Government-run Healthcare Would Backfire, Making 'Public Option' the Only One

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we look forward to working to achieve that aim.

pandora jewellery of HI 10:11PM December 12, 2010

I lived in Vermont when then Governor Dean successfully "expanded" the state coverage. The above article is pretty accurate about access to care, particularly in more remote areas of the state. Doctors either dropped accepting the Medicaid option or refused to accept new patients with this coverage. The real kicker is that then-Governor Dean was actually encouraging employers to drop their healthcare coverage for employees who may have qualified for the Medicaid coverage. The real culprit for Vermont's healthcare woes at the time (and I believe much of the country's as well) was the adoption of community rating and guaranteed issue legislation. Under community rating, all insureds pay the same premium no matter what the age, health, or habits of the insured. In other words, a 22 year old healthy person paid the same premium as a 58 year old lifetime smoker who was 50 pounds overweight. The object of the provision was to lower the rates for older voters. Unfortunately, the real effects (which were predicted by many industry analysts during the public hearings on the policy) was the flight of younger healthy individuals from the voluntary insurance market. The second item was guaranteed issue, which basically removed underwriting standards from the health insurance industry. A person who smoked, was overweight and had never participated in healthcare coverage could not be rejected for coverage by a company licensed in the state, nor could pre-existing conditions be excluded. Again, during hearings, industry analysts predicted a massive flight from the state by insurance companies. At the time of enaction of both pieces of legislation, there were over 25 companies providing health insurance options. Within five years, there were 7. While both pieces of legislation were well meaning, their unintended but predictable consequences have had a tremendous impact on the healthcare coverage within Vermont. At hearings in the Statehouse, I provided recommendations for possible solutions. First and foremost was the "socialization" of the medical schools in the state. By this, I advocated (and continue to advocate) that the state pay the full tuition, fees, room, board and a stipend for all students accepted into the programs. Those students, after completion of both medical schools and their residencies, would be required to work for 5 years for Vermont at a facility to be assigned. After that 5 year commitment was completed, the doctors would be free to pursue their specialties and independent practice. The goal was to provide a base level of care throughout the state and to remove the significant debt that many doctors accumulate pursuing their degree. The second option was a multi-tiered (by age) pricing plan which would encourage the enrollment of younger, healthier adults (18-35) into health insurance programs. This foundation is absolutely necessary for any system to succeed. Unfortunately, neither the Democratic-led legislature nor the governor agreed

Ray Overton of NY 9:19AM June 25, 2009

What a joke. Quit trying to scare people. Healthcare costs so much now, people just want to be covered, and their willing to wait in longer lines if that's what it takes. Ask anyone who has lived in European Countries with Universal Coverage. It works. The horror stories you hear are seriously minority viewpoints, outside the mainstream of the medical community. In the US most of us have to worry everymonth about whether or not we can afford healthcare, I am sure Dr. Philip Gingrey, with his MD salary, doesn't have to worry about such things.

Damon of NV 5:00PM June 10, 2009

Strange that a republican would resist a market option for government provided healthcare, I guess their donors in the insurance industry realize that they can't compete against a superiors system. It's very obvious if you do the research that healthcare is a natural monopoly, it's a damn shame that single payer is off the table for the cowardly congressmen who don't want to fight the insurance companies.

andy of OH 2:45PM May 28, 2009

Healthcare should be an option for all, but a government-run, one-payor health system might not be the best option. A professor at the University of Pennsylvannia recently looked at FDR's New Deal (where Medicare / Medicaid started) proposals from the 1930s, and a striking finding was how low the government's healthcare cost projections were for the following decades versus the enourmous cost we are realizing now. Looking into what was driving healthcare cost over the past decades, technology (everything from GE oncology tech to IT) was actually found to be one of the largest drivers.
Technology (health records, etc) is one of the key drivers that Obama expects to decrease healthcare costs. I have not heard of anyone actually showing that technology decreases healthcare costs (disregarding self-served advertisement by technology companies). What this professor described did make sense -- that technology generally increases cost as it identifies problems earlier / sooner and that very expensive treatments are then used more frequently to correct the problems.
There is more than one option to funding universal healthcare. I am surprised so many people are pushing for government run when the government has not managed Medicare / Medicare well and that Canadians / Europeans have not found this model to be successful. Even if Obama can run it effectively, history has shown future presidents would not likely have as much focus.

John of PA 1:18PM May 27, 2009

Dual systems offering the choice of public or private care will save hundreds of billions of dollars over what is currently spent on health care, and leave no one behind.
Insurers and private care givers would not be forced to cope with indigent and precondition patients freeing them to compeat for the most profitable buusiness.
A government owned and operated system funded by a national sales tax, run like the VA, dispensing all public funded care, with free prescribed care and medications, no insurance, no co pays, no precondition exceptions, free period, will end the nightmares for individuals that use this government care. Businesses selecting public care for their employees would not have to pay or be involved in health care period.
Private insurance and care providers would no longer be required to cope with indigent and pre condition patients. Individuals happy with their private systems could continue paying for and using systems they like. Dual system; public or private. You choose. The Veterans Administration has been controlling the problems with access, cost, quality, and malpractice successfully for years.(The Best Care Anywhere by Phillip Longman)
http://www.washingtonmonthly.com/features/2005/0501.longman.html A study by OMB comparing this dual plan with other reforms would be fascinating.

BillWatson of CA 12:40PM May 27, 2009

Excellent example of public healthcare challenges. Someone ought to bring up other States and Canada as other examples of rationing of healthcare under Government administration. There seems little doubt that the alternative concept of a national system of small efficient Emergency Hospitals may provide part of the answer to keeping the general availability of affordable healthcare for both insured and non insured patients needing a physician.

Wayne Currie of GA 9:44AM May 26, 2009

Hmmm… Health Care for ALL Americans is Simple!
1) MERGE Medicare with Medicaide into one single "Income Based" system for poor and elderly citizens.
2) REQUIRE insurance companies to provide the same basic coverage for ALL Non-Medicare/Medicaide citizens, regardless of health status, at affordable rates.
3) ALLOW insurance companies to "Profit" by offering additional benefits and options to those who qualify and are willing to pay the difference.
As for Funding…
1) Changing from an "Emergency Treatment" to a "Preventive Care" system will save local communities billions, maybe even trillions of taxpayer dollars!
2) Small business will be able to compete globally and hire additional taxpaying employees!
3) Wealthy seniors will pay their fair share!
4) The tremendous burden on future generations will be greatly reduced!

jpinsatx of TX 9:40AM May 25, 2009

I believe I remember from a class discussion on Russia that it was about the fact of government run medical and food systems in Russia.They were 2nd rate compared to Americas systems,this was in the early 70's.I fear with all this government ran movement with President Obama and Democrats we are on a fast track to Socialism.The government needs stay out of the private enterprise system it already controls so many aspects of Americans lives.
Stephen Beal

STEVE BEAL of GA 4:55PM May 23, 2009

I will be the first to say that meshing of plans may not mix. But for you to say that current insurance plans do not limit access to both physicians and services is ludicrous. The current practice is that insurance companies cut rates and physicians decide whether or not they can afford to participate at the going rate. My current physician opted out of two of my 'employer-sponsored' plans in the past five years because of low reimbursement rates and failure to be paid timely.
I lived in Britain for three years and during that time had the opportunity to observe their National Health Service. None of my friends ever were denied access to their physicians, tests, or required surgeries- and would laugh at the thought of it. However, to think that here you can have a hybrid of this won't work.
Medicare is one of the most efficient government run programs with an administrative overhead between 2-3%. Contrast that to most insurance companies with average adminstrative overheads between 37-38%. Where does that money go? Into claims departments which are known not to pay those claims. Into lobbying efforts for congress (Even Rep. Gingrey fails to mention his #2 contributor in 2006 was an insurance company which proves my point.)
Rep. Gingrey uses Medicaid as his yardstick. Medicaid is chronically underfunded and is a national disgrace because it is allowed to be managed by the states... and isn't that a basic republican strategy these days, that things can be handled better further down at the state level? It can't. They have to have the money and can't be forced to beg 50 different times a years- it doesn't work.

Jill B of GA 7:40AM May 23, 2009