TWO APPROACHES TO HEALTH CARE REFORM

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Editor’s note: Here’s a handy, popular comparison of the leading Democratic approach with the single-payer approach prepared by Leonard Rodberg, Ph.D., professor and chair of the Urban Studies Dept. at Queens College/CUNY, and research director for New York Metro chapter of Physicians for a National Health Program:

By Len Rodberg, Ph.D

Private Insurance, Public Option with Mandates

Candidate Barack Obama: “Quality, affordable, and portable coverage for all”

• The problem: Too many uninsured
• The solution: Require everyone to have insurance
• Private insurance with a public Medicare-like option
• Insurance “exchange” to facilitate purchase of insurance
  *Guaranteed issue, community rating by insurance companies
• Sliding-scale subsidies for low-income individuals and families
• Employers must contribute or pay into a public fund
• Continued reliance on private insurance, no regulation of premiums or reimbursement practices
• “Keep what you have” - continuing restricted choice of providers and medications
• Cost control through computerization, disease management, insurance company competition

Expanded and Improved Medicare for All (HR 676)

John Conyers: “Ensure that every American, regardless of income, employment status, or race, has access to the highest quality and affordable health care services possible.”

• Automatic enrollment in unified public plan
• Free choice of doctor and hospital
• Complete portability
• Comprehensive benefits
• Doctors and hospitals remain independent, negotiate fees, budgets with public agency
• Public agency processes and pays bills
• Financed through progressive taxes
• Addresses regional and local variation in resources
• Cost control through budgeting, capital planning, emphasis on primary care, encouraging more productive, cost-efficient work force and cost-effective medical practices.

What’s Wrong with Any Approach that Includes Private Insurance?

• Will not achieve universal coverage
• Will not improve insurance coverage for the average person
• Will not make affordable insurance available to everyone
• Will not address the problem of underinsurance (co-pays, deductibles, denials, exclusions)
• Will not control the continuing growth in the cost of health care and premiums.
• Require complex, intrusive mean-testing and income-based subsidies.
• Well be opposed by insurance companies and many businesses, especially small business
• Doesn’t benefit enough people to build great popular support.