|
It seems hard to believe
to us, but there is actually a debate going on about whether health
care reform should include a public plan option – as opposed to only
private insurance plans. (Never mind whether health care reform
should simply be one public plan, or a choice of public plans!)
We have discussed why a public plan is necessary. The inevitable
conclusion is that any reasonable approach to health care reform
must include, at the very least, a public option.
But what would a public plan look like? What elements of a public
plan are essential? Here are the indispensable dozen elements:
1. Like the long-standing, public Medicare program, the plan should
be available to all, throughout the United States, without
exclusions for pre-existing medical conditions, and with community
rating (the same base premium for all, regardless of age, medical
history or other "category" that the person may fit into).
2. The public plan should resemble the traditional, public Medicare
program. (Polls show that 80% of Medicare beneficiaries are either
"extremely" or "very" satisfied with Medicare.) In designing health
care reform policy makers should learn from the successes of
traditional Medicare and the costs of privatization.
3. The public plan, as well as any other plans authorized by
Congress, should receive additional payments or "risk adjustments"
for sicker or more costly patients. This is necessary so no plan
ends up being a default for more costly people with the result that
it becomes insolvent.
4. The public plan's benefits should be at least as broad as
traditional Medicare, and should be enhanced by adding coverage for
mental health, dental services, long term care, vision care and
eyeglasses, hearing aides, and increased coverage for preventive
services.
5. A greater emphasis should be placed on primary care, especially
for manageable chronic conditions. This emphasis should be
financially encouraged with incentives to providers and enrollees.
Perhaps most importantly, the plans should have a clear rule that
care designed to maintain (as well as to "improve") function or
health status is covered.
6. Out-of-pocket expenses should be limited. Public plan premiums
(and those of private plans, if they are to be offered) should be
affordable, with no co-insurance or deductibles. Although there is a
school of thought that requiring patient co-pays makes them better
health care consumers, studies show that when cost sharing required,
many people cannot afford it and forego necessary medical care or
prescription medication. The result: more serious medical conditions
and more costly care down the line. (Rosenthal, What Works in
Market-Oriented Health Policy, New England Journal of Medicine, May
21, 2009)
7. Subsidies should be provided for lower income persons, based on a
sliding scale, which would assist with premium payments. Premium
costs should capture regional costs differences, as should subsidies
to lower income people.
8. The public plan should have the authority to negotiate prices
with health care providers and pharmaceutical companies.
9. Enrollment procedures and time frames in the public plan should
be user-friendly. Eligible persons should be able to move freely
between whatever plans are offered, particularly when there has been
a change in an employer's health care coverage or a change in the
individual's circumstances.
10. There should be a simple, easy to use appeals process for
(public and private) plan participants based on the Medicare appeals
process, and assuring that all current due process and appeal
protections guaranteed to Medicare beneficiaries are afforded to
participants in plans created through health reform, including the
public plan and any private plans.
11. The public plan should include financial payments to providers
for offering interpreter services and for translation of materials
into the major languages of the enrollees whom they serve. Education
and training should be offered to providers to assure that treatment
and patient education is culturally relevant, in order to assure
positive health outcomes and minimize the need for more expensive
care down the line.
12. US citizen-children
and the parents of those children, if the parents reside in the
United States, should be eligible to purchase insurance through the
public plan.
These dozen essential elements of health care reform would ensure
that enrollees are able to access comprehensive, affordable health
care and achieve positive health outcomes at a reasonable cost to
society.
Isn't that what health
care and health care reform should be all about?
Blog About it!
www.cmahealthpolicy.com |
