Insurers and Single Payer Insurance

Yesterday we overviewed my vision for a regionally-impelemtned single payer program. Today I'd like to take a moment to talk about the role of health insurers in a single payer system.

Private insurers will still have the ability to offer insurance to those that can afford it or have employers who choose to offer it. This would certainly be a reduced pool of potential customers, which leads us to our next point.

First, and perhaps most importantly, I don't envision any single payer national health program as being mandatory. While some might argue that a mandatory program would ensure similiarity of care and keep the best providers from simply continuing to deal with those that are privately insured, I would respectfully suggest that health care providers are far more interested in providing care to those that can provide the most efficient profits, not just serving the wealthiest clientele. Layers upon layers of bureaucracy within insurers eat into their profits and hinder their ability to serve. There's no reason to believe they would not be just as willing to forego those nusances as the public would be to get their health care without them.

Under a national single payer program I see the insurers participating in a number of ways:

• Serving as contractors to process reimbursements, a skill which many are expert at and in fact could enhance the regional concept I proposed yesterday. Numerous regional insurers could leverage existing relationships with providers and cut overhead no longer needed under a single payer system.
• Continuing to offer supplemental insurance for elective procedures, which can be among the most profitable for providers (and insurers who sell such insurance).
• Managing Medical Savings Accounts. This segue into the finance arm of health care is natural for insurers, who can surely innovate new ways of offering MSAs that benefit the consumer.
• Providing low-cost options to compete with a single payer system. This may seem contradictory to my earlier suggestions but far from it. Private industry competes with government service in many ways when there are profits to be made, and instituting a single payer system could entice insurers to develop new low-cost insurance that doesn't exist right now. This could lead to higher volumes and more profits.

Just a few thoughts this Sunday. I look forward to your feedback as we continue to explore this fascinating topic.

A Regional Approach to Single Payer Health Insurance

Editor's Note: I apologize for not posting yesterday as promised but we were having problems with the cable modem, which have thankfully been resolved.

On Thursday I had began a discussion of why single-payer options might be a good candidate for the type of aggressive reform in health care that I personally think we need. I should begin by saying that although I think Mr. Nader has some good ideas, I want to be perfectly clear in my disappointment that none of the three remaining candidates who actually have some semblance of a chance of being elected have formulated a plan that takes into account single payer options. Here's why I believe that:

1) A single payer option can be coupled with existing health care payment options, public and private more easily than brand new programs.
2) Single payer options can be administratively less burdensome than some of the policies currently being offered.
3) Single payer is the option that best allows drug companies and insurers to partner with the government to negotiate costs and streamline service delivery. Frankly, any option that discounts the role of insurers in the solution is shortsighted. (I should give fair credit to Sen. Obama for his plan, which in fact does involve insurers heavily.)

One of the proposals that I believe is most well thought-out and seems most likely to succeed in this country is the proposal that was offered some years ago by Physicians for a National Health Program (http://www.pnhp.org/). In the proposal, PNHP offers the same sorts of arguments that I outlined on Thursday. Namely that single payer is a method of reducing health insurer bureaucracy and freeing up resources that now are spent in billing and collections that could, and perhaps should be used to provide clinical care. But does PNHP's proposal go too far when they offer up a solution for hospital care that would in essence convert every hospital to a non-profit and mete out a monthly budget from the National Health Insurer? I believe so. We have seen India attempt the same situation with its government-run hospitals, as well as Britain. One of the major criticisms that opponents of universal health care level is that Britain, often held up as the standard for universal health care has tremendous problems with equalizing the quality of their care across clinics and hospitals and that patients often have to endure agonizing waits to get necessary care. These criticisms, by and large are accurate, and should be taken into account when we rush into believing that a universal health care system must swallow whole all of the providers to ensure the evil profit monster of corporate health care is vanquished.

As an aside, if you'd like to look through some of the most reasoned criticism on single payer health insurance Goodman and Herrick produced an excellent paper for the National Center for Policy Analysis available here.

I disagree with any attempt to nationalize health care assets because nationalizing inherently kills the competitive spirit that advances health care facility's ability to improve their quality of care. In Britain, as Goodman and Herrick adequately point out, it is not unusual to see advanced technology in one room coupled with poor technological health care equipment for other types of care within the same facility. Providers are going to be paid the same for their relative investments, why should the providers improve?

Providing avenues for profit is not necessarily a bad thing, and we quite honestly have numerous government programs that either directly provide or open avenues to incredible profits for contractors and grantees alike. Why then can we not allow a single payer system, whereby the Federal Government is the payer, to provide these mechanisms?

One way I believe this can be accomplished is through regionalization. MEDICAID, TANF and numerous other assitance programs are delegated to states to implement. It should be no surprise that any new federal single-payer program would be delegated as well. This would allow for difference in reimbursement rates among different states, to accomodate the different health care needs. The technological advancement for care needed in rural Northern Idaho will be far different than mid-town Manhattan. And truthfully, given the different standards of living in those areas, the national insurer should allow for fluctuations in service cost.

Allowing states to recommend different reimbursement rates for various services would not leave us with the same problem of skyrocketing costs. Rather, it would allow for some standardization among states for essential services and preventative care, while allowing those providers who have invested heavily in a particular speciality...say cancer treatment...to recoup their investment. True, people might still have to travel long distances to get this specialized care, but what universal program would solve this problem? It is reasonable to believe that providers will go where their services are most needed. And because these specialists will now have the added benefit of simplified billing and collections, they will be able to offer the same level of care to many, many more patients. That equals more business for them, and more profits.

Where does these leave the insurers? More on that tomorrow. The insurers will play a significant role in this process, and will even find themselves able to continue competing with other insurers and improving their ability to bring profits to their shareholders.

Why Ralph Nader MIGHT Be Right...

Back about 59 and one-half years ago the United Nations proclaimed the Universal Declaration of Human Rights. Article 25 of that document reads:

"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services..."

The US of A, whether we like it or not, has some responsibility for this statement. It seems to me the fundamental issue in any discussion about universal health care is what we believe as a society. Do all Americans believe this? Certainly not. Do most? Maybe. Do policy makers? It might seem clear by their words but by their actions or lack thereof--I don't believe so.

Lots of discussions become fruitless because human beings have a tendency to focus on the wrong questions. In this debate on health care policy we are seeing play out I don't think we (the voting public...or the non-voting public for that matter) have done a very good job of pushing this discussion toward the fundamental question posed above. Do people have a right to medical care?

Nearly 60 years ago the better part of the world's nations said they believed that people do in fact have a right not just to basic care but health care that supports and furthers their standard of living and well-being. Yet today our national discourse focuses on the various strategies available to solve a health care crisis that I would argue many Americans don't even believe exists.

As many lively discussions as Rob and I have had on international recognition of rights, he probably can figure out where I come down on this issue. I tend to agree with Article 25; I think people in a global society that values human life have to in turn value health care. We have to value it to the point that we're willing to give up some of our resources (taxes, or money through other means) in order to ensure the right we value is protected.

Whether or not we are even in a global society is an issue perhaps Robert and I will tackle another time. You'll find we have differing views on that one as well. :-)

Tomorrow I'll get into more about how a modified single-payer insurance system should be explored in this country. For right now let me list out some of the reasons why I think Ralph Nader MIGHT just be right with his plan to expand Medicare coverage for all Americans, but a few caveats of my own thrown in in the interest of reasoned fairness:

• A Single Payer system doesn't necessarily have to cut down on medical choices, and can allow for the patient to make the ultimate decision on health care.
• A Single Payer system can, using Medicare as an example, provide efficient coverage and cap administrative costs to ensure layers upon layers of bureaucracy are not created.
• A Single Payer system can continue to encourage competition to control health care costs, but also bring the added benefit of economies of scale to help keep costs down on common medical services and prescription drugs.
• A Single Payer system does NOT equate to "socialized medicine."
• A Single Payer system MAY (emphasis on may) be the easiest 'radical overhaul' of our health care system because infrastructure is already in place.
• A Single Payer system does NOT equate to "government-run health care" and can in fact foster partnership that is beneficial for health care providers and insurers.
• A Single Payer system MUST be coupled with other reforms in health care services to ensure lower costs and increased access to care for those who need it. No other country's model is perfect, and no other country's model will fit nicely into the U.S. we need a unique system that can borrow successful components from other systems.

More to come...stay tuned.

No Hump Day

Felt like hanging a sign on Wednesday to explain that there was no Hump Day topic, so that's why I didn't blog today.

I did have a very good day, though, and feel much better about the prospects for my future thank even yesterday. I still have a lot of waiting and pondering to do, but at least it's not as onerous as it seemed before. I'll write more to explain my ambiguity as things develop.

-- Robert

So You Had a Bad Day

I am back-dating this post to explain my Tuesday. If it sounds like I am being intentionally ambiguous, it's because I am.

My Tuesday started with some real concerns about where things in my life were headed. By the end of work, I had at least sorted out some of the reasons for fearing the worst, thankfully. Still, any time something comes along with enough inertia to knock me off course or at least give me pause like that, I tend to stop and reflect. Questions like "Am I doing the right thing?", "Is this what I am meant to be doing?" or "Where do I go from here?" pop into my mind. I think it is healthy to have a little self-reflection now and then, and it doesn't always have to be positive. I spent a lot of time reflecting Monday and Tuesday night. There are still no clear answers. Is that a good thing? Time will tell. For now, I know I have some things to consider, and I still have a bit of a waiting game to play with regard to my business. We still have to wait a week and a half for the results of our bid from last month. Fingers are crossed, prayers uttered, and shooting stars have been wished on... and time goes on.

My apologies if this post makes no sense to anyone but me. I just had to write my thoughts down somewhere, and what better place than for all the world to see?

-- Robert

P.S. I have often enjoyed playing the song "So You Had a Bad Day" when bad things happen, thus the title.

The Streak Ended

I know, I know, so many out there were cheering me on, but I had to take a rest. Okay, I'll wait for the applause to die down. Thank you. After coming within two days of fifty days straight posting, the streak ended. I was tapped out. I just couldn't put up a post that contained nothing of value. I couldn't even bring myself to log in to for a little bloggin'. No, instead I chose to savor good friends and a loving family. I preferred to spend time playing Monopoly with my lovely wife. Alas, the streak has ended. I know, I know, you were all heartbroken. The pain will subside, though, in time. Maybe one day I will reach fifty. For now, farewell.

-- Robert

P.S.: This post was sponsored by satirical society of self-centeredness. Now back to your regularly scheduled basic blogging.

Good People

Last night we spent an evening with my wife's Relay for Life team until the kids needed to get to home. Tonight we spent the evening with our friends and their children, having a grand time. All of the people we spent these evenings with are what I call good people. They aren't perfect, and they may not even be all that much like me in a lot of ways, but they're the kind of people that make me feel fortunate to know them. I feel like elaborating, but at the same time, trying to explain their goodness might diminish it with unsatisfactory words. These are just the sort of people that others are drawn to, who others appreciate knowing, and who triumph over the obstacles in their paths because they have the will to do so. I have the utmost respect and admiration for these friends who we have grown close to, and I look forward to knowing them in the days, months, and hopefully years to come. Having one true friend in life is a mark of success. Having friends like these makes me feel quite fortunate and successful.

-- Robert