DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

Search

Do you favor a public plan?

At the risk of jumping into the hornet’s nest, I will start by linking to Bob Doherty – Are the right questions being asked about the public plan?

For liberal and conservative true-believers, the debate over a public plan has become a surrogate for the broader debate over the role of government in our health care system. If you believe that the government needs to take on more responsibility for financing and organizing health care in the United States, you want a public plan. (Many of those who favor a public plan option would like it to be the only option – like Canada – but have decided that this is the best they can get right now.) If you believe that the problem with American health care is too much government and not enough private initiative and responsibility, then you are opposed to a public plan.

Largely missing from the discussion, though, are the details of the “it” that everyone is arguing over. There is general agreement among policy wonks that the current Medicare payment structure is dysfunctional – it undervalues primary care and rewards volume instead of value. If so, then, does it make much sense to create a new public plan that takes this same flawed payment structure and add 10%?

Would there be safeguards to ensure that payment rates under the public plan are competitive with private insurance and high enough to ensure sufficient participation by physicians and other “providers”? Or would it end up looking more like Medicaid, where low levels of payment have resulted in low levels of physician participation and generally, poor access to care?

Medicare also does not cover most preventive services. Does it make sense then to replicate this same benefit structure in a new public plan?

One could imagine a public plan that is better than Medicare. It would pay primary care doctors more, create incentives for value, rather than volume, and cover preventive services that largely are left out of Medicare. It would pay enough to ensure sufficient participation by physicians. It would compete with qualified private insurers, but on a fair playing field.

As Bob suggests (and I agree 100%), your perception of a public plan depends on how you interpret the phrase and your political economic belief structure.

I could construct a public plan that I would support strongly, and a public plan that I would vote against.

Why might I favor a public plan?  If that plan actually forced the private insurers to compete, the public plan might encourage insurance plan transparency.  Have you ever tried to understand health insurance?  Comparing apples and oranges is simple compared to health insurance.

We need transparency and simplification.  If a public plan yielded that goal I would be happy.  Such a movement could lead to decreased administrative costs for physicians, and less hassle for patients.

If a public plan requires physician involvement, and provides inadequate coverage, then I do not believe we should be excited.

A public plan is not necessarily a bad idea; as always the devil is in the details.  We should debate and try to influence the details before we decide that we like or dislike the concept.  Too many pundits have already set their opinions in concrete without knowing those details.  And you wonder why physicians dislike politics.

Categories
Meta
Blogroll
Newer Blogs