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Tell Sen. Baucus single-payer should be on the table

By GENE FENDERSON
Great Falls Tribune
January 5, 2009

In presenting his national health-care plan, "A Call to Action -- Health Reform 2009," Sen. Max Baucus said, "My door is open and I seek partners with 'can-do' spirits and open minds.'"

Earlier though, in the health-care forums he held around Montana, Sen. Baucus stated very strongly that a single-payer health-care plan "is off the table".

Believing that the senator's "door is open," I maintain that a single-payer system must be on the table because it can help save our present and future economic well being as a state and nation.

The estimated cost of our present health-care system is $2.3 trillion dollars per year, more than 16 percent of our gross national product, compared to less than 9 percent of GNP in other industrialized countries.

I estimate the total amount spent on health care in Montana at $5.5 billion a year, including both private and public sectors. Well over $1 billion of that is spent on exorbitant administrative fees and cost shifting (people with insurance being billed higher charges to offset some of the losses from providing care to people who are underinsured or uninsured because they cannot personally afford it, their employer cannot afford it, or they don't think they need it and do not want to pay for it).

We don't really have a "system." What we have is a confused maze of coverage types and providers -- Medicare, Medicare Advantage, Medicaid, SCHIP, military, veterans administration, Indian Health Service, federal employee coverage, health savings accounts, community health centers, private insurance, dental insurance, vision insurance, medical coverage in auto insurance and more.

Unfortunately, the Baucus plan simply adds even more layers of confusion to this hodgepodge, which is already driving costs up and up for all Americans. We can do better. We must do better. That is why a single-payer system must be on the table.

What do we need? A basic, simple plan that charges all individuals who can afford it and all employers their fair share. One that covers all Americans, rich and poor, healthy and ill, young and old. A plan with no one refused coverage, no exclusions for pre-existing conditions, absolute choice of providers, total portability, no bankruptcies due to health-care bills, and an overall cost comparable to other industrialized nations.

A plan that will also provide our primary caregivers a standard of living that will attract and retain them.

What would work? A plan modeled on Medicare.

Medicare works well. It has overhead of 2.2 percent compared to 15 percent to 20 percent or higher for private insurers, even some nonprofit insurers.

Medicare has kept millions of Americans out of poverty, protected their hard earned savings and their homes, and allowed them to live with dignity.

Medicare includes supplemental insurance plans which help hold down over-utilization. A comprehensive American Medicare Plan could cover all Americans with a simple enrollment process based on proof of citizenship.

Existing systems serving specific populations (the military, veterans, and American Indians residing on their reservations) could continue to cover these populations. At their option, Indian tribes could choose to be covered by the American Medicare Plan.

A comprehensive American Medicare Plan could be implemented over a 10-year period allowing the system to expand in stages.

An incremental approach also allows insurance companies to change their product lines and services in a systematic, orderly fashion. Coverage would start the first two years by enrolling children and young people through age 25, by far the cheapest group to insure.

The second two-year group to enroll would be adults age 26 through 36, then the next two-years, those 37 through 47, the final two-year group would be those 48 through 64, the most expensive group.

As each adult group (those ages 26 through 64) enrolled in the comprehensive American Medicare Plan, they would also select a supplemental plan.

A person whose employer provided a supplemental plan as a benefit would automatically be covered under that plan, in addition to the American Medicare Plan.

Union members whose health and welfare trust offered a supplemental plan would be enrolled in that plan. Others could choose a supplemental plan from those offered by the government or by private insurers.

The American Medicare Plan would be paid for through an employer payroll tax calculated on a sliding scale of wages and number of employees, helping to level the playing field among all employers. Payroll tax credits would apply, as they do now. Full coverage for children from age 0 to young adults age 25 and people earning less than two hundred percent of the poverty level would be paid for from these revenues.

Adults making more than 200 percent of poverty would pay the normal Medicare fee and their own supplemental plan premium, based on a sliding scale. These costs would also be tax deductible for the individual.

This is just the outline of a uniquely American single-payer plan that could work, but only if Sen. Baucus puts a single-payer approach to health reform back on the table and opens the door to discuss all the options.

We need real change in health-care and we need it now. Please join me in urging Sen. Baucus, all of our congressional delegation and President-elect Obama to keep single-payer on the table and a part of the discussion.


Gene Fenderson was a board member for a Montana Taft-Hartley Health-care Trust Fund for 25 years and continues to participate in the health plan. Write to him at gfenderson@imt.net.

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