Americans Want Health Security & Affordability, and Don’t Care About Myths & Legislative Procedures

As the House of Representatives prepares to vote on health care reforms that President Obama made a priority and which the electorate brought him to the presidency to enact, it is vital to focus on the big picture. The American people – and Members of Congress – should recognize the unique nature of this historic opportunity. This is a watershed moment that will define our nation’s social responsibility, preserve our economy, and improve our quality of life.

Americans Care About the Policy, Not the Process & Sideshow Issues

When facing such a transcendent turning point, it is no longer appropriate to be dissuaded by the arcane intricacies of the legislative process, nor by myopic devotion to sideshow issues. We all want enhanced health security and affordability, and, once we have it, we won’t care if it came by way of Reconciliation, the “deeming” mechanism, or some other legislative vehicle. After reforms are enacted, Americans who are protected against termination of their coverage for pre-existing conditions won’t care about targeted programs for Vermont, Florida, Connecticut, and Montana.

The same Americans who are angry now about the reform process will become much angrier in future years if reforms are not enacted and their insurance is terminated or becomes unaffordable because they are not protected. Without reform, an ardently pro-life family whose insurance stops due to reaching their lifetime coverage limits after a serious illness of their child will be much more focused on that than on their opposition to the 2010 bill due to its abortion language.

Policy That Does What Is Right for Americans

Ultimately, the benefits of substantive policy – and its improvement of our social fabric and quality of life – prevail. Abraham Lincoln did not allow projections of commodity market fluctuations to alter his drafting of the Emancipation Proclamation. Franklin Roosevelt did not withhold his leadership on Social Security legislation until the intricacies of tax treatment of deferred income for early retirees could be fully coordinated. Lyndon Johnson did not delay the enactment of Medicare until the anti-government naysayers – who today have organized into Tea Parties – were on board. Today’s America would be unimaginable without these advances.

At historic moments, such as the one that our country is currently facing, it is necessary to simply do what is right. The health care reforms that are under consideration are the right policies for America, in both the near- and long-terms, as they would have a positive impact for virtually all Americans (even including the insurance industry, which would collect premiums from millions more people, and enable the risks and costs to be spread among a much larger pool).

Myths, Misconceptions, & Deceptions Are Overcome By Facts & Courage

Doing what is right takes courage and commitment to the facts, especially in light of the many myths, misconceptions, and deceptions that have been propagated by self-focused special interests. Insurance companies fear the reforms because they will have to stop certain activities that have given them a competitive advantage, at the expense of the people who they are supposed to serve. But, since it would be unseemly and transparent for them to fight the bill on those grounds, they have instead manufactured illusory demons which fuel opposition by those who are susceptible to such manipulations.

Knowing that some percentage of the population is stridently anti-government, the myth of a government takeover of health care was created, even though there is absolutely nothing in the bill – nor even in earlier incarnations – which substantiated this. Knowing that most Americans are strongly supportive of their chosen health care providers, the myth was created that the ability to choose one’s providers and insurer would be curtailed, even though President Obama repeatedly emphasized that if you like your doctor and/or your insurer, then you can keep them, and the legislation confirms that. Knowing that everyone is worried about the cost of health care, the myth was created that the legislation would cause premiums to skyrocket, which has been debunked by economists and the Congressional Budget Office, and is patently untrue by virtue of the millions of Americans who would enter and pay premiums into the health insurance market.

In the current climate of unfounded, unsubstantiated, and even paranoid fears of change, doing what is right for the overwhelming majority of Americans requires fortitude to take action based on the facts, rather than on fears, by summoning dedication and determination. Moving the country and the people toward increased health security and affordability will depend on decision-makers’ willingness to embrace the responsibilities, ideals, and commitment to public service that are inherent in serving the greater good, rather than the good of special interests.

Policy Based on Core American Principles

The upcoming vote on health care reform is about principles. Humanism and equality are at the core of expanding coverage to those who do not have it, and preserving coverage for those who do. Fairness and consumer protection are at the core of affordability, to ensure that insurance corporations cannot price families out of the market with hikes in premiums, copayments, and deductibles. Fiscal responsibility is at the core of reforming the economics of our health care system to ensure its long-term sustainability for both the public and private sectors. Opportunity and justice are at the core of health security, which enables individuals and families to engage in “the pursuit of happiness” as they choose, without vulnerability to corporate self-interest.

The denial of these principles for the benefit of all Americans would be tantamount to giving amorphous, intangible, unsubstantiated fears priority over people. If a republic relegates the needs of its people to the back bench, it would be a foreboding sign of the unraveling of the social fabric. The deficiencies and injustices of our health care system have been so extensively evidenced and documented that it is imperative that they be remedied. Anyone who thinks that they are not vulnerable to these shortcomings is just one serious diagnosis or illness away from discovering that they are wrong. Reform is necessary to reinvigorate our core principles. The moral deficit that is being inflicted by our health care system is reprehensible and intolerable.

The health reform legislation being considered might possibly mean that each of us would pay an extra dollar for a meal at a restaurant to ensure that the cook, the waiter, the cleaning team, and their families have health coverage and the security that comes with it. But who among us would rather pay a dollar less for a nice dinner while looking at a crew that is uninsured and living in fear of illness? Moreover, if they do not have insurance, they may not have gotten treatment for an illness or disease that could be communicable to us at the restaurant. And, without insurance, if they did get treatment, it is likely that they went to an emergency room or a public health facility which was paid for by the rest of us anyway, as taxpayers and by shifting the cost to those with insurance. The waiter who serves the dinner would also like to be served well by legislators who can provide them with health security.

Rising to the Occasion to Do What Is Right

The day of reckoning on health reform is rapidly approaching. It will be one of the most important votes in the career of every legislator. It is a vote that each legislator will remember long after their retirement, either with satisfaction for having done the right thing or with dismay for having succumbed to pressure, special interests, and unfounded fears.

Some might worry that support for reform could impact their career, including their re-election prospects. But, opposition to reform could also result in their electoral defeat, both for denying their constituents the benefits of health security and affordability, and for their failure to take a courageous, principled stand that would improve the quality-of-life of those who they were elected to serve.

The legislation would advance health security and affordability in many ways, from prohibiting denials of coverage due to pre-existing conditions, to enabling millions of uninsured Americans to obtain coverage; and from limiting insurer hikes in premiums, copayments, and deductibles that price people and small business out of the market, to ensuring long-term sustainability of the health care system by containing costs for the public and private sectors. This is very tangible, meaningful progress. Yet, that doesn’t mean that the legislation is perfect, nor that it exactly reflects what any single person would most like it to contain. But that is the nature of democracy and politics as “the art of the possible” between President Obama, 535 Members of Congress, and a long list of citizen- and interest-groups. The old maxim that “the perfect must not be the enemy of the good” is perhaps more true in the context of health reform than any other issue.

An Historic Moment For the Country…..and For Each Legislator

If Congress does not pass health reform now, there will not be another opportunity for many years to come. And, when it does come again, the problems with our nation’s health care system will be so much more extensive, intractable, amplified, and varied, with costs having skyrocketed past the point of being able to be reined in. Reform at that time will be much more extreme and painful, and much less likely to resolve deficiencies and put our nation’s health spending on a sustainable track. It is critical that we do not miss this historic chance at substantial progress for the sake of individuals and families, businesses and economic growth, and preservation of our society and fiscal health. Now is the time to unite our diverse citizenship under the tent of health security and affordability for all, or risk further fragmentation and hardship which will be monumentally more difficult to repair.

Legislators for whom the vote on health reform is especially vexing would be well served to consider not only the impact of voting for the bill, but also the impact of voting against the bill. This vote goes right to the heart of public service. It will become increasingly apparent in the years to come that supporting this legislation was the right thing to do for America and Americans. Years from now, when looking in the mirror, a legislator will not see the insurance lobbyists, a group of Fortune 500 CEOs, nor a little room of over-heated Tea Partiers. Instead, the person looking back will be the person who voted on the 2010 legislation to increase health security and affordability for all Americans.

Achieving Compromise on the Public Option Through A Hybrid Solution

When baseball and basketball players went on strike in past years, they eventually went back to the field and the court by crafting a hybrid solution that met the essential needs of both players and owners, rather than one side winning an “all or nothing” victory. A similar approach for negotiating a hybrid solution could be valuable in resolving differences on health care reform.

Both the House and Senate bills offer myriad improvements to our nation’s current health system in terms of access to coverage, cost controls, health care quality, and insurance regulation. Yet, the fate of the “public option” remains an important, and contentious, issue. Although the House bill includes only a scaled down version – accessible only to the individual, family, and small business markets, which face the steepest premiums – insurance companies opposed it strenuously. They and others were, of course, successful in keeping the public option out of the Senate bill (for example, by the efforts of Senator Lieberman, who represents Connecticut, the nerve center of the insurance industry).

Insurance companies will rake in premiums from having millions of new customers, and they are fighting hard to keep these premiums exclusively within their domain. They suggest that they could not handle the competition that a public option would provide. But it is precisely that competition that would pressure them to restrain premium rates and rises, since the small group and individual markets are the most vulnerable to insurer pricing schemes.

A solution is still being sought which would satisfy the competition, coverage, cost control, and quality improvement rationales of the public option, while doing so in a way that would not allow the Federal government to function as a full-fledged insurer for this market (even though the government does fulfill this role with Medicare and Medicaid).

There is a solution to this quandary.

Proponents of the public option envision it functioning just like a private-sector insurance company, as one of the options accessed through the “purchasing exchange”. To do so, it would engage in a number of activities: (a) it would market the program, and pool together individuals, families, and small businesses who choose to enroll; (b) the Federal government would underwrite the program and take on the financial responsibility (i.e., assume the risk); (c) the government would establish the premium rates; and (d) the government would administer all aspects of the program, including collecting premiums, enlisting providers, and paying claims.

However, the goals of the public option could be achieved by fulfilling just some of these roles, and, in so doing, placating its opponents. A hybrid model could serve this market through a true public-private partnership between the government and the insurance companies, with a blend of roles:

1. the Federal government would market a “publicly-administered option” to individuals, families, and small businesses who are eligible to participate in the “exchange”, enroll those who select this option, and create a risk pool among those who would be covered by this option;
2. insurance companies that seek to cover enrollees would apply to the program to be a participating insurer under this program, and would submit its underwriting, coverage, and customer service plans to the program administrator, to ensure conformance with standards established by the administrator;
3. proposed premium rates would have to be approved by the administrator, and an insurer could not participate – nor, in the future, increase premiums – until the administrator approves the rate schedule;
4. enrollees in the “publicly-administered option” would select an insurer from among those that are approved for participation, pay their premiums directly to their chosen insurer, and interface with the insurer for all of their customer service needs and related issues;
5. participating insurers would assemble a provider network to satisfy all enrollee health care needs (in conformance with standards issued by the option’s administrator), manage all financial aspects of its relationships with providers (e.g., payment of claims and other forms of compensation), and transfer to the option’s administrator a small amount of premiums to cover the expenses incurred in executing the administrator’s role;
6. enrollees in the “publicly-administered option” could switch insurers during an annual open-enrollment period if they are not satisfied with their insurer for any reason (e.g., cost, customer service, the provider network, etc.); and
7. the option’s administrator would establish an ombudsperson and a review board for enrollees to resolve complaints and appeal decisions relating to the insurer’s practices and decisions.

This hybrid of roles would satisfy each of the objectives that are sought to be achieved by the public option, while still keeping the Federal government from becoming a direct competitor of the private insurers. Coverage would be expanded by virtue of element #1; competition would be enhanced by elements #2, #4, and #6; cost control would be advanced by elements #3, #5, and #6; and health care quality would be improved by elements #2, #5, #6, and #7. At the same time, the private health insurers’ role in the market as underwriter would be maintained by virtue of #2.

Although private insurers would still be the underwriters of policies under this hybrid, and they may also compete for business in the “exchange” as a stand-alone option, the “publicly-administered option” still offers considerable value to consumers. This option will ensure that the risk pool is large enough to minimize costs, premium rates and rises are scrutinized and approved by the administrator, customer service mechanisms are in place, the provider networks are sufficient, and that there is recourse to challenge practices and decisions which consumers find objectionable.

Bridging the gap between the House and Senate bills with regard to the public option is certainly challenging. However, the development of a public-private partnership for a “publicly-administered option” has the potential to satisfy a broad range of stakeholders and achieve sufficient support to enable the health reform legislation to proceed on to other issues.