Health Care Insurance Debate Questions Unfold
Major Issue Still Government-Sponsored Plan Versus Private Insurance
Jun 13, 2009
Health care reform must encompass changes in coverage and financing with an emphasis on preventive care and effective coordination of services, said former Democratic Senate Majority Leader Tom Daschle and former Health and Human Services Secretary Mike Leavitt. Appearing at a National Press Club forum June 2, sponsored by the nonpartisan AmericaSpeakOn.org, the two differed, however, on what the extent of the government’s role should be.
Rationing of care already occurs through inadequate insurance, the restrictions imposed in having a preexisting condition, and the inability to join a group health plan, Daschle noted. Access to necessary care in most other industrialized countries statistically is better than in the United States, he added. But access there to elective care is not as good as in the United States.
Acknowledging a departure from some in his own party, Leavitt, previously the Republican governor of Utah, said the market alone isn’t the answer in health care because an unstructured and unorganized market won’t resolve the problems in and of itself. “But I do think government can organize a marketplace where those decisions can be made,” he said.
Maintaining Level of Care
A key step is separating necessary and unnecessary care, Daschle stressed. “No one’s really talking about cutting below the level we’re at today. All we’re doing is trying to curb the growth of costs in the out years to save money from what they would be if we did nothing.”
Precedents exist for a private system operating under federal regulatory structure. Examples of autonomous decision making authorities in government outside of Congress include the Federal Reserve and the Federal Aviation Administration, Daschle said. “There are frameworks within which the consumer can make the best choices but the regulatory opportunities for us to make sure that it smoothly can be put in place.”
Among tools he advocates are use of health information technology, preventative care, payment reform, and eliminating unnecessary care and certain medical malpractice expenses.
Some in Congress are considering modifying the tax exclusion for employer-provided health insurance, requiring employers to offer insurance or pay into a pool, federal program cuts in Medicare and Medicaid, or possibly health insurance cooperatives—whether operated by states or nationally—to offer health insurance as a possible alternative to a public plan option. Both the House and Senate are trying to pass health care legislation in time to deliver a single bill to President Obama by October.
Opposition to Delaying Cost Implications
It’s unrealistic to focus on access now but delay cost issues until later on, Leavitt said. With the current health care approach in Massachusetts, he told the forum, the state is “making progress on access but the costs are astronomical because there are no real changes in the system.”
From his standpoint, Leavitt said he cannot reconcile adding $1.3 trillion to health care to the 16% of the entire economy now going for that purpose, and to put so many more on Medicaid as well as add a public insurance option plan that will drive more people from private to public plans.
The president favors a public option while most Republicans oppose one. Obama named Daschle as HHS secretary, but the former senator withdrew earlier this year following the revelation he had unpaid taxes.
Steven Dennis and Tory Newmyer, in the June 10, 2009 Roll Call, writing in “Chairmen Insist on Public Plan: Blue Dogs Remain Opposed,” noted some of the opposition to a public plan except as a fallback provision. “Advocates of the trigger idea argue that the threat of a future government-sponsored plan would be enough of an incentive for private insurance companies to act; some also expressed fear that the insurance industry would use its financial muscle to try to scuttle health care reform.”
Medicare Part D Plan
Unlike Leavitt, Daschle does not view the Medicare Part D prescription drug plan as a model for health care because of huge remaining drug coverage gaps for senior citizens. He prefers the TRICARE program for military dependents as a system in which the government assumes the risk but the insurance companies are responsible for administration of the plan.
The former HHS chief countered that Part D essentially had a public plan with a choice for coverage outlined by Congress. “Ninety-four percent of the public chose something other than the public plan,” he said. “The difference in Part D and the public plan is that the federal government was paying for everybody, it wasn’t the employers and it is the employers who are going to pay a lot on this.”
Despite denials to the contrary from Daschle, such involvement would mean the government was in charge, Leavitt said. “If you’re financing it and if you’re paying for it all, believe me as a guy who oversaw the biggest payers system in the world, you’re controlling it.”
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