Toward Health Insurance Reform

Mar 20th, 2009 | By Hot News Reporter | Category: Insurance Today

In 1990 the U.S. League of Women Voters undertook a two-year study of funding and delivery of health care. A key conclusion reads, “The position calls for a national health insurance plan financed through general taxes, commonly known as the ‘single-payer’ approach.”

With all the health plans recently put forward, it’s a wonder anyone can parse truth from fiction. Since 2001, when I turned 65 and joined the Medicare brigade, the solution seemed simple: At birth register every infant to the Medicare rolls. As the plan exists today, only people in their declining years use Medicare, thereby making the cost of care exorbitant. It is the opposite for private health insurance plans that seek to cover primarily healthy people.
Were every American enrolled in one large insurance pool, the healthy would help pay for the sick, as insurance is supposed to work. Having a single-payer plan like Medicare in which the government pays all the bills, administrative costs are in the area of 3 percent. Why so low? Because there are no costs for advertising, marketing, and high-paid executive salaries and bonuses and there are no profits.

The complaint that doctors do not accept Medicare would be eliminated if more resources were available from healthy enrollees. If that were the case, you wonder, why isn’t such a plan in place? The answer, unfortunately, is politics. Health insurance companies contribute heavily to political campaigns and employ many people. Their leverage on health care is enormous. Many people argue they don’t want a “socialist” system, not realizing that Medicare is such a system that has existed successfully for years.

AARP, our country’s largest organization of seniors, is tied to the hip with United Health Care. It handles its supplemental insurance policies. Can it be objective? Individuals must do their own research on this issue. There can always be private insurance for those who want more than what a public system might offer. If they can afford it, let them have it.

U.S. Rep. John Conyers (D-Mich.) has re-introduced bill HR676, a single-payer universal health care plan, to which 42 representatives have signed on in the new congress. Not one senator has offered support.

The United States is the only industrialized country without universal health care. Taiwan recently created its system after researching those existing elsewhere. Their conclusion? Single-payer systems deliver the best, most equitable medical care at the lowest price (2 percent administrative costs). Experts say Taiwan now has the world’s most efficient, convenient, and effective health care system.

No national system can afford to offer everyone everything. It would be unsustainable. There must be limitations, and the devil is in the details. For those who cannot afford today’s health insurance premiums, a public-sector health insurance plan offering preventative care is critical. The U.S. government spends more per person for health care than any other industrialized nation—without universal coverage.

The states have been forced to play a guinea-pig role trying various systems to learn what works best. The Massachusetts system, which mandates coverage, was touted as the answer, but it appears their cost estimates were too low and with today’s budget constraints, they are running into fiscal problems.

Health groups in Connecticut are looking at a public-private partnership system called SustiNet designed to include everyone who wants to join by 2012; it is not mandated. It appears that a bill will be introduced in the Connecticut General Assembly some time in March. Encourage your representatives to become familiar with its content.

Premiums would be on a sliding scale, and the single-payer would be the state. By 2014 it is possible that all but 2 percent of Connecticut residents would be involved. One of the main backers of SustiNet is the Universal Health Care Foundation of Connecticut. The supporting coalition includes business and labor leaders, clergy, health-care providers, and advocates. A rally of 500 people gathered in Hartford in January to encourage state legislators to support their plan.

SustiNet allows people satisfied with their existing private coverage to keep it. The system merges state employees and retirees with HUSKY and SAGA participants into a self-insured pool. Folks eligible include those without access to employer-sponsored insurance—sole proprietors, other self-employed individuals, and those offered employer-sponsored insurance that does not provide affordable access to essential care.

Employers, starting with small businesses, non-profits, and municipalities but ultimately including any employer in the state, will be eligible to participate.

SustiNet distinguishes itself by offering key coverage features over and above the norm. It covers medical home services, mental health, and dental care. All applicants are accepted regardless of pre-existing conditions. Income limits for HUSKY eligibility increase. Premiums and co-pays are subsidized based on income.

Providers receive fair compensation for the care they provide to those eligible for HUSKY, thereby reducing costs that are not reimbursed and increasing access to care for lower income people. Automatic enrollment, adequate affordability subsidies, and informed consent are used as mechanisms to achieve universal coverage.

U.S. health care costs are exploding and must be contained. Until the federal government comes up with a viable solution, Connecticut’s legislators and governor are obliged to use their creativity to help residents cope.

Marilyn Mackay heads the membership committee of the League of Women Voters of Southeastern Connecticut. The league, open to men and women, is a non-partisan group that encourages informed and active participation in government.


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