Health reform legislation is now focusing on building a regulated marketplace (or exchange) for plans to offer insurance to individuals. The regulations would require health insurers to offer a standard set of benefits at a single (or at most age-specific) premium and to take all comers, even those of us who actually will need medical care in the near future. The idea would be that you can choose among, say, 10 plans all offering a mandated set of benefits, but perhaps varying on co-pays, deductibles, and choice of providers.
A marketplace of competitive -- but regulated -- health plans offers the best hope of reaching a reasonable balance between costs, access and quality of medical care, because consumers (that's us) would be able to exercise the strongest vote possible against a plan that skimps -- select another! Same with a plan that costs too much. Over time, plans would come to look more and more alike. But, most important to my mind is that a competitive program would hasten the integration of medical care delivery into systems of care. That's where hospitals, physicians and other providers get together to offer a health plan in which they share the savings that come from making care more rational and cost-effective. (And, in every open season, they'd have to give some of those savings back in reduced premiums in order to stay competitive.) Integrated health delivery systems can be larger than one city or county. They can involve arrangements with nationally recognized high-quality cancer centers, for example, to offer state-of-the-art care. You might be willing to pay a bit more if your plan included access to the best specialty centers for certain types of care. Most important, integrated health systems would have to compete against rivals on both quality and cost.
The current fee-for-service system is a drag on system integration, because doctors are paid piecemeal and do not benefit from talking with one another or investing in more efficient use of hospitals and technology. It's a dinosaur payment system.
How does the public option come into all of this? The public option is essentially a Medicare add-on. It will piggy back onto the Medicare fee schedule and fee-for-service piecemeal payment system. So long as it pays physicians enough to keep enough of them accepting public option patients, it will be a drag on the needed evolution to systems of care. It will perpetuate the disjointed, disconnected, dysfunctional, and dissed (by me) current system.
That's my main problem with a public plan. Even one that pays doctors generously (and therefore gets buy-in from the altruistic American Medical Association) is likely to gum up the works for real reform of the health care delivery system for a long time to come.
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I believe we need a National Insurance plan. Insurance is not portable if it is employer paid for. As the jobless rate goes up more of us will be without coverages. Only through a national system will we be able to ensure that health coverage is available. All the arguments do not do an adequate job of identifying costs. We talk of excessive tests, procedures, etc, but where are these quantified to be able to say that a fee for service system is the issue? One problem with the system we now have is that the insurance companies negotiate payments with physicans, hosptials, labs, etc. Those not insured pay the full freight which has no bearing to what the rates the insurance companies have negotiated. I have no doubt that a government system can negotiate better rates for enrollees. Likewise we are inundated with scare messages about the risks of a national system. While there are short comings there are definite benefits. What about the importation of less costly drugs? In the bills this has been eliminated to favor the pharma companies with the message that they are less safe. Aren't the drugs used in Canada that are much cheaper less expensive only because of the negotating power of the government? Free market has not accomplished any reforms. Only profits for the main players. Why do you expect greed not to get in the way of any meaningful reform of the health care system? Obama has already sold out on the main critical issues. we will get the change but in my mind it will undoubtedly make the situation worse.
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