Saturday, October 10, 2009

If You Don't Believe Me, Believe Them

The Institute of Medicine is an independent, non-profit organization whose goal is to improve decision making on issues of healthcare. The Institute of Medicine's Committee on the Consequences of Uninsurance has proposed 5 key features that would be required of plans to extend health insurance. This list is from the Institute of Medicine's Uninsurance Checklist.

1. Health care coverage should be universal.

2. Health care coverage should be continuous.

3. Health care coverage should be affordable to individuals and families.

4. The health insurance strategy should be affordable and sustainable for society.

5. Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient centered and equitable.

A single payer plan--such as Medicare for all--is probably the best way to achieve this, but seeing the heartburn caused by the proposal of a public insurance option I doubt that single payer is in the cards right now. However, when you consider these key points, HR 3200 and the Senate HELP show the most promise. Both include the public option, which would stand to keep the costs of the private plans under control. The Senate Finance bill is probably not sufficient--state-based co-ops are not likely large enough to incorporate a pool of covered lives to adequately share the risk and keep costs low enough to be viable (especially if Republicans refuse any federal backing to ensure financial stability in the early stages).

So far, I have not seen conservative plans to reform healthcare in a way that would meet the criteria noted above. Plans like this from Gov. Bobby Jindal don't really seem to answer the call. I don't really see how they will address the cost issues. Even if HSAs and government tax credits make some form of coverage available to all in theory, how will the costs of insurance be kept in check? There is nothing in this proposal that would keep costs of plans contained. In fact, costs could rise quickly if patient costs are being subsidized in some way and the insurers can get away with raising costs some--overall patients might pay less, but the subsidy would need to cover more.

I'm sure Republicans would like to claim that the magic of the free market would work all this out--that competition between insurers would keep everyone in line. The fact is that, right now, insurers do not really compete among each other. Communities and states will have one or two insurers that dominate the market, to the exclusion of other companies. The free market is not working.

Free markets only work when consumers--patients, in this case--can reasonably refuse to purchase a product if the cost is not reasonable. I can choose not to buy a new car, a new TV, a new house, or a certain brand of mustard of the cost is more than I choose to pay. However, every single one of us will need healthcare. Maybe not much, and maybe not right now, but everyone will have to make use of this resource. With that being the case, consumers cannot really decline to pay for this product and therefore insurers have no real cost pressures to reduce the amount they charge.

So: real, honest healthcare reform that will meet the obligations listed above must include a public option to keep costs affordable. It also needs to have a mandated set of benefits in order to make sure that the affordable plans are actually worth something. Coverage must be available regardless of pre-existing conditions and regardless of your current employer.

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