"Reforming Health Care: Four Solutions from the United States Congress" was hosted by The New School yesterday here in NYC. Five members of Congress spoke about the four competing plans they are hoping might provide better health care while controlling unsustainable cost increases, declining quality, and the growing number of Americans who have no insurance or are underinsured. [I outlined the details of these plans in the previous blog post.]
It all comes down to this: do you trust the private insurers, the free market or the government to be the major factor in leading this effort? Some panelists talked about the idea of creating a health care plan that was uniquely American. Except for the single-payer solution which seeks to replicate the idea used in most industrialized nations, the mandatory private insurance plan and the free market plan would be unique to this country. But, they are untested and would be experimenting with the largest expense in the American economy as well as the personal care health of its citizens.
If there were an underlying theme to all these plans it would be the effort to break the link of healthcare insurance to employment. Tax incentives to individuals will play a major role except, of course, in the single payer model. Common to all these plans is the notion that each individual would have to take on a new level of responsibility to understand and accept preventive measures including improving diet and following an exercise regimen.
Bob Kerry, the president of The New School and former governor and senator from Nebraska, served as the moderator. and opened the event by discussing what he faces as an administrator for the health care benefits for his employees. He felt a responsibility in helping these people navigate their way to a reasonable solution to health care.
He said that this would be the first year that the baby boomers would be seeking Medicare benefits.
Kerry provided a personal perspective on some of the Senators. He mentioned Oregon Democratic Senator Ron Wyden's connection to New York by way of his wife's family ownership of the Strand bookstore.
He talked about Tom Coburn's practice in obstetrics, delivering over 4,000 babies in Oklahoma. The program for this event says, "...Senator Coburn had pledged to serve no more than two terms in the Senate and to continue to care for patients."
The first presenter was Ron Wyden and he talked about his involvement, along with Republican Senator Bob Bennett from Utah, in creating The Healthy Americans Act which will provide all Americans with the ability to enter a private health insurance plan of their choosing.
Wyden provided this quick calculation to underscore the waste that is endemic in our present system: with a yearly budget of $2.3 trillion for a population of 300 million, this would result in physicians taking care of 7 families while they received a salary of $200,000.
The beginnings of his plan came from the idea that the average American would want the same plan that members of Congress had.
Central to this plan is the concept selecting participants and creating pools that insurers could use to dilute risk. He told Kerry that as an administrator for his school, he would be removed from the process since it would be up to the private insurer to build a pool from any number of businesses or private individuals.
He later mentioned during the panel discussion that he wanted to talk with the American people to find out what they thought about their personal responsibility in participating in a plan where private was mandatory. This seems to be the biggest objection that he encounters.
He told of his conversation with a skier from Bend, Oregon who said he didn't have health insurance. Wyden said he pointed to the mountain and asked what would happen if he had an accident. The skier said *then* he would buy health insurance.
Here's a video where Wyden talks about his encounter with the skier:
Tom Coburn, MD, Republican senator, talked about his Universal Healthcare Choice and Access Bill that would be market driven. He said that the American health care system has never been fully exposed to the free market forces that would allow competition to moderate cost.
To illustrate this he asked, "Why is it that only doctors know who the bad doctors are?" He believes that transparency is needed so that individuals can make informed choices for their health care.
This would place consumers in the driver's seat for determining how they could negotiate for the best plan available. Those consumers who don't choose to try to bargain for the best plan would be eligible to buy into a default plan for their state.
His next point was about economies of scale. For an example, he talked about a woman who enters any hospital and requires a laparoscopic cholecystectomy (gallbladder removal using small incision surgery) which he said would normally cost $25,000. Instead, he offered the possibility that there could be a center of excellence where most patients with gall bladder disease would be sent. The insurer could then negotiate an arrangement where a discount is sought by giving payment up front, perhaps bring down the cost to $4,000. He said that this type of bargaining, leverging volume with discounts should be encouraged. It's interesting that Bob Bennett also underscored this point.
He talked about incentivizing risk by creating high risk pools that insurers could bid on. For instance, a patient with diabetes would have a higher level of reimbursement. Insurers who could contract companies that specialize in chronic disease management could serve these high risk patients more cost effectively
This incentivizing is also aimed at what he calls upfront health care or preventive medicine. He talked about approaching parents about providing better dietary option for their children, eliminating the caloric dense foods high in fats and high fructose corn syrup. This brought about one of the few rounds of applause for the panelists.
Coburn told Kerry that our healthcare system is an oligopoly in that not enough insurers can participate in the healthcare market. He wants to expose the healthcare market to more free market forces.
Unlike Rudy Giuliani and Mitt Romney, but in agreement with John McCain, he favors a plan where the consumers are not limited by state mandates and can choose plans anywhere in the US. I wonder if he would go so far as allowing re-importation of pharmaceuticals as a cost saving measure for consumers.
As an example, he mentioned that a 26-year old man can purchase a year's worth of health insurance in Kentucky for $650, while in New Jersey that same fellow would need to spend $7,250. You can seen in the video below that Kerry responded by saying that public companies have an obligation to shareholders to provide highest return and this might be a conflict in providing the lowest premiums in a free market. Richard Burr jumped in and mentioned that there might be another insurance company with a similar product that would be willing to provide less to its shareholders to expand its reach. He added Congress was able to increase competition and transparency thereby reducing costs with the Medicare Part D. He said premiums decreased by 28% and pharmaceutical costs lowered by 33%. Kerry then asked why this didn't prove that a government run single-payer plan could increase competition and negotiate lower costs. Not included in this video clip is Coburn's response where he said that Congress needed to borrow money to keep Medicare afloat, putting the burden on future generations. His plan for healthcare reform is intended contain costs right from the start.
Richard Burr, Republican senator from North Carolina, talked about his Every American Insured Health Act which would also utilize the free market to drive down the cost of premiums.
He illustrated to need for the individual to pick and choose plans by talking about his 22-year old son who had to leave coverage under Burr's health care plan. To continue with a similar plan would have cost $5,400. He called his son college and asked if they had made arrangements for health insurance coverage. He reasoned that having a population of young and mostly healthy students would give the school in negotiating better premiums for this pool. As it turned out his son was able to enroll in a plan where the premiums were $1,400.
Finally, John Conyers, Jr., Democratic Representative from Michigan, made his case for a single-payer plan, The United States National Health Insurance Act where government would fund private providers. It would replace the 1600 private health insurance providers with one governmental agency that would administer all health care entitlement programs.
Conyers cited the massive overhead the currently burdens health care spending including the advertising, CEO salaries and other expenses of companies supplying products and services. His plan would allow the government to negotiate these expenses down.
The question arises if the government can effectively bid down prices as well as operate a beauracracy efficiently.
Kerry asked if all those ads you see in the subway, coaxing people to sue their doctors would continue under the single payer plan or would special efforts be taken to address tort reform. Conyers said that this was not part of his plan, and would have to be addressed by the judiciary committee of Congress.
Conyers related the story of a woman who had gone to an ER and was told that she needed a lifesaving operation at that moment, but would first have to provide $500 upfront. She later told Conyers that that was the only bad check she had ever written.
He said he was tired of all horrors stories of people being turned away from ERs illegally.
There was little time for questions from the audience, since the congressmen were on a tight schedule. I was disappointed by the first two questioners who were health care professionals and essentially asked how they would benefit from these plans. Questions about access to the pool of health care dollars continue to be in the mind of many. It's time for the people expecting better care to speak up.
