Extending Medicare and "Fairness" to Private Insurors

According to today's NYTimes, the Obama adminstration's preferred approach to health care reform is to allow individuals/families AN OPTION to buy their insurance coverage from Medicare, thus extending Medicare's reach beyond its current insured group of those 65 and over and certain disabled persons. The cost to a family of four would be approximately $9,000 per year compared to the current $11,000 per year average for private insurance. Anyone could purchase private health insurance if they prefer to.

The articles state that the insurance industry's objections are that such an offer of government-based insurance would be unfair to them since they would not have the bargaining power of the government in negotiating medical costs (and pharmaceutical costs once the ban on such price negotiation - imposed as part of the Medicare Part D legislation - has been eliminated).

Medical providers expressed concern that their compensation would drop if the Medicare program gets even greater power.

"Fair?" When we are talking about the national interest in assuring more affordable health care for the public, reducing the absurd amount of our GDP that we pay for health care and providing care for the approximately 40 to 50 million with no medical insurance of any type, where does "Fair to the commercial insurors" fit into the matrix. Compensation for providers? Well, if some of the obscene amounts paid to specialists is reduced, I will not be offended and perhaps some of those savings could be used to more appropriately provide better compensation for the family/primary care physicians.

The United States has shown that relying on profit-making private insurance companies to cover medical costs simply does not work. We have the highest percentage of GDP of any nation going to health care and we have rather embarrassing outcomes in light of what we pay. Our cure rates, infant survival rates are among the lowest of the Western world

It would be nice to be "fair" to the insurance companies but they are not a protected class when the interests of a national health cost and provision crisis is facing the US.

There are many scare tactics being used by those with vested interests in keeping the system unchanged. The providers and the insurors point to Canada as though their system does not work (and in some ways it does not but those weaknesses are not brought into the US by any plan to extend Medicare).

SINGLE PAYOR VS. SINGLE PROVIDER:

There is a difference between NATIONAL HEALTH CARE and NATIONAL HEALTH INSURANCE.

National Health Care is the British model and in part the Canadian model. Under this system in Britain, the physicians, laboratories, hospitals and ancillary services are operated by the government, the National Health Service in Britain. In Canada, while varying from province to province, the hospitals and diagnostic facilities and the ambulance services are operated by the government health programs but physicians are in private practice but paid for the services they provide by the government health insurance. People choose their own personal physician in Canada and, in some circumstances, choose the hospital they will enter. Because many provinces in Canada and the National Health Service in Britain have underfunded the hospitals and diagnostic facilities they operate, there are indeed waiting lists of often unconscionable lengths for some tests or procedures. Urgent and emergency care is, however, no different than what exists in the US now.

National Health Insurance is a completely different concept and this is what is being proposed by an extension of Medicare availability. National Health Insurance does not provide care at any level as occurs in Canada and Britain. National Health Insurance simply pays for the care that the private health care provider, lab or hospital provides. This is what currently happens with Medicare and with private insurance as well. But it does so with certain benefits:

1. It does not seek to generate a profit.
2. It benefits from a larger pool of insured persons to spread the costs.
3. It is able to more effectively negotiate prices for services, supplies and drugs.
4. It is able to establish rational levels of care provision.
5. It can more effectively encourage primary care and early care as well as preventive care.
6. It works better if it keeps costs down; private insurance is more profitable and works better for the shareholders if medical costs and premiums are higher (a percentage of profit on a larger number is bigger than a percentage of profit on a lower number).

and so forth.

Beware the scare tactics that say or imply that the Administration is proposing national health care -- no such thing is happening. The only proposal is for national health insurance as an option. Given the option of lower costs for similar or better care, the Adminstration is quite correct that citizens will likely opt for the expanded Medicare option.

Beware the scare tactics that say that expanded Medicare will result in rationing of care. Care is already rationed by private insurance companies. The insurance companies have formularies of medications they will cover and unlisted pharmaceuticals are simply unavailable. Insurance companies dictate which physicians or hospitals you can go to in order to receive insurance coverage (Medicare insureds can go anywhere). Insurance companies dictate to their participating physicians what type of care will be covered and what type will not -- in effect, private insurance companies are determining what care you will receive by simply denying coverage for what they don't want to pay for.

Finally, the United States already has National Health Insurance for more than half of the population of the country: Medicare, Medicaid (for the poor) and the Veterans Administration already insure more than half of the population. The Administration is not talking about a quantum leap or a change of direction in any way -- this is simply an expansion of what we know already works.

Fair? Let's be fair to ourselves and take this uncomplicated, relatively inexpensive step to make Medicare an option for everyone. We cannot sustain the current system. And don't allow yourselves to buy into what is simply propaganda from those who stand to lose huge profits.

And I am a free market person!!! But there are certain things that do not work in a completely free market. We long ago determined that utilities such as water and electicity are so essential that they required governmental intervention to assure universal availability and affordability. We further adopted policy that said that competition in the provisions of utilities does not work unless well regulated. It is simply time to acknowledge that available, affordable, quality medical care is such a universal need as to be treated in the same way.