By Mike McGann, Editor, The Times
Do no harm. That is the first precept of modern medical care. This doesn’t mean standing there while someone is bleeding out, of course, which is the current state of American health care.
I was happy to give Guy Ciarrocchi, the president of the Chester County Chamber of Business & Industry, his say last week about not expanding government’s role in health care.
Here’s mine:
As I was standing at the counter in the Kennett Square Walgreens — for the second straight day — trying to figure out why Aetna appeared to have cancelled my health insurance (despite the nearly $2,400 monthly check we send them via an administrator to cover me, my wife and two college kids), I was asking myself: “exactly how much worse could government-run healthcare be?”
The truth of the matter, despite Guy’s rather pedestrian GOP playbook histrionics last week, arguably not worse and possibly much better, and yes, cheaper. And, ironically, the greed and short-sightedness of the Republicans and the insurance industry might be driving a quicker move toward single payer.
Generally speaking, I’ve been against Medicare For All — I do think there’s a place for private sector insurance — but in truth, as Republicans have slowly dismantled the Affordable Care Act (which — stunner — actually did lower my family’s health insurance costs, before Republicans in Congress cut off subsidies and tax credits for the program, neutering it), we’re right back where we started, with spiraling costs and health care rationing (when people are skipping does of insulin because of cost, we’re in full-on rationing).
I have long felt that two concepts: a public option buy-in for Medicare and a Medicare-55 program made a lot of sense as first steps, though.
Yes, we’d have to rework reimbursements for hospitals and doctors (both have been underpaid by Medicare typically, as compared with private insurance PPO rates) — and we’d have to pay for it. This would prevent hospitals from closing and doctors shutting practices. Still such a move would potentially save them money as they’d see less of an onerous burden of dealing with private insurance companies requirements to jump through hoops to get paid (not to mention how much gets written off when health care providers finally give up when claims are “lost” and denied after the fact by insurers).
Here’s how: both programs would have to require a premium of sorts (and I think this could be scaled by income) and yes, we’d have to raise the contribution rate on Medicare in steps beyond the 2013 hike on incomes over $200,000. We could boost rates at $400,000, $1 million and $10 million to boost overall revenue. Additionally, we’d need to allow this newly muscular Medicare to negotiate pricing with drug companies, and finally bring drug pricing on par with other western countries to contain costs.
To be blunt: public insurance will be more cost effective than private insurance — Medicare overhead is about 4%, while private insurance is closer to 20%. As coverage plans would be pretty universal, it would be easier for providers to figure out what’s covered and what’s not — no more surprise sticker shock, when one doctor at a provider isn’t in network — everyone would be in network.
By taking the 55 to 64 year old people out of the private insurance pool, we should see a drop in costs for private insurance (we should, but I’m dubious, as insurance companies will continue to be more concerned about profit over people’s health care). If the public option is able to win in the marketplace, though, insurers will have little choice, but to drop prices to compete. This, of course, is why they oppose it so strongly.
By allowing small businesses — and entrepreneurs — to buy into the government plans, a lot of headaches and cost will go away. Maybe the corporate behemoths might be less impressed, but small business owners in Chester County will benefit greatly.
But I have to admit, in recent weeks, I’m beginning to see my Medicare buy-in/Medicare-55 plan as half-measures. If we can make the changes needed to do those, frankly, we could move right to single-payer.
Raise my taxes? Knock yourself out.
If my taxes go up $10,000 a year, but insurance drops $24,000 — I’m ahead, way ahead. If employers no longer have to worry about providing health care and all of the headaches of providing health care — think of the savings. Even if half of the savings are moved to salary (in part to offset the higher taxes), profitability will increase.
And here’s another thought: health care costs are one of the big drivers of cost increase for local school districts (about 70% of annual budgets). If all teachers and staff are on a government-run health care system — we could see sizable drops in real estate taxes.
In short, only two groups lose: private insurance companies and rich folks, if this is done right.
Everyone else could win.
While some insist on an immediate transition to single-payer, I do think my half-measures are a good first step to one, unified system within the next 20 years.
It’s clear that we need to do something, as the current system is not sustainable — my own health insurance is more than my mortgage, which is sheer lunacy.
