President Obama plans to update the nation tonight on the national health care system that is on the front burner as differing factions push one of three bills being considered by Congress.
A common thread throughout the bills is “individual mandate” – that is every American would be required to carry health insurance.
Not unlike auto insurance, the responsibility would fall on the shoulders of everyone with the unemployed or underemployed receiving waivers or discounts. Verification you have insurance would be submitted with your tax returns. For the uninsured, that means purchasing a health policy or face financial penalties.
A new report by the Commonwealth Fund, a private foundation that studies health policies, finds that three-quarters of Americans who try to purchase a private policy cannot afford one.
Massachusetts as a Model
The concept of covering all 47 million uninsured people or face penalties is modeled after a requirement Massachusetts initiated three years ago.
"Without an individual mandate, you're never going to get to universal coverage," said Bradley Herring, a health economist at Johns Hopkins University to MSNBC.
In that state, residents who choose not to carry health insurance paid a penalty of $220 in 2007 which rose to $1,020 this year. The end result was that 432,000 more people signed onto health coverage with 71,000 exempted because they fell below the minimum income level.
"It's worked out better than I would have guessed," said MIT economist Jonathan Gruber, who serves on the board of the Massachusetts program to MSNBC. "We didn't anticipate the increase in employer-sponsored insurance."
Bringing younger and healthier Americans into an insurance pool spreads the risk and lowers the cost for everyone.
The challenge will be to design a basic benefits package that is affordable for the individual mandate purchasers.
Mayo Clinic Model
President Obama likes to point to the Mayo Clinic in Minnesota as a model of high-quality, low-cost care.
Unlike most communities where doctors work independent of their local hospitals and are paid by private insurers or Medicare in a fee-for-service arrangement, Mayo doctors are paid salaries, and they do not receive more for providing additional care. Working as a team, team members agree on reducing unnecessary tests and office visits. Electronic health records better monitor patient outcomes.
When applied to Medicare, a single payment approach would streamline care. Kaiser reports that a team of providers would receive a single fee for a hip replacement, covering the hospital stay, the surgery, and rehabilitation.
Never one to shy away from adding his voice, Fox commentator Sean Hannity falsely claimed on Monday, “If you don’t have private insurance the year that this bill is passed, you can’t get that later on from your employer” reports Media Matters.
But the president's own doctor for 22 years (until Mr. Obama entered the White House), Dr. David Scheiner is publicly opposing his former patient and calling for a single-payer option.
Dr. Scheiner says he was disinvited from ABC News where he planned to discuss single-payer.
“I would have asked about single payer in that we already have one that works. Eliminate insurance companies that are causing incredible costs and havoc on the system,” he told Amy Goodman of Democracy Now in an interview today.
“The problem is the private insurance companies. Their record has been so abdominal that to have them in the program just doesn’t make sense.”
Dr. Scheiner says $300 billion is wasted every year by insurance companies and huge CEO salaries. (The head of Aetna makes $23 million a year, he says).
“Insurance companies repeatedly interfere with the care of patients. The insurance company is in the room every time I see a patient.”
Dr. Scheiner is a member of the American Public Health Association, the oldest organization of doctors that support universal health coverage and available health services that encourage preventive and early intervention care.
In a 2003, a group of APHA physicians writing on Single-Payer National Health Insurance, claim patient co-payments and deductibles would be eliminated, and Americans could visit any doctor or hospital they chose for their care under proposed government-sponsored insurance that would replace private insurers.
The plan was signed by thousands of practicing U.S. doctors, hundreds of medical school professors and deans and two former U.S. surgeon generals.
The report says most hospitals and clinics would stay privately owned and operated under the plan, but would receive a monthly government allotment to cover operating costs. Physicians could continue to practice on a fee-for-service basis or receive salaries from group practices, hospitals or clinics. The plan would also pay for health equipment, construction of health facilities and prescription drugs.
The World Health Organization reports the U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries in delivery. #