Should we fear government-run health insurance?
by Dr. John Messmer
Sunday July 05, 2009, 8:59 AM
By Dr. John Messmer
In the three decades I have been a physician, I have been a strong opponent of a government-run medical system.
Medicare and Medicaid are touted as programs that work. However, Medicaid is extremely difficult to work with as a physician, and Medicare is a conglomeration of rules and programs that would confuse Rube Goldberg.
There is a commonly held belief that Medicare's administrative costs are well below private insurers. Part of the reason Medicare has low administrative costs is it shifts them to the hospitals and physicians. The other part is that much of Medicare's costs are hidden in the federal bureaucracy and how Medicare gets the funds to run.
The only real cost difference between Medicare and private insurance is the cost of personnel in private plans and no profit margin for the government. Medicare pays private insurers to run the insurance program, and they make a profit from that contract. Do you really think they are managing Medicare that much more efficiently than they manage their own businesses?
I would prefer to have private industry fix our health insurance system, but I know it never will. If private insurers had any intention of doing it, they would have responded to President Clinton's attempt to fix health care with a well-designed, affordable solution that was inclusive of everyone, transferable when leaving a job or residence, based on shared risk among all subscribers and was available to anyone regardless of their health status. They have had more than 15 years to respond but have done nothing.
Millions of Americans have no coverage for health care, some by choice, but most because they can not find or afford it. Millions with health insurance are not covered for serious health conditions or are covered inadequately. Millions more have coverage and are spending it on unnecessary services or paying more than the services are worth.
For many Americans with health insurance, the cost is unbearable and getting worse. It's clear that private industry has no intention of fixing this. It's not in their business model.
The only option left is a government plan to fill in the gaps. Yes, it will compete with private insurers. It will probably drive the cherry pickers, who select the most highly profitable people to insure, out of the health insurance business. Good riddance, I say. If the plan is properly designed, it will provide coverage for preventive services and treatments that are evidence based. There should be a co-pay for people above a certain income. Private insurers can continue to generate income by selling expensive plans with lots of options and supplements to cover the co-pays and deductibles of the government plan.
Dr. John Messmer is associate professor of family and community medicine at the Penn State College of Medicine and associate vice-chair for inpatient medicine and medical director of the Penn State Hershey Medical Group, Palmyra.
Small employers would not have to struggle to pay for a lousy plan just so they can offer something to their employees. Large employers would be able to offer a menu of plans depending on how much an employee is willing to contribute.
I suspect I would have criticisms of this new government-run plan as I now have for Medicare and Medicaid. It would probably have the same complicated billing rules and a million exceptions to the rules that all insurers now have. It will probably inadequately reimburse primary-care services just like all the other insurers. But at least people will have the ability to get medical care. It disturbs me far more to have patients skip needed care for lack of ability to pay than to have one more government bureaucracy.
If the private insurers and their conservative supporters want to avoid a government-run plan, they should use the energy they expend defending the status quo to work on real, comprehensive solutions so we can have an affordable system in which no one is excluded from care.