In the aftermath of the latest Republican House of Representatives’ attempt to “repeal and replace Obamacare” two things are certain.
- Health care is an entitlement due to all American citizens and a smaller group of legal non-citizens.
- Health care costs too much for too many people.
Quinnipiaq polling found only 17 percent of people approved of the Republican health care bill after hearing Congressional Budget Office projections that 14 to 24 million Americans might lose their health care coverage if the American Health Care Act became law.
Only eight percent of respondents supported just repealing Obamacare without replacing it.
But more than 50 percent want significant changes to the program. Changes that will reduce cost – the cost of insurance and the underlying cost of health care.
Americans Reject Government-Run Health Insurance
It is an axiom of American politics that Americans reject a public health care option.
I don’t know whether to be worried or amused that members of Congress do not recognize the USA has a defacto public option?
Rhetoric to the contrary: 49.6 percent of the American people get their health care paid for by a government-run insurance program. The dictionary definition of a public option!
Consider the facts.
There are 47.2 million Americans on Medicare.
More than 70 million Americans are covered by Medicaid through a variety of programs that have been added over the last half century.
- Medicaid covers about 40% of all children in the United States
- Medicaid pays for about 50% of maternity expenses in the United States
- Medicaid pays for 2/3 of nursing home expenses in the United States
The Veterans Administration claims 8.9 million health care plan participants.
The Bureau of Indian Affairs provides health care for approximately 2.2 million American Indians and Eskimos who live on traditional native lands.
The United States military insures +/- 14 million uniformed active duty and retired service members and their families.
The Obamacare private health insurance exchanges subsidizes premiums for 11 million Americans without employer based health insurance who are not eligible for either Medicare or Medicaid.
Approximately 4.8 million federal employees including civil service, executive and legislative branches and the courts participate in the federal government (employer) health insurance program
Add it all up — 154.8 million Americans get their health insurance from the federal government at a cost of +/- $2 trillion (about 64% of all health spending in the United States).
Embrace Reality with Public Option
What if Congress seized on the opportunity instead of railing against “government intrusion into health care”? They could turn the USA public option into a benefit instead of a financial sink hole with a bad reputation – an excuse for the escalating cost of care in America.
Let’s start with a new piece of legislation that all Americans without a law degree can understand:
A public option health insurance program open to everyone from age 0 to 64 years not covered by private employer health insurance. The plan would cover all currently mandated Essential Health Care Benefits.
To succeed Congress must remove the “Medicaid stigma”— the broad public perception that Medicaid is health care for only the poorest people delivered by less skilled personnel in substandard facilities. The insured cannot be embarrassed to “show their card”!
The new product must appeal to the 11 million who are currently insured under Obamacare exchanges and to some portion of the remaining 23 million Americans in the private insurance market. People must be willing to pay out-of-their-pocket to belong to the program.
This alternative begins with assuring prompt access to current-in-industry standard treatment in first class facilities – for example, Kaiser, Humana, Cleveland Clinics, and Sutter Hospitals – probably operating only as health maintenance organizations.
Congress should “guarantee” the plan offers best-in-class care options by enrolling themselves, their families and their staffs in the new public option.
The public option must be a good enough product to compete as one of the choices for Federal employees and their families.
Access to a public option health insurance card could bring the nation’s 8.9 million veterans improved care in their home communities.
How to Create a Realistic Funding Source: Follow the Money
A new and realistic funding source must be a cornerstone of the new legislation — fair to all, affordable and paid for now and into the future (not adding to the national debt).
There’d be some savings to be recouped into the public option funding pool from existing government activities:
- Collapsing the five or six government insurance bureaucracies into a single department.
- Eliminating the Obamacare guaranteed profits to private insurers.
- Claims processing through Centers for Medicare and Medicaid Services (CMS) at .84 cents a claim
There would be new funds earned from premiums paid by insured – based on income.
But these savings and premium payments would not come close to paying for the subsidized care of close to one-third of Americans = +/- $1 trillion/year
Every American has to know where the $1 trillion is coming from, how it will be collected, and how it will be spent.
Since the 1980s there has been a shift in our economy from production (30%) to consumption (70%).
Fewer good paying manufacturing and other semi-skilled jobs have swelled the rolls of Medicaid and reduced the role of employer-paid insurance.
Logically, then, the new source of revenue to pay for public option health care (even to continue to pay for Obamacare and Medicaid) must come from the consumption side of the ledger – taxes paid by the ultimate consumer.
Take a Small Step First
Congressional Republicans should acknowledge reality — pass legislation authorizing the development of a public option health insurance program effective January 1,2019.
Force Democrats – who have long argued for a public option — to “come to the table” leading to lasting, bi-partisan legislation.
Establish a budget line item and allow tax reform legislation to move forward.
Provide certainty to the current health insurance market and warn against unjustified 2018 insurance premium increases.
Encourage the health care industry, fearing further regulation, to come to the table with alternatives to ever escalating health care costs.
Isn’t that the bottom-line for all Americans?