Monday, January 12, 2009

Health Care Reform

There’s energy in the air in DC. People are excited. There’s a sense that change really is coming, and here in DC, many are trying to bridge partisan divides to have real conversations about how to rebuild a better, stronger, healthier America. What’s exciting about this is that it seems you can replace “DC” in those sentences with any city, from Portland, Maine to Portland, Oregon. Health care reform is on the table, and the time for careful action is now.

Health Care Reform is like a Candy Store

There are probably about as many ways to make changes to our health care system are there are flavors of Jelly-Belly. There are about 15 different plans from Congress, and you can bet every industry, consumer, and provider group could tweak their own best plan as well. President-elect Obama made numerous statements throughout his campaign, ranging from full support for single-payer health care to a promise that health care reform would allow anyone who is happy with the insurance they currently have to keep it. His nominee for Secretary of Health and Human Services, former Senator Tom Daschle, has some other ideas too, but acknowledges that a single-payer system would be the most cost effective way to provide good care to all.

OWL has advocated for single-payer health care since its inception, and is absolutely maintaining its single-payer voice. We are working in several coalitions with other groups to make sure that the consumer voice is heard loud and clear in the reform negotiations, and in fact, in discussions with Health Care for America Now! (HCAN), we have been asked to maintain that position so it doesn't disappear from the table. To be frank, I don’t think there’s the political will to go all the way on a single-payer plan. The question then becomes, does the bumper sticker on the back of our vehicle read ‘Single-payer or Bust” or “Single-payer or Other Plan that is Far Better than the Status Quo?” OWL is without question making the case for single-payer repeatedly, loudly, and clearly, and having our voice will contribute to a plan that is closer to single-payer than not if we can’t go all the way.

Single-payer, Universal Health Care, and Medicare-for-All (Or, Lions and Tigers and Bears, Oh My!)

These terms get thrown around, but it would do us some good to know what we mean when we use them. They are related, but not interchangeable.

A single-payer plan means that the federal government would be writing the checks to pay for health care for everyone. Instead of Sue having Insurance A, Joe having Insurance B, etc., and each insurance company being a separate payer, all claims would ultimately be paid by the government (like traditional Medicare payments).

Universal health care simply means that everyone has access to care. This phrase is a bit of a misnomer to me, because, technically, one could argue we already have this. Anyone who is in need of care can get it, either from their primary doctor, an urgent care center, or an emergency room. I don’t mean to suggest it’s good or affordable, or that it’s used appropriately, but it’s there. Universal coverage is a different goose. This refers to everyone having some form of health insurance, public or private. This includes high-deductible plans, which we know leave people effectively underinsured, with very high out of pocket costs, but which is considered insurance for the purposes of a universal coverage system. This comes with other problems too – namely an individual mandate that requires people to have health insurance or pay a fine. Both of these situations result in too many people still going with out coverage, care, or both, because they truly cannot afford it.

Medicare for All (MFA) is also a broad term to be used carefully, but generally means expanding the existing Medicare program and infrastructure to cover everyone. We have to recognize that Medicare is increasingly complex, currently includes options that allow private insurance companies to administer Medicare plans, and largely does not cover preventive care like annual physicals, dental, and vision services. MFA isn’t quite as simple as it sounds, since major changes would have to be made to cover appropriate services for all ages, but the basic infrastructure is already in place, and starting there would put us leaps and bounds ahead of starting from scratch. There is a strong grassroots movement supporting Congressman Conyers' HR 676 MFA legislation. Support in the Senate is a different story, and it would take a great deal of communications from home states to get the ball moving there (hint, hint).

Health Care Reform, Generally Speaking

There seems to be support and momentum building for large-scale reform, and in the right direction. You may be aware that Senator Max Baucus, Chairman of the Senate Finance Committee, recently released a white paper on health care reform. It was intended as a discussion starter, and people certainly are talking. It largely reflects the public/private compromise President-elect Obama campaigned on during the general election. While it represents a commitment to reform, it's incredibly moderate, too moderate as a place to start discussions, I think, and certainly the left wants to view it as a floor, while the right is hoping it is a ceiling. Nonetheless, it makes rational, focused support for MFA very important. In addition, Congressman Waxman has taken over control of the House Energy and Commerce Committee, which will bring new energy and a more liberal agenda to that committee. Waxman has been great on health care and women's issues (and a long list of other issues), so this is a good omen for health care reform.

I know some are opposed to OWL working with HCAN. It is important to know that there is no HCAN "model" for reform. What HCAN is working on is a set of principles about what "universal" coverage and "affordable health care" mean, and plans that fit those fundamentals could come in all shapes and sizes, single-payer included. HCAN does propose a way for private insurers to coexist with a public plan, but it doesn’t necessarily mean a single-payer plan wouldn’t fit. I know some think working with this group is compromising our position, but I believe the opposite is true. Our goal is to have everyone covered, receiving high quality care in the most cost-effective manner. We think MFA is the best way to do this, but any step forward is a step forward, and working with other groups who want to walk in the same direction lends more weight, and more frequent forums, to our position.

Owls to the Skies
A year ago, comprehensive health care reform sounded good on the campaign trail, but probably wasn’t a bucket filled with much water. Now, with the economy in trouble, bailouts going around like holiday cards, the bucket is quite full. The silver lining to the economic downturn is that real health care reform has jumped to the top of the list of priorities, with a great tag line – we can’t afford not to. If a plan moves forward, people are talking about expanding Medicare to cover more people, eliminating the 2 year wait for Medicare disability, Medicaid eligibility based on income, without the categorical restrictions that currently exist, and a private but heavily regulated and subsidized plan for those in between without employer coverage. I think employer coverage will be protected heavily, and rather than taxing the benefit, it sounds like companies that don't provide a floor package could be penalized. It will be messier and more complicated than this, certainly, and it isn't a perfect fix, but it's astonishingly better than where we are. Throughout the negotiations, OWL will continue to be a voice for MFA.

OWLs across the country will have to decide if they want to shape the discussion from a seat at the table or from a bullhorn outside. There is merit to both positions. I would argue a compromise – bold and diplomatic. Make the case for MFA, but stay at the table. If we can’t get MFA, let’s get as close as we can. We need to keep our eyes on the prize – better, affordable health care for all.

Your U.S. Senators and Representatives need to hear from you. At their DC offices, at their district offices, at town hall meetings, everywhere. And they need to hear from your mothers, daughters, sons, sisters, husbands, neighbors, friends, bank tellers, schoolteachers, dental hygienists, and the dog walker. Be an advocate for comprehensive health care reform –talk to everyone you can, and get them to reach out too. This effort depends on grassroots momentum. You are the voters. Tell your representatives in Congress you want Medicare-for-All!

-Natale Zimmer

Health Policy Director, OWL


Anonymous said...

Joan Bernstein and her husband, Merton, have argued forcefully for a Medicare for all model but have also suggested that an interium step could be using Medicare as the publically available insurance plan for everyone. This seems like a good middle ground. Ellen

Anonymous said...

I've had several thoughts on reading this---and I've read it several times. I am one of the serious single-payer advocates, but I think your argument about having "a place at the table" is convincing. There have been many times in the last few months where a "hybrid" plan seemed inevitable, however I have been gratified to see a lot of single payer advocates who just won't let this approach die. I'm especially gratified to know that OWL is part of this "voice", again. OWL has long been a force for single payer.
Kathie Piccagli