Step by Step Health Care Reform

If a single payer system is to be based in whole or in part on Medicare, would it not be prudent to make certain that Medicare has been brought fully up to speed before placing a load on its infrastructure. I don't know if you have seen this letter from then Chairman of committee on Energy and Commerce dated Feb 28, 2008. It concisely paints a clear picture of the Medicare and Medicaids future under the Bush administration.

http://energycommerce.house.gov/index.php?option=com_content&view=article&id=63&catid=18:platforms&Itemid=58.

What the Bush Admin did to both Medicare and Medicaid is inexcusable, and has left both programs crippled by poor management and chronic underfunding. The AMA estimates that the for profit health insurers added an extra $200 billion in cost to medical care in America due to inefficient administrative practices. http://www.ama-assn.org/ama/pub/news/news/health-insurer-report-card.shtml. In my home state of Alaska, our Medicaid program for elderly and uninsured children spent only $1 billion. How many years will it take for $200 billion to escalate into the $1 trillion that is CBOs estimate of the cost to implement health care reform as outlined in H.R. 3200.

I favor a single payer system, but first, I believe it is absolutely critical that we make much needed repairs and improvements to the following three elements of health care.

1. Revamp the current regulations governing the multi-payer, for profit health insurance system (if we in act a public option without doing so, we risk duplicating an already broken system). H.R. 3200 is a terribly long bill, but much of it is dedicated to amending already existing codes and acts (social security, public service health act, federal tax code, among others). This is critical to health care reform. We passed TARP into law in September, and we have watched as the money poured out of the holes in the regulatory system governing financial entities. I see the same potential for disaster with health care reform. Already, one can see evidence that special interest are jockeying for position at the health care trough.

2. After plugging the holes in the laws regulating health insurance, we must push for a public option. If one reads the Cautionary Statements in any of the most recent 2nd Quarter Financial reports (http://www.aetna.com/news/newsReleases/2009/pr_2ndquarter2009_earnings.html), one will gain insight into the deepest fears of the insurers, and near the top of that lists is COMPETITION. For years the baby boomers have paid into health insurance, and many still believe they have built up some sort of pool of reserves. According to AETNA's last report, no evidence of these reserves can be found. The boomers were a healthy bunch for years, and the revenue just rolled into the coffers. When Gramm Leach Bliley broke down the barriers separating the various financial entities and allowed for the creation of umbrella companies, the profits generated by our premiums was just too good for Wall Street to pass up. Our policy premiums got divvied up at the end of the year and paid out to shareholders. The medical and health insurance industry comprise as much as 16% of assets in some portfolios. Proper regulation of existing health insurers will break the hold that Wall Street has on them. The will make a profit, but they won't be able to rake in the handsome sums of previous year, and forced to maintain reserves, our premiums will not fluctuate in wild abandon (11-21% this year alone). Indeed we might see the membership to benefit ratios increase to levels seen in the eighties (84% today. 94% in the eighties and 90's). Only with proper regulation can a public option be effective. What good will it serve to create a government option that plays by the rules, when the private sector can find safe harbor in the nooks and crannies of deregulation. The public option will lose money, and the deconstructionist will giggle and say, "See we told you the government can't do anything right." They should know, they worked feverishly for decade to roll back the regulations governing health insurers. Whatever revisions may be imposed on H.R. 3200, they must not undermine the language that would provide for a stable and well funded public option. I don't mind diverting the $200 billion wasted by health insurers to a well funded, well organized public option. I do mind having money from my premiums "redistributed" to shareholders as dividends, or to executives in the form of pensions, and bonuses, and that is precisely what has been done.

3. While we rebuild the regulatory structure governing private health insurers, and implement a public option to challenge their monopoly, we must rev up the engines powering medicare and medicaid. Once this is done, and only after this is done, we can begin to restructure the system to accommodate a single payer system. Failure to provide the two programs with the muscle and backbone to carry the load will result in collapse, and once again, the deconstructionist of government will laugh and say I told you so. They should know, they did their best to rip these health care system apart. As Mr. Dingell pointed out in his letter, both programs are still heavily underfunded. H.R. 3200 provides for the return of the $576 billion into Medicare over the next ten years. This was the amount cut in the last year of the Bush administration. Our President is performing a key function of his executive duties by supervising the restructuring key elements of Medicare and Medicaid. His Secretary of Health and Human Services, Kathleen Sibelius, is getting the information highway back up and running, and finally, can we fully assess the damage done during the past administration. I invite everyone to peruse the news releases from the Department of Health and Human services: http://www.hhs.gov/news/. By scrolling backwards in time, one is able to see the building blocks of change being constructed.

I realize that the dialog of health care is maddeningly complicated, but if we look at our individual situations with health care, we can discern what truly ails the system. I recommend that those who have health insurance call their insurance companies and have their claims person walk them through a test claim. They will do this, but it takes time. Grab a cup of coffee and take notes. You will not fail to be surprised. Look at your insurance from the perspective of do I have enough to pay for any unaccounted for expenses, then find out what those expenses might be. This is purely business, and they need to cough up the information. You pay them green backs, and you expect a certain type of product in return.

Part of the battle facing health care reformers is this: people are happy with their insurance, but only about 13% or so have actually had the opportunity to use that insurance. They need to understand how ineffective the system has become. They need to challenge that system.

Another component of change lies with our attitudes towards medical care for all Americans. We must see health care as a key component to a healthier, wealthier nation. After WWII, Europe and Brittan were faced with millions of walking wounded. They had no option, but to build systems capable of accommodating the sick, the wounded and mentally ill displaced and wandering the highways and bi-ways of the countryside. Why? Simple. Europe and England had been devastated by the bombings of the war. Dresden lost 45,000 people in round of incendiary bombing, and I imagine scores of badly burned victims required advanced treatment for many years after the surrender of Germany to the Allies. America is facing its own health care crisis today. We need to face the fact that we will have to accommodate the needs of our elderly, and I will remind my and the younger generations, that the boomers put a lot of bread into the system. Irregardless of earning potential, all Americans have a right to essential health care. We will be a better nation for it. Think of all the energy and money that could be diverted away from years spent paying off medical debts and into small businesses, or even just the purchase of goods and services.