PNHP: Healthy Americans Act is the "Wrong Model"

Well, it comes as no surprise that not everyone would agree on this broad reform proposition. The PNHP has posted an article extremely critical of the Healthy Americans Act. It states that: "the bill depends on the 'mandate' model of private insurance." This is truly a core issue in health care reform, mandating insurance. Through a social lens, a mandate whether private or for a federal plan, resembles how we deal with car insurance. If you drive a car you MUST purchase insurance, however there are differences in this scenario since your personal health does not have as direct affects on those around you (unlike running over a pedestrian in your hummer.) Mandating people to purchase private health insurance is tricky. The issue of compliance and enforcement is an obvious talking point for the critics. A national health plan provides a mandate, but a mandate for government to cover all individuals. As we know there is strong conservative opposition to government fitting the bill for everyone's healthcare. They believe that centralizing and growing the so-called beauracracy limits an efficiently run health care system. So this issue is of primary concern when trying to reform the system. It seems the idea of this bill is to pull away from employer based insurance but to stay in a private market for insurances to compete for this new pool of health care consumers.

The bill also provides a framework of 3 risk pools and government subsidies are to support the lowest (medicaid) of them. It assumes that the problem with medicaid is not that the program is not comprehensive, just that it is underfunded, it underreimburses providers and therefore is limited in where it is accepted. Further subsidies would be provided to those plans so as to increase where medicaid and the like would be accepted. This seems like a simple thing to write in a bill, but not easy to execute in reality. The idea however, is a concrete solution to the lack of acceptance of medicaid.

The article in PNHP went on to attack two more principles of the act:
"healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite - market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care."

Most people probably agree that our health care system should include some kind of incentives for personal responsiblity. That concept is not foreign even to socialized medical systems like the German system. Here is an example of some German social security code regarding health care personal responsibility:

• Services must only be used insofar as necessary
  
• Copayments are to be requested where treatment is required as a result of a criminal activity, deliberate self harm, or a "non-medically indicated measure such as cosmetic surgery, a tattoo, or a piercing"
  
• Financial incentives are to be provided to those taking part in preventive measures, screening, and check-up programmes, those taking part in managed care programmes, or those who do not use general practitioner or hospital services over prescribed periods
  
• Threshold for copayments of chronically ill and cancer patients are to depend on their compliance with screening and treatment regimens

How these incentives are provided fairly and uniformly is a burden for any piece of legislation and this act shows its vulnerability on the issue.

As for the issue of market forces, it has plenty of arguments on both sides. In our system dominated by employer based health insurance, the competition my be limited by the big players purchasing the plans. Competition may not be acting to fully improve the health care provided and the efficiency with which it is run. For instance, costs of insurance company infrastructure have been estimated as enormous percentages of the entire healthcare spending in this country, noone can argue that that is efficent. The insurance companies themselves also rake in huge profits and are really the biggest winners in the system, wheras physicians and other providers struggle to get their share. Also, if the market was maximizing efficiency then our system should prove to be a better medical system than a universal coverage system, but we lag behind many nations' in a plethora of statistical data measuring the effectiveness of our healthcare. The opposing argument is that we cannot write of the market in health care. If the system was weaned off employer based insurance, it could be possible that a higher level of competition would arise from the huge pool of independent consumers looking for private plans. This could lower prices and improve the efficiency of our system. There is obviously something wrong with the way the current insurance/market system is set up. If we are to maintain the private system that we have, it has to be changed so as to encourage improvement.

Regardless, the debate is healthy and going strong. At least if nothing else, we seem to be making something happen. Party players are coming together and working on compromise which is when the country tends to actually move forward. The next blog will continue with this discussion.