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Posted by on Aug 11, 2009 in Economy, Health, Media, Politics, Society | 6 comments


A public plan or option does not necessarily require a governmental entity as an administrator, nor the creation of a subsidized non-profit foundation, a healthcare co-operative, or anything resembling a government-run program as part of the proposed local Health Care Exchanges. We could merely require that minimum healthcare coverage be offered to every American in a “public” plan by every private sector health insurance company. Democrats should not insist on a public plan run by a new governmental entity as central part of their reform efforts when such an approach may be excessive and not needed to ensure universal coverage.

Switzerland has universal coverage but through public legislation requiring all private insurers to provide a minimum “public” health insurance plan to all citizens covering a specific list of treatments, drugs, equipment, and care, including various patient rights and protections. All physicians and healthcare providers would have to accept payments from this minimum “public” plan. The monthly premiums for this plan would be regulated and some public subsidies would be available for those who could not afford them to ensure all people have health insurance.

As in Switzerland today, every person would be required to purchase at least the minimal “public” policy from one of the more than 60 private healthcare insurance companies. The U.S. could require that every private business would have financial obligations to help subsidize premiums for the poor, or they would continue to offer health insurance to their employees. Health insurance is not tied to employment in Switzerland but they do regulate their private health sector more than the U.S. but not enough to drive away private enterprise. They also spend only 11% of their GDP on healthcare versus 16% in the U.S. – a significant savings.

Private insurers would be able to compete and offer additional healthcare coverages and plans in addition to the minimum “public” policy they offer to those individuals and businesses that need or want to supplement the basic insurance. All individuals would have complete freedom to choose their physicians and healthcare providers, and could purchase additional insurance at any time from private firms. The Swiss system already provides this universal coverage working with the private sector and without any government-run public option.

The U.S. could easily use some of the Swiss system and merge it onto our existing system. This might actually get some meaningful healthcare reforms passed this year – and even in a bi-partisan fashion, but only if reform takes such a limited yet comprehensive approach. Everyone in the U.S. should not view the current efforts as the end-all for healthcare reform. Instead 2009 could be a worthwhile start on several reform fronts, upon which we can build upon in a rational, bi-partisan, continuous experimenting and learning effort over the next 10 years.

A big administrative savings for all the major players in healthcare system, including the taxpayers and patients who pay for everything, would be to have one nationwide claims form for most procedures that would work for all private and public insurance carriers. Another would be to strictly police the system for fraud and abuse. We really have to set up an independent national entity with offices in each state to aggressively fight double and triple billings for the same procedures, over-charging for some equipment and services, and the serious problems arising from early discharges from hospitals resulting in costly readmissions. Why these common-sense approaches have been ignored for so long is beyond comprehension.

I personally believe that our “healthcare system” is more of a bloated and wasteful disease management system – and not really designed to encourage wellness or a healthy population. We need to encourage a lot more experimentation with respect to better treatments and cost containment over the next decade.

We also need to address medical malpractice reforms that would reduce unnecessary and costly excessive testing and “cover-your-ass” medicine. However, all medical mistakes must be honestly addressed and corrected systemically. Furthermore those unfortunate people injured or family members of patients killed by malpractice must receive fair and just compensation promptly without having to resort to lengthy and expensive litigation.

Conservatives and Republicans have set up dozens of “straw men” and fake claims about proposed Democratic healthcare legislation. Even though none of the multiple documents in the House and Senate come close to these outrageous allegations, many people believe them.

Too many people have been misled into believing that big fascist-style death squads will descend upon America killing certain unwanted people, healthcare will be severely rationed, abortions will be performed on unwilling victims, the government will strangle patient choice of physicians, the free-enterprise system will be destroyed in a socialistic coup, and a myriad of other myths will occur. These falsehoods have naturally enraged uneducated, fearful and confused people across the country. Unfortunately many voters believe what they want to believe and they have to be educated or placated. What they lack is an actual piece of legislation that actually contains the language they imagine.

Perhaps a House or Senate subcommittee should put together a bill that contains every possible nightmare that the noisy opponents really fear and imagine. If there actually existed such a horribly dangerous and obviously unpopular bill, then everyone could rally against it, both houses could denounce it and quickly vote it down. Then we could simply move onto real healthcare reform without the lies, misinformation, demagoguery, grand-standing, and overall idiocy the current debate has engendered.

If the various legislative proposals had this evil document with which to be compared, then we could readily see the differences, and the best choices might become more obvious and easier to make. It doesn’t help that all the current proposals in Congress lack clear summaries of their more than 1,000 pages of text, and that key provisions have not even been written since the members are still arguing about what to do.

There are a number of different proposals on the table being debated and several viable alternatives but lack of information permits imaginations to run wild and we end up with the fear and chaos of today. All the inane, ridiculous, asinine, moronic and extreme proposals should be put out for public display in one piece of legislation and then roundly defeated. This would calm down a whole lot of the electorate in quick order.

Democrats have to clearly explain their healthcare proposals in a short summary so any voter can quickly grasp their meaning. President Obama should make a televised national presentation of what his main goals for reform are, not continue to coyly hide behind the myriad of proposals being hashed out in confusion by Congress. He must clearly state that the reforms this year are just a major first step that will take several years and more honest experimentation to succeed, particularly in the area of controlling costs. This might placate the Democratic base that wants far more reform than the majority in the country want to undertake in 2009.

If Democrats with their absolute control over Congress and the Presidency cannot deliver on healthcare reform, new climate, environmental and energy plans, immigration reform, and start getting people back to work, they will all face hell in November 2010 from the voters. Democrats may have to do all of this without any Republican support but they have to manage their own members better. They will either succeed or fail together.

Appealing to the fears and gut feelings of voters is sometimes appropriate if Democrats show the results of doing nothing in healthcare. It would be good to remind voters that most Republicans even fought the creation of Medicare, something they now claim to be defending. Democrats cannot win the debate on an intellectual basis alone. They should learn that much from past Republican political and legislative successes, and their willingness to fight in the trenches for their goals. People are emotional creatures and sometimes they have to be addressed on various levels – but always maintaining the truth. If Democrats do not match Republican zeal and emotionalism in all national debates and legislative initiatives, they will certainly face many defeats in the future, regardless of their growing demographic strength.

8/11/09 by Marc Pascal in Phoenix, AZ

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