Advocates, usually at the ready with families for the press to interview, don’t seem to be trotting them out to talk about affordability or the obscure indexing provisions that the Center on Budget and Policy Priorities brought to the attention of Kaiser News Service and Campaign Desk. Those provisions would cause families with modest incomes to spend a larger and larger share of it for health insurance as time goes on. It might be easier for the Joneses in Peoria to take the penalty and run.
A perspective piece published two weeks ago in the New England Journal of Medicine pointed out that the polls now show the same things that they showed during the various stages of the Clinton reform effort. The authors say that “Americans’ impressions of the legislation’s likely impact on their own situation will be the most important factor in determining the level of public support.” The polls may be similar, but one thing is different. In 1993-94, the media, which did not do a great job then explaining the Clinton plan to the public, at least ran winners and losers pieces from time to time. This year they aren’t even doing that.
It’s past time for the story to shift from Capitol Hill to Peoria. Here’s what we suggest: Go out and find the people who will experience the good and bad of reform and tell their stories. Report on what they spend now for the usual things—car and mortgage payments, food, gasoline, life and auto insurance premiums, clothing, entertainment, taxes, presents for Christmas, credit card debt, savings for college or retirement. Tell what spending five percent, ten percent, or twelve percent for health coverage will mean for other spending priorities. How will that change through the years, given what Congress currently has in mind for indexing the premiums? Find out what kinds of “affordable” insurance they can actually buy. Investigate what employers are offering this year? Will people with good health plans—the so-called Cadillacs—see their insurance turn into Edsels?
This is the Consumer Reports 101 the public needs. It’s the stuff that Ron Wyden worries about.
As always, readers are very much in Ms. Lieberman's debt for her sober and informed work.
#1 Posted by Norman Birnbaum, CJR on Tue 17 Nov 2009 at 12:11 PM
Here is a good case study that could be used for comparison: http://www.guardian.co.uk/lifeandstyle/2009/nov/03/brain-abscess-surgery. It's about an editor from the Guardian who wrote about his recent and sudden health emergency from a brain abscess. He is an otherwise healthy 41 yr old man who had no reason to suspect that he might experience a health crisis that would require emergency brain surgery and 5 months recovery. He describes his treatment by the British NHS, including home visits from his doctor, and his aftercare experience. He is not writing to complain or celebrate his treatment, just matter of factly describing what happened to him and that he's happy to be back at work. An American's story would likely include dramas about insurance coverage and would likely be focused on the financial catastrophe caused by treatment and losing 5 mos from the job. An upcoming beef-and-beer fundraiser would likely be a reason for an American to write about the crisis. So I would like to know how this man would experience his emergency in America under the reforms on offer.
#2 Posted by MB, CJR on Tue 17 Nov 2009 at 01:06 PM
Excellent perspective for the "common man." Now the poverty stricken who receive Medicaid will be increased by 7,000,000, placing them in competition with those already on Medicaid, who can't find a doctor to see them even now. So, if the common man suffers, the more unfortunate are merely herded into a larger stockade, that much farther from the feeding trough of actual medical care. As a newcomer to these informative articles, I may have missed a reference to William Hsiao's "First Question:" Is health care a human right? Until we answer that question in the affirmative, we will be applying bandaids at the cost of reconstructive surgery, with all the expense nd none of the results.
#3 Posted by Laurence Lewin, M.D., CJR on Tue 17 Nov 2009 at 10:51 PM
There seems to be no interest in addressing the cost curve associated with healthcare. If this was of any concern, the members of Congress would look at the idea of establishing state Medical PSC's. State Medical PSC's have the power to make healthcare affordable for the average citizen.
A Medical PSC would set the price for each Medical Charge Code used to bill insurance. Prices would be set on a fair and reasonable basis based on actual provider costs plus a reasonable mark-up (profit margin). The mark-up could be matched against the average profit margin of the state insurance companies (now about 6%). Under this arrangement, as the annual profit of the insurance companies goes down due to the over-use of medical services, the doctors mark-up (profit margin) is reduced accordingly. This ties the profitability of the medical providers to the profitability of the insurers. This "check and balance" mechanism will encourage doctors to consider the impact of how they provide services.
The state insurance commissioner can monitor the profit margins of the state healthcare insurers to ascertain adequate competition to keep profit margins reasonable.
Under a Medical PSC there is no provider network or provider service contracts. All insurers provide state-wide coverage and all providers are paid the same for identical services. State Medical PSC's will minimize healthcare costs, but keep them fair and reasonable. Then Washington can change the laws to extend healthcare and subsidize the disadvantaged. And the states via their Medical PSC's can insure that the money made available for healthcare is stretched to the limit. This is how the American healthcare system should work.
All who read this should contact their congressional representatives and demand that state Medical PSC's be considered!! This is the REAL solution to controlling costs!!
#4 Posted by Dan Smith, CJR on Thu 19 Nov 2009 at 10:16 AM