As one reader from Texas said: "I bought medicine in Mexico for 23
years before I became eligible for the promised land of Medicare."
Would you favor or oppose a government-administered health insurance
plan — something like the Medicare coverage that people 65 and older get
— that would compete with private health insurance plans?
8% No opinion
Would you favor or oppose a single-payer health care system, in which
all Americans would get their health insurance from one government plan
that is financed by taxes?
7% No opinion
Comment by Don McCanne
During the health care reform debate there was considerable support for
a "public option" - providing individuals an option of choosing a
Medicare-like program, administered by the government, that would
compete with the private health plans. During the legislative process it
received much publicity, but it was eventually eliminated from
consideration under pressure from the insurance industry that did not
want any competition from the government. A vote on a single payer
proposal also was promised by the Democratic leadership in the House,
but eventually the opportunity for that vote was traded away in politics
We still hear calls for a public option that many contend would address
the high costs of health care, though few seem to understand that it
would hardly have any impact on costs since it would be only one more
player in our dysfunctional multi-payer financing system. But we also
hear calls for a single payer system - an improved Medicare for all -
that actually would slow spending while meeting other important goals
such as universality and equity.
How are these messages resonating with the public? The competitive
public option concept is supported by 59% of those polled, whereas the
single payer concept is supported by only 43%, with 50% opposed.
Although some might dispute this polling based on the phrasing of the
questions or whatever, to me these results seem to suggest a much more
serious problem. Instead of the national debate that we should be having
- single payer versus our fragmented multi-payer system - the debate is
being shifted to our private insurance-dominated multi-payer system
versus a multi-payer system with a public option - a Medicare-like
program that you can purchase in place of private insurance.
What does that shift in the debate do? Well, first of all, it ensures
that single payer will continue to be left off of the table as we move
forward. Second, it allows the insurers to exercise damage control by
ensuring, through their ownership of Congress, that the public option
would be prohibited from gaining an "unfair" competitive advantage
against the private insurers. During the reform debate the insurance
lobby was successful in selling the concept that the public option had
to be removed from the control of government and have restrictions
placed on it that would make it worse than the private plans. Just
opening that door was still too much for the insurers, and so the
concept was tabled. But when it comes back up again, the insurers want
to have that debate rather than the single payer debate, and they are
ready for it.
Another concern about the public option debate is that the concept is
being deliberately conflated with the premium support concept as a means
of ensuring that there is strong public support for improving health
care value through competition - competition of private health plans,
that is. The government would provide support for the insurance premiums
through virtual vouchers that would provide an option to purchase
various plans through the public exchanges. Thus the insurance industry
gets precisely what it wants with the debate being limited to how much
damage can be done to the free-standing public option, public in name
only, to be sure that it does not unfairly compete with the private
insurers (inadequate funding of reserves, prohibition of "advertising,"
increasing adverse selection through the requirement of being the
safety-net insurer, requirement to maximize cost sharing, requirement of
using ultra-narrow networks, etc.).
Maybe some of this is a stretch, but we really have to be concerned when
the perception of the public at large is that we don't want a single
payer system but we do want a government plan that competes with private
insurers. The issues are complex. We have a lot of work to do to educate
the nation on the true facts behind reform options. As far as messaging
is concerned, right now the single payer opponents can dismiss our model
with just one word: competition. Now just try to find one word or phrase
that explains why single payer is vastly superior to private plans
competing in the marketplace.
at 5:56 PM