Will a Public Plan Bring Better Care?
Letters
New York Times
Published: June 24, 2009
To the Editor:
Re “A Public Health Plan” (editorial, June 21):
A public plan option that competes with private insurers won’t fix health care. Competition in health insurance involves a race to the bottom, not the top. Insurers compete by not paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients. These bad behaviors confer a decisive competitive advantage; a public plan would either emulate them — becoming a clone of private insurance — or go under.
Moreover, the savings on overhead from a public plan option are far smaller than you suggest. While it might cut insurers’ profits (which is why they hate it), that’s only 3 percent of the roughly $400 billion squandered on health bureaucracy annually.
Far more goes for armies of insurance administrators who fight over payment, and to their counterparts at hospitals and doctors’ offices — all of whom would be retained with a public plan option. In contrast, a single-payer reform would radically simplify the payment system and redirect the vast savings to care.
Steffie Woolhandler
Cambridge, Mass., June 21, 2009
The writer, an associate professor of medicine at Harvard, is a primary care doctor.
To the Editor:
Your editorial suggests that primary care physicians are paid more by commercial health plans than by Medicare. In my practice as a family physician in the Bronx for almost 30 years, it just isn’t so.
Over the last few years the commercial plans have taken advantage of their one-sided contracts to pay about 70 percent of Medicare rates, or about $48 for a visit. CMS Medicare pays $71; the commercial Medicare Advantage plans pay me about $42, and require many administrative tasks.
Health Affairs reported last month that primary care doctors average $72,675 in annual costs for fulfilling commercial insurance’s authorizations, certifications and billing work ($14 a visit).
Medicare has proven far more efficient over 40 years for patients and primary care. That is why the New York State Academy of Family Practice has supported a single-payer plan.
Bob Morrow
Bronx, June 21, 2009
The writer is on the board of trustees of the New York State Academy of Family Practice.