Freethought San Marcos: A column
by LAMAR W. HANKINS
I don’t know what President Obama will say in his planned address to a joint session of Congress about health insurance reform on September 9. I do believe, after much study on the subject, that if he has any hope of achieving one of the hallmark promises of his campaign, he must focus on a few principles that are essential to make a significant difference in the health insurance marketplace. And it doesn’t require a 1000-page law to do so.
1. It is as immoral to deny health care to a person as it is to deny that person water. The way most people in the US pay for health care is through health insurance. With nearly 100 million Americans uninsured or unable to afford the medical care they need through their existing health insurance, the President should propose that Congress allow any person who wishes to do so to join Medicare.
Medicare is a well-established and well-understood public option that is administered at a very low cost (3 or 4 percent of total costs of the program). It was modeled after the Canadian single-payer system when it was proposed by President Lyndon Johnson nearly 45 years ago. Medicare participants are allowed to choose their own medical providers, so there is no government interference in the health care decisions of individual participants.
This simple change to the system would make health insurance more affordable for businesses that are able to provide health insurance or share the costs with their employees. Businesses engaging in international commerce should find that they would be more competitive if Medicare were an option for their employees. When added to the children’s health insurance program, Medicaid, VA health care and health insurance, and the Indian Health Service (IHS) (which serves American Indians and Alaska Natives), the change in Medicare eligibility would mean that virtually all Americans needing health insurance will be able to have it, regardless of where they work.
For those few others who cannot afford even the Medicare premiums and co-payments, some provision can be made to provide a subsidy so that they are covered and no longer depend on the emergency rooms at local hospitals.
2. Repeal the provision in the Medicare drug benefit that keeps Medicare from negotiating fairer drug prices. If you believe in market forces at all, negotiation for better prices should be available to Medicare just as it is available to Walmart, the VA, and IHS.
3. Private health insurers must be required to provide coverage without regard to pre-existing conditions. This is how Medicare and the other federally-funded health insurance and health care systems work and should become a standard for the private health insurance market. Otherwise, the private market will be used only by those people who are the healthiest, placing a greater burden on the public systems. The recent record profits of the private insurance system indicate that it can afford to provide coverage without regard to pre-existing conditions.
4. The premiums charged by the private insurers must be uniform within broad geographical areas based on health care costs in the designated area. That is, a person in San Marcos should be charged no more than a person in Kyle, or Buda, or Wimberley for health insurance. Establishing the boundaries of those health care coverage areas will give Congress and the health insurers something to negotiate.
5. Health insurers must be prohibited from dropping customers who become ill. When medical costs exceed a pre-determined amount, a system of catastrophic health insurance can be established to cover medical costs over that amount. This system would be similar to umbrella insurance policies now available to pay for excess liability costs incurred in a traffic accident. For example, if I have a $100,000 per accident automobile insurance policy and I cause a traffic accident in which the damage exceeds the $100,000, my umbrella policy will cover the costs up to $1 million. A similar system can be established for private health insurance.
6. Private health insurers must be prohibited from requiring pre-approval for health care treatments and tests ordered by a physician and for access to a specialist. This procedural change should reduce the overhead costs of the private insurance marketplace and make the private market more attractive to those who can afford it. When you are sick, the fewer hassles you encounter, the better the health care experience. Pre-approvals are an unnecessary corporate bureaucratic roadblock, and they result in a loss of treatment for those people less skilled in negotiating with insurance companies or unable to negotiate because of their medical condition. The ability to negotiate with corporate bureaucrats should not determine your access to treatment ordered by your physician.
Whatever the President says later this week to Congress, it should be brief, simple, and directed at a few essential changes in the health insurance system. If he chooses not to require changes in the private health insurance system–items 3 through 6 in my list–opening up Medicare to anyone who wants to participate in it can, by itself, alter the way the private insurers do business. That, coupled with drug-price negotiating by Medicare will go a very long way in reforming the present system.
As best-selling author and talk show host Thom Hartmann has written, health insurance reform legislation “could probably be just a few lines, like when Medicare was expanded to include disabled people.” Such a change would allow “any American citizen (to) buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.” This provision would make the change revenue-neutral.
Hartmann suggests that, to keep this change revenue-neutral and available for people of low income, the rates could be raised slightly for all new participants so that those who want Medicare coverage and whose incomes are under 200% of the poverty rate for their family size could afford to participate.
This is what Hartmann calls “Medicare for anybody who wants it.” Those who want private health insurance are welcome to it. This change in Medicare eligibility could be as simple as explaining “here’s what it’ll cost if you want to buy in, and here’s the sliding scale of subsidies we’ll give you if you’re poor, paid for by everybody else who’s buying in.”
The more complicated and complex the reform proposals, the more likely they will be distorted by ideological opponents who have failed to offer solutions that satisfy the health insurance needs of the nearly one-third of our population that does not have health insurance or can’t afford to fully use the insurance they have. What we need now is to get basic health insurance to everyone who needs it. Further reforms, if they are needed, can come later.
President Obama was elected to create the change he promised us he supported. We expect him to honor those promises. If he doesn’t fight for at least the simplest change that will provide affordable health insurance for all Americans–opening Medicare to all who want it–he will reveal himself as just another run-of-the-mill politician who is more concerned with party politics and the next election than with doing the right thing for all the people who make up this nation. To me, at this time in our nation’s history, having Medicare for all who want it means that we will have a government that a Republican president from Illinois once described as “of the people, by the people, (and) for the people.”
© Freethought San Marcos, Lamar W. HankinsEmail | Print