Hearing on the Nation's Uninsured

United States House of Representatives Committee on Ways and Means Subcommittee on Health April 4, 2001
Testimony of Sara J. Singer, Executive Director, Center for Health Policy, Stanford University:

"Our plan would provide near-universal coverage among the non-Medicare population by making private plans more affordable. It would do so by using insurance exchanges to promote competition among plans."

Comment: The proposal of Sara Singer and her colleagues, Alain Enthoven and Alan Garber, includes the following:

* Insurance exchanges (private or public) - would offer individuals a choice of at least two plans, one that "provides some coverage for treatment by most providers," and one that is a "low-priced alternative"

* U.S. Insurance Exchange (USIX) - like Federal Employees Health Benefits Program, for small employers in "areas in which private exchanges do not emerge"

* Refundable tax credits - for families who purchase insurance through an exchange, phased out with increasing income

* Default plan - automatic for lower income individuals who do not enroll in a health plan - federal funding at 50% of the tax credit - for financing of public hospitals and clinics and "open access" providers

* Phased in cap - limit amount of exclusion of premiums from taxable income to "encourage value-based purchasing"

* Independent Exchange Commission (IEC) - similar to the SEC, to "encourage smooth information flow and functioning of insurance exchange markets"

It is amazing how tenaciously Singer, Enthoven and Garber adhere to the doctrine that the solution to our health care problems is to promote competition between health plans, in spite of the overwhelming evidence that the private bureaucracies of health plans continue to waste a tremendous amount of valuable resources, while failing to provide for the unmet needs of the uninsured and underinsured. It is also ironic that, in recognizing that this model has not worked, they now are proposing government bureaucracies, including the USIX and IEC, along with tax subsidization. Yet this very expensive program will enable only "some coverage," or a "low-priced alternative," or additional funding of public facilities as a default (doctrinaire multi-tiered health care). To allow the "market" to function, they are recommending more government involvement and more taxpayer funds, while doing virtually nothing to correct the excesses of the industry, and failing to propose a satisfactory level of assured coverage.

What is even more amazing to me is that Sara Singer continues to reject the brilliant proposal strongly supported by her cousin and our friend, Quentin Young. It is a proposal that would meet their goal of controlling health care costs, but on the supply side by utilizing health planning and global budgeting, a much more humane approach than making health care unaffordable for low and moderate income individuals by providing only inadequate, Spartan coverage. That proposal, of course, is universal, comprehensive, publicly-administered insurance, with everybody in and nobody out!

Don McCanne