Schumer Explains How He Would Level Playing Field Between Private And Public Health Plans
Schumer Explains How He Would Level Playing Field Between Private And Public Health Plans
Editor’s note: Today, we are live-twittering the Senate Finance Committee’s roundtable on how to expand access to health insurance coverage.
The New York Times’ Robert Pear reports that Sen. Chuck Schumer (D-NY), who is spearheading the effort to include a public health care plan in the final health reform legislation, “has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance”:
- The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.
- The public plan should pay doctors and hospitals more than what Medicare pays.
- The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
- The officials who manage a public plan should be different from those who regulate the insurance market.
- The public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims.
- The public plan should be required to provide the same minimum benefits as private insurers.
All of these seem fair enough. Leveling the playing field to allow private insurers to compete head-to-head with a public model (whether it be a Medicare-like arrangement or something that more closely resembles self-insured states) is an important pre-requisite for putting the theory of lowering insurance costs through competition into practice. But the crux of the issue is reimbursement. What Schumer doesn’t really address here is how the public plan will reimburse providers. Yes, it may pay more than Medicare does (as it should), but how will it set its rates? If the plan builds on the Medicare infrastructure, will it be able to use its negotiating clout to extract bargains or will it be required to pay something close to what private insurers (which rarely negotiate on behalf of their beneficiaries) currently compensate?
What’s troubling here however is Pear’s assertion that “one way they propose to do that [level the playing field] is by requiring the public plan to resemble private insurance as much as possible.” Remember that leveling the playing field is one thing, striping the public plan of its inherent advantages (its ability to use its size to negotiate better prices and its lower administrative costs) is another. After all, if the public option is just a clone of a private plan, then it’s pretty useless.
4 Responses to “Schumer Explains How He Would Level Playing Field Between Private And Public Health Plans”
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The whole idea of the “public plan” was that it would be available to people who couldn’t get, or couldn’t afford, private insurance.
So, if the “public plan” is to be funded by premiums and co-payments, how on earth could it ever be affordable to people without money?
May 5th, 2009 at 11:31 amA public plan should be available and it should be able to negotiate for lower drug costs (as should Medicare / Medicaid), like the VA. My hospital has a healthcare plan for the uninsured, where their premiums are based on income, so those making less pay less. This plan also has a price for Dr.’s visits (like $25.00 payable when you arrive).
A public plan should incentivize wellness (for both the patient, the physician and the treatment facility) and be based on outcome instead of the cost of treatment.
None of these ideas are new, but to mimic the current Private Plans would make it doomed to fail.
I can only hope that input from Public Health and Non-profit professionals will be included in the debate, not just the for profit enterprises, as they will tout their successes but not mention all of those for whom this system has failed/ denied benefits (too costly), etc.
The plan must include the patient’s bill of rights, advanced directive (mandatory) and ability to obtain care if out of local assigned healthcare entity.
We must all recognize and be willing to accept the concept that the plan will not be perfect, but anything is better than the systems that are currently available. The one issue that has not been addressed by anyone is how to handle those who CAN afford but opt-out of any healthcare insurance.
Lot’s of unknowns, but doing nothing is like saying that waterboarding isn’t torture. The “head under the covers” approach from the public will be disasterous. The public must step up and use a standardized web-based forum to voice their opinion (as if you are a GOP in blue state or Dem in red state, you voice will not be heard).
May 5th, 2009 at 12:39 pmAny insurance plan needs start up capital. Having a public plan get no appropriations is a huge hand cuff right off the bat.
May 5th, 2009 at 1:03 pmcheck out socialized medicine maybe you would like that; wailting forever for proceedures if approved at all, etc. Every time the government tries to manage and regulate something it always ends up a bigger mess than before.
May 6th, 2009 at 4:35 am