“Every Decision from Here on In Must Put Patients’ Interests First”
Does anyone remember the original goal of healthcare reform? I could type it in my sleep: “to provide high quality, affordable care for all Americans.”
Today, the goal has shrunk; the current Senate compromise aims only to make certain that 30 million uninsured Americans have insurance–which may or may not provide access to the care they need.
Washington would do this by mandating that all Americans buy insurance—or pay a penalty. Insurers, in turn, will be required to accept all customers, despite pre-existing conditions. Insurers will not be able to charge you more if you are sick– though they will be able to put a gun to your head if you are middle-aged.
Optimists say that by providing insurance for everyone, we will save tens of thousands of lives. Maybe. Maybe not.
Glass Half Empty
Over at Firedoglake, Scarecrow takes a grim view of the “compromise” that Senator Joe Lieberman has extracted from his colleagues: “Whatever Joe Lieberman’s motives, the reality is that he just performed a moral crime on national television. He’s essentially said that if Democrats want to provide even poor health insurance to 30 million uninsured Americans, the federal government and those citizens will have to pay blood money to an industry protection racket that will have the economic and political power to set the terms of that protection, shield itself from oversight and competition, and raise prices at will. . .
“The health reform debate is no longer about ‘reform,’” Scarecrow argues. “It has now become a hostage rescue effort for more than 30 million innocent victims”—i.e. the uninsured. "Every decision from here on must put the victims’ interests first, and whether we pay the extortionists’ ransom demands or not depends how that serves the victims’ safety.” I agree. This is not a time to stop negotiating.
Let me be clear: the “extortionists” are not just the private sector insurance companies (which desperately need 30 million new customers), but the hospitals, drug-makers, specialists and other players in the system. Will they put patients’ interests first? In other words, under the new scheme will they agree to make safe, comprehensive care available at a price that patients and taxpayers can afford?
Much depends, first, on how the private sector insurers are regulated. At present, we’re told that they will be overseen by the Office of Personnel Management (OPM), the group that administers Federal Employees’ Health Benefit Plans (FEHBP).
OPM does not “regulate.” It oversees. Rand Health Compare explains: “There is no designated minimum benefit package for FEHBP plans. The federal government does mandate certain coverage (such as for catastrophic expenses and mental health parity), but in general FEBHGP plans can provide highly variable products that differ in types of services covered, copayments, and out-of-pocket limits within broad categories (such as hospital, surgical, ambulatory, and obstetric care). . . . Depending on the plan selected, enrollees may have different cost sharing for out-of-network providers.” http://www.randcompare.org/options/mechanism/open_enrollment_in_fehbp.
How good are the “in-network” providers? That varies.
Within the FEBHP, “choice” means that you are “free to choose” (forced to choose) the plan that you can afford. Typically, less expensive plans carry higher co-pays. The FEBHP Chinese menu also offers “high-deductible” plans that some employees cannot afford to use, except in an emergency. This may mean that they go without the regular care and chronic disease management that their families need.
When it comes to using the sheer size of its membership to negotiate lower premiums for federal employees, OPM has made little or no effort. From 2001 to 2008,, average premiums have risen by 62.3%. Over the same span, Medicare has done a better job of controlling spending, keeping health care inflation down to 6% a year.
On top of runaway premium increases, FEHBP participants have watched co-pays climb http://www.afge.org/index.cfm?page=ContentTest&fuse=Content&ContentID=1410.Under the least expensive Blue Cross/Blue Shield plans patients are charged $25 for each visit to a primary care physician who is “in network.” If they go to a doctor who does not accept the plan’s fees, patients must pay the full bill, without help from their “insurance.” If a patient winds up at the ER, his co-pay is $75. If he is hospitalized, he pays $100 a day up to $500 –unless the hospital is “out of network;” in that case, he pays all charges. For some prescriptions that are not in the plan’s formulary, the co-pay is 50% of the cost of the drug. http://www.ibx.com/pdfs/custom/fep/2009_fep_chart.pdf
The major reason federal employees like their insurance is that the government pays up to 75% of annual premiums. (Though some federal employees still don’t sign up because they cannot afford 25% of premiums that can run as high as $13,000 for a family plan.) Under the Senate plan, the uninsured will not be so lucky. Unless they qualify for subsidies, families who sign up for a menu of private plans modeled on FEHBP will have to foot the entire bill themselves.
Keep your eye on what happens when the House and Senate plans are merged. The House legislation calls for federal regulation of insurers. The Senate bill leaves regulation to the states —and many states just won’t be inclined to regulate.
In part 2 of the post, I’ll talk about why the Senate plan would leave many older Americans uninsured, and why it is not likely that the private insurers overseen by the OPM will take it upon themselves to put patients’ interests first.
That said, I also will elaborate on the features of the House and Senate plans that deserve progressive votes– as long as they survive final negotiations.
Finally I will explain why I’m not giving up hope. Reformers have lost the game, not the match. This is just the first piece of health care legislation that you will see over the next three (or four) years.