Contentious: President Obama has called for sweeping healthcare reforms. Above, Obama introduced US Health and Human services Secretary nominee Kansas Governor Kathleen Sebelius in the White House last month.
(Jim Young/Reuters)Photos (1 of 1)
Healthcare battle brewing: political groups gear up
A public insurance alternative is likely to be the most contentious of the reform proposals.
By Alexandra Marks | Staff writer/ April 8, 2009 edition
Reporter Alexandra Marks discusses the upcoming debate over health care reform.
Reporter Alexandra Marks
New York
The Obama administration hopes to give all Americans the option of buying into a public, Medicare-style health insurance plan. That is now shaping up to be the biggest flash point in the emerging debate about healthcare reform.
Advocates of a Medicare-style plan say it would give consumers a lower-cost alternative to private insurance, forcing those private insurers to become more responsive to consumer needs. Opponents counter that it would undermine the private health insurance market by prompting millions of businesses to switch to the cheaper, public alternative. In the long term, they argue, that would undermine consumer choice in healthcare.
Lawmakers and their staffs are currently hammering out the details of reform legislation that is expected to go to the floor in June. But interest groups on the right and left have already begun a fierce ideological battle, with each side trying to shape the public’s perception of a public insurance plan.
A coalition of conservative groups led by The Heritage Foundation just issued a list of “six deal killers” for healthcare reform. Top on their list is the creation of a public health insurance alternative. On the liberal side, Howard Dean is leading a grass-roots campaign and petition drive with groups like MoveOn.org and Democracy for America to support a Medicare-for-all-type alternative in any reform legislation.
“This is a relatively new idea. It’s not completely framed in the public’s mind yet, and so the debate could shape where people finally come out on the idea,” says Robert Blendon, a political and healthcare analyst at Harvard’s School of Public Health. “Initially, people are very favorable to the idea of a choice that could get them good medical care at a lower price, but they haven’t thought about the implications yet.”
In the past, opponents have swung the public
Currently, a few polls show that more than 70 percent of Americans support the idea of having a choice between a private and a public health insurance plan. But as history has shown, that could change dramatically.
In 1992, when President Clinton first outlined his Health Security Plan, more than two-thirds of Americans initially supported the idea. Then, the health insurance industry launched a massive advertising campaign opposing the plan. Within a year, support had plummeted along with any chance of healthcare reform.
Similarly, in 1945, when President Truman proposed a national health insurance plan, 75 percent of Americans were in favor. But after the US Chamber of Commerce and medical groups attacked the plan as “socialized medicine,” support sank to just over 20 percent.
“It really matters how each side gets their ideas out there and frames the debate – both sides are trying to influence bloggers and columnists to lay the groundwork for how people see it,” says Professor Blendon. “On one side, it’s framed as a terrific thing that will lower costs and give you more options. On the other, it’s painted as something where people could end up in a straitjacket of government-directed healthcare.”
Impact on consumer choice
Opponents of a public health insurance alternative, such as the Health Policy Consensus Group, the conservative coalition that issued the list of “deal killers,” contend that the government would use its “regulatory, pricing, and taxing authority” to favor its own plan. The group says that would make it difficult, if not impossible, for private health plans to compete and consumers would eventually find themselves without private insurance alternatives.
“If Obama sets up a public plan, and then he sets up an employer mandate on top of it – where all of the economic incentives are designed in such a way that employers will start dropping people by the millions out of their existing private plans – there is no way Obama keeps his promise that everyone can keep their current health insurance,” says Robert Moffit, director of the Heritage Foundation’s Center for Health Policy Studies.
A Rasmussen poll in December 2008 found that 58 percent of Americans would oppose a public plan if they thought it would undermine their present private insurance policy.
Supporters of the public insurance option charge that conservative groups are “blatantly” misrepresenting Obama’s plan and exaggerating its impact on private insurers. “There will always be people who want private insurance, and this system allows them to have it,” says Dr. Dean, founder of Democracy for America. “It would be like what everyone over the age of 65 already has: You’d be able to choose your current plan, or you could choose a public option like Medicare.”
The presence of a public health insurance plan will not drive private insurers out of business, say advocates such as Dean, but force them to become more efficient and responsive to businesses and consumer needs because they’ll have some competition.
While each side gears up for battle, some health-reform advocates are concerned that inflexibility on this issue could damage the overall goal of reform.
“It’s one thing to seek strong and broad support for different faces of healthcare reform, but it’s another to draw hard lines in the sand. That demonstrates a reckless disregard of the American public’s need for meaningful healthcare reform,” says Ron Pollack, president and CEO of Families USA, a health-reform advocacy organization in Washington. “Clearly, on the very difficult issues that are at the heart of healthcare reform, there needs to be a willingness to search for common ground instead of a knee-jerk rigidity.”
Comments
2. Patty McCredie | 04.08.09
Redstickcreek is absolutely right. And it’s beyond me why we have to be so careful of the feelings of the health insurance industry. After what they’ve done to us, why do they now get to dictate terms?
3. Arturo Randolph Melian | 04.08.09
I am an American citizen living in Sevilla, in the south of Spain. We have a public health care system and it works GREAT. There is unlimited care, operations, medicines, etc. The facilities are clean are you are treated with competence and politeness.We have a toll-free number for booking an appointment with the doctor.
You have a medical card wich you take to the pharmacy, they introduce it in the computer, and out comes your list of medicines, for wich you pay very little, a token amount. There are all kinds of agreements with the pharmaceutical industry to offer many drugs as generic, lowering the cost considerably.
In addition, anyone can ALSO have a private health insurance, if he so wishes. Not many people do, since the public system works quite well.
Overall, our system is estimated to cost about 45% less than the for-profit US system, and covers everyone.
On the contrary, in the US we have seniors going blind or dying of diabetes after having worked all their life, due to a lack of medical coverage. I find the present US system a cruel anacronysm, an inmoral barbarity improper of a civilised country that claims to have Christian roots.
I hope Obama is not timid and goes ALL THE WAY towards implementing a European-style system. If the American people saw and experienced what we enjoy in Europe, there would be an armed uprising demanding immediate implementation of the same thing. This reality of the well-run public health care in Europe is deliberately hidden, it seems to me, from the American public.
Time to find out !!!
4. edword | 04.08.09
Three days in the hospital can cost the same as a new house. Lose the skyscrapers and executive jets,everybody who works-pays and you get to keep your house. Per Canada it won’t be as good as we have now but if you happen to get sick for a week you won’t owe the health care industry for the rest of your life.
5. Skeptic | 04.08.09
Why is it that no one is mentioning that Medicare doesn’t pay all of the medical bills today? Almost everyone with Medicare has a medicare supplement policy of some sort to pay the difference. And even with that and the often mentioned “greater efficiency” of the program, why is it in financial crisis? Just curious…
6. John Lentini | 04.08.09
When I am sick, my goal is to find care. My insurance company’s goal is to maximize shareholder value. Paying for my health care does not further that goal. My insurance company may even hire another company (whose goal is also to maximize shareholder value) to further restrict my access to care.
We hear alot about health care being “rationed” by government bureaucrats after health care reform. What we have now (those of us who are insured) is health care being rationed by insurance company bureaucrats.
This is no way to deliver health care.
7. Ash Reddy | 04.08.09
In this day and age when 10s of millions of Americans are suffering from lack of decent healthcare and insurance, I am surprised that there is even a debate on this. Any common man and family in America making less than 200K annually should find a public health program good for them. If the rich want to get their own private doctors so be it. For example, an X-Ray that should cost $5 costs about a $1000 in America, a clear ripoff. Let the govt train another 500,000 medical professionals in America and bring cost of healthcare per family under $1500 per family, whether it is employer or employe paid. What is sad is the number of people I see going to India for medical surgery. Unless you are old and covered by medicare, there does not seem to be any way out for poor and unemployed middle class people in America to get decent healthcare. Try getting medical treatment without insurance and you find yourself paying 5X times more!
Maybe offshore medical companies India and Phillipines need to come in and cover the uninsured at 10% of the corporate rates! This seems to be the only option if the govt, companies and people do not agree on a good healthcare policy. Do we want to outsource more jobs overseas?
8. Jenny L | 04.09.09
Only a single-payer approach to healthcare reform will END THE INHUMANITY OF OUR FAILED HEALTHCARE INSURANCE SYSTEM, WHERE PROFITS ARE MORE IMPORTANT THAN PATIENTS’ HEALTH.
Only a single-payer approach will end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor and has resulted in 50 million Americans without healthcare and 87 million Americans without health insurance at some point in the past 2 years.
The solution? NON-PROFIT, UNIVERSAL, SINGLE-PAYER HEALTHCARE. It works well in many, many countries around the world.
HR 676, The United States National Health Insurance Act, would ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services.
9. StephanAndrewBrodheadForCongress | 04.09.09
Medicare is a disaster. Obama wants more money sent to the Government coffers because Medicare, Medicaid, and Social secuirty are broke. They will plunder the fund just like they did Social Security.
http://www.youtube.com/watch?v=-FSoXKapKQs
10. James Stepp | 04.09.09
“The group says that would make it difficult, if not impossible, for private health plans to compete and consumers would eventually find themselves without private insurance alternatives.”
(tiny violin playing) Oh, you mean the companies who make their money by refusing care? The industry that has us paying twice as much for our health care as a percentage of GDP and yet we still have over 1/3rd of our people not covered? The scumbags that are, right now, using their lobbying and propaganda arms to protect their right to our dollars paid for with our blood, our loved ones and lives? You mean the very companies that have entire staffs devoted to looking for any nit picking thing they can find to deny you care so that their CEO can have another mansion?
If private insuance is so great why are we having this debate in the first place? Right now we do not have a health care system in place. We have a system for companies to make money on the misery of the people.
11. Bullawa | 04.09.09
The expensive & haphazard system of health insurance in the USA is now a major economic hazard. Just ask the big 3 auto companies. Change is necessary for the economy to become stronger & more competitive in the global village. Employer paid health care must be brought to an end & the massive funds held by large employers could be used to assist in the setting up of the public health insurance system.
Voters want equality & security. They appear to have learned from the previous 3 attempts to implement national health insurance. I do not think the lobbyists will find it so easy to defeat the will of the people this time.
The real alternative is to be found in Australia where every person pays a small tax (2.5% of nett income) except the very poorest who are treated at taxpayers expense. That guarantees access to all necessary health care including hospitalisation in a public ward. If you want all sorts of extras like private ward, choice of doctors & many unnecessary procedures such as vanity procedures, then you join a health care fund with a choice of private insurance or the Government run Medicare Private.
At present if you want benefits for physiotherapy, you have to be in a private fund. That is one service that should be covered by the public program. There is massive evidence that the availability of physiotherapy has a huge cost/benefit advantage in the longer term as far as the economy is concerned.
President Obama need to talk to Prime Minister Rudd.
12. Stephen Schimpff, MD | 04.09.09
Health care reform should not just be about access, important as that is. We need to address the high costs of care and the less than adequate quality of care and that means dealing with issues that most politicians probably do not want to tackle. Today the most costly care is of complex, chronic illness that, once developed, last a life time - like diabetes with complications or heart failure. Care today is not well coordinated and will not become so until reimbursement methodologies change. And many of these illnesses are due to our own adverse behaviors like smoking, obesity, poor nutrition, lack of exercise and stress. These are tough issues but they really need to be on the front burner.
13. Christian Bailey | 04.09.09
Consumers do have the ability to purchase affordable health insurance for themselves and their family. A recent customer was able to buy a very good health insurance policy from us for $138 per month. If she had lived in Massachusetts she would be paying nearly $300 per month because they have a government run universal health care system. People need to be aware that if the government steps in they will be paying significantly more for less coverage.
14. Gary | 04.09.09
If you loved the INS (remorphed as the USCIS), you’ll love what health care will become under Barack Obama.
15. Monica Nicosia | 04.09.09
As a self-employed individual who relies on her spouse’s health insurance plan, I think that offering a public insurance alternative is long overdue obligation. The private health insurance industry has had decades of opportunity to demonstrate the wonders of their offerings without true competition. Let’s see how they fare against an entity whose mission is to provide good quality and fiscally-responsible health care and not to accumulate profits for its owners or shareholders.
16. Dr. David Robinson | 04.09.09
A “public health insurance system” hybrid is sorely needed. Perhaps an idea is to have private insurers form non-profit subsidiaries which partner up with states in order to offer their plans at low cost to qualifying citizens. As a published author who addresses the potential insurance changes (strategicbookpublishing.com/TransformingBodyMindAndSpirit.html), I agree with Dr. Dean. Best, Ddr. avid Robinson
17. Ron | 04.09.09
Not all Government agencies work for the interest of the American people,a
perfect example of this is Washington State Department of Labor and Industrial Insurance. It is in bed with Business,they deny your claim or refuse to pay for pain medications after 30 days.Do they do this to lower cost? If you are injured on the job you can’t sue your employer,so you seek some benefits from L&I.You are referred to an “independent” doctor (who is in the pocket of L&I)
They decide you are healthy and should return to work as soon as possible.
On a quarterly bases the money for employees accidental Death/Injury is returned to the company.President Obama is in for a bigger fight than even the Middle East.If Healthcare isn’t fixed now it never will. America finally has a president of the people for the people.He has a tough fight against the traditional “Powers That Be”,that are exceptionally good at spinning the truth.The example of Washington State is just one case of varied interest that will group together to protect their interest by maintaining the “status Quo”. I hope President Obama wins but I think there will be a
campaign of disinformation just as there was against President Clinton.
18. Ron White | 04.09.09
They didn’t print my comments because I explained how Washington State Department of Labor & Industry denies to an injured employee then refunds those payments back to the company,making it cost effective to operate in Washington State.The poor health care Americans receive can be blamed on more than insurance companies. There are many different agencies that have their own self-interest and have made backroom deals in an effort to justify
their existence,while they spin the truth so they appear to benefit the general population they are only interested in themselves.If President Obama can pull off this miracle of providing health care to America there will be an end to many under handed agendas .
19. Sonya | 04.11.09
Private individual plans can and do deny people with pre-existing conditions. If you are unemployed or self-employed and don’t have access to group insurance offered by a large employer, and you have diabetes or high blood pressure, you can be denied for private individual plans. In many states even if you do get accepted, your pre-existing condition can also be untreated from one to three years before the insurance picks up the cost. People are dying in this country for untreated pre-existing conditions, and this is barbaric. Something has to be done or more people are going to die from lack of treatment.
20. Rachel in California | 04.13.09
Yes, we need affordable and available health care.
Yes, it would help to train more medical professionals, to bring their salaries more in line with the incomes of the people who have to pay them (through taxes or premiums).
Yes, the current American patchwork system is leaving more and more people uncovered.
Obama’s plan looks good. The Australian plan would be worth checking out.
We’re going to have to fight the insurance industry. If enough businesses join the fight to reduce their employee expenditures, we might win.
21. Lynne | 04.21.09
Guess what folks? Medicaid and Medicare are BANKRUPT. Health care rationing is around the corner and the government can and will say NO to any kind of treatment it deems fit….and by that time you will have no CHOICE. Ask any person from a country with socialized medicine how happy they are with their system. They get poor healthcare and limited choices. If you get really sick, they will pay to have you put to sleep.
Wake up, America!
22. Jerry McIntire | 05.06.09
@Arturo, #3
ditto! Our current system is barbaric compared to other developed nations with better care and lower costs– all with single-payer, universal health care.
You rationing-scare commenters need to check your facts.
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1. redstickcreek | 04.08.09
The care of human beings is not a commodity or product subject to an insurance paradigm, where claims(losses) are to be minimized for the sake of profit.