Why Not Just Work for the Public Option
We have heard from many who think it is better to forgo the battle for Single-Payer, or Medicare for All, and work for a good public option instead. Many of these well-meaning people say that Congress will not enact a Single-Payer program and it is important to work for the good public option to make sure that is included in any health care reform bill. I was even contacted by one person, who claimed to be a Single-Payer proponent, but who wished to not be contacted again concerning Single-Payer because she considered SPAN Ohio to be misguided and misdirected since the group wasn't working for a public option.
These people are not seeing the forest for the trees. They are probably correct in saying that Congress will not enact a Single-Payer program in this round of "reform." However, if they truly want to work for a GOOD public option, and the operative word here is GOOD, then they should be pounding the streets for Single-Payer. The only way to achieve a GOOD public option is to make it seem like a reasonable solution, a middle ground so to speak.
However, a GOOD public option cannot and should not be the end product. Physicians for a National Health Program has studied the situation and points out the fallacies in argument by those who expound a public option will cure our health care woes.
The "Public Plan Option": Myths and facts
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Myth: A public option will increase choice for patients. Fact: A public plan option will not increase choice of what matters for our health: choice of caregivers and choice in location of care. Patients will still have a limited choice of provider restricted by networks and will pay more to see providers outside of their network. Patients will still have to seek authorization for treatment. The public option will add one more plan to the hundreds of plans that already exist.
Myth: A public option will enable patients to keep their own doctor, regardless of changes in employment or health. Fact: A public plan option does not guarantee patients can keep their doctor regardless of employment or health because it leaves the employer based system of health care provision intact. If an employer chooses to change to a new plan, patients may have to change their doctor or pay higher fees to stay with their doctor. Insurers have strong financial incentives to enroll the healthy while avoiding the sick patients; thus if a patient becomes ill, they still risk losing their employer based insurance.
Myth: A public option will force private health insurers to compete on a level-playing field, especially in limited markets. Fact: The Medicare HMO experience shows private plans undermine fair competition despite regulations. They avoid the expensively ill (called "cherry-picking") and use their marketing power to attract the healthiest patients. Private HMO Medicare also costs 12 to 19% more than traditional Medicare despite having a healthier population. The current Medicare experience combined with experience in many different states that have tried this type of reform shows that public plans are left with the sickest patients and fail due to rising costs while the private insurers continue to collect premium from the healthiest patients and maintain their high profits.
Myth: A public option will provide everyone with the security that quality, affordable coverage will always be there. Fact: Our health care system is unsustainable. Health care reform that includes a public plan option will add hundreds of billions of additional dollars annually on top of 2.5 trillion dollars, (twice what any nation spends per person). We have vast domestic and international experience with public option schemes, and in no case have they resulted in universal coverage. This is because private insurance companies seek to enhance their profits by screening out sick and unprofitable patients, ultimately relegating most of the sick and costly to the public system, which quickly comes unraveled due to rising costs. Absent effective cost control, any increase in coverage or benefits will quickly be erased by rising costs. In conclusion, 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.
Myth: A public option will provide better care to patients by driving innovation in the quality of care physicians provide. Fact: A public plan option would not improve overall quality: (1) it would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations, (2) it would keep intact for-profit, investor-owned hospitals, HMOs and nursing homes that have higher costs and score lower on most measures of quality than their non-profit counterparts, (3) it would add yet another payer to our fragmented system perpetuating challenges to coordinated care, for example, there will still be a need to collect premiums, track enrollment, disenrollment, etc, and hospital/NH payment will still require the an enormous billing apparatus.
Myth: A public option will reduce health care costs. Fact: The public option will not reduce health care costs for several reasons: there are no savings on physician office bureaucracy ($85 billion annually would be saved annually with single payer), no savings on hospitals' billing or internal cost tracking ($90 billion annually would be saved with single payer, hospitals already use computerized uniform bill UB-82), no savings on NH/home care bureaucracy ($24 billion annually would be saved with single payer), inadequate insurance overhead reduction ($93 billion annually would be saved with single payer). In summary, studies show that even if more than 50% of patients switch to a public plan, this will only result in 1/7 of the savings that could be achieved under a national health care system ($47 billion v $363 billion annually savings). Adding a public option to the array of private insurance companies in existence will only exacerbate the waste and inefficiency inherent in a patchwork system of health care finance. In their drive to fight claims, issue denials and screen out the sick, insurance companies generate more than $350 billion in administrative paperwork waste. The proposed insurance industry regulator entity will only add another layer of needless bureaucracy to this already bloat-heavy system. Maintaining this system means that no effective cost control is possible and the system will rapidly deteriorate as costs increase. Only single payer can expand and improve coverage to everyone without spending more than we are now.
Those who have been involved in the health care reform movement for a long period of time have repeatedly pointed out that significant social change such as a Single-Payer system has historically come from the states. That is going to hold true on this issue as well. That is why the efforts of SPAN Ohio are more important now than they have ever been.
House Bill 159, the Health Care for all Ohioans Act, received its first hearing in the Ohio House last week. For the first time, it was received with serious consideration and well thought questions, even from a couple of Republicans on the committee.
There is still time to get in on the act. Visit the SPAN website at www.spanohio.org and sign up to volunteer. Call Debbie Silverstein at 673-8524 or e-mail at dsilverstein@neo.rr.com to get involved.
