VARIOUS FLAVORS OF HEALTHCARE REFORM

From VOX, recently, I received a very interesting article 

Democrats 8 Plans for Medicare for All

which attempts to spell out the eight plans for universal health care so far cooked up by Congressional Democrats.  Though there’s no chance of any one of them being adopted under the current administration, it was clarifying to read it, because it helped to identify what I wanted to see in healthcare legislation, and what I most definitely did NOT want to see there. I figured that it might do the same for you, so I thought I’d present the gist of it here. The article sums up the eight plans in the diagram I reproduce below:

Please note that all eight plans – as Vox reports them – assume the Government’s regulation of health care prices. So even if the least generous of the plans was adopted, the result – presumably – would be better than what we have now.

Plans Number 1 (the House of Representatives’ HR676),  and number 2 (the Senate’s S1804) both are paid for strictly by tax increases, and would offer broad coverage for everyone, with no co-pays, deductibles, or pre-existing conditions.  As such, they are the only true single-payer bills being considered. In fact there are only two differences between them both, which we will consider later. 

Note that insurance companies are deliberately excluded here – a consequential decision for the drafters, since traditionally, employers offering health insurance can deduct that expense from their taxes, which means, as Vox says, that “companies’ dollars stretch further when they buy workers’ health benefits than when they pay workers’ wages.”

Taking that into account is Plan Number 3, Medicare Extra for All,  proposed by the think tank, Center for American Progress. This would achieve universal coverage for all legal residents through a combination of private and public insurance – at least for the next few decades.  The plan would let employers continue to offer coverage to their workers so long as it met federal guidelines. At the same time employers would be offered a similar, tempting option: to stop offering coverage and instead pay a payroll tax equivalent to what they currently were spending on health coverage.  But how tempting that offer would be depends on how generous the Medicare Extra plan turns out to be, a crucial detail which hasn’t been specified yet. What has been specified is that every new born would automatically be enrolled in the new plan, so that ultimately the resulting healthcare plan would look a lot like the single-payer plans being sponsored in Congress.

Plans 1, 2, and 3 are designed to bring healthcare coverage to everyone.  Not so the rest of them.

Plan 4, The Urban Institute’s Healthy America Plan aims to disrupt the employer market as little as possible. Recognizing that most people with employer plans are reasonably happy with them, they would set up new insurance marketplaces for those whose insurance isn’t very good anyway – mainly the Obamacare and Medicaid populations.  The cost of their insurance would be covered partially by tax increases, and partially by the premiums they'd pay into the system.

Plans 5 through 8 are buy-in programs – paid for in no way by higher taxes, but by the subscribers only. As such they would exclude all those unable to afford it.  For that reason I'm against them.

But I’m against buy-in programs also for another reason, and for that, let me refer to an email I just received which quotes Wendell Potter, whose every word here is worth reading and taking to heart:

“I spent 20 years as a health insurance executive before leaving my job as a vice president at Cigna. I can tell you firsthand that by focusing on a half-baked measure like a Medicare buy-in, Democrats would hand a huge gift to the private insurance industry while doing less than the bare minimum to help struggling businesses, workers, families and patients.... It’s time for Democrats to stop proposing health care reform that relies on insurance companies to play fair. After two decades in the for-profit health insurance industry, I can assure you they never will. They have no interest in doing anything that might in any way jeopardize profits. Their only interest is delivering profits to their shareholders. From that perspective, the status quo is very profitable. For everyone else, not so much.

Champion dramatic reforms, not half-measures!

Business owners are struggling to provide health insurance to their employees, workers' take-home pay is shrinking as their premiums go up, patients are literally begging for their lives on fundraising platforms like GoFundMe, doctors and hospitals are drowning in paperwork dealing with insurance claims departments, and more than 80 million people lack adequate health insurance. That number is increasing every year. Reform is desperately needed.

Democrats have the chance to be the champions of that reform if they don’t waste their energy on half-measures. Instead of thinking about how they can make small tweaks to the health care system, they should start thinking about how to enact dramatic reforms that will assure universal coverage while reducing costs and encouraging economic growth. Voters and taxpayers are asking for Medicare for All. It’s time to listen.”

For all these reasons, I’ve left Vox’s description of the four “buy-in” plans for you to read in the original document (see the link). You can make up your own minds. 

Dio

PS: If you’d like to leave a comment (and I hope you will) simply click on the number of comments area. In the comment box that appears, you can share your thoughts.