Blog Debate: Competition on a Level Playing Field
Editor's Note: This is the second day of a blog debate about what approach we should take on health care reform in 2009 will be Dr. Don McCanne, a retired family physician now serving as Senior Health Policy Fellow for Physicians for a National Health Program, and Jason Rosenbaum, a writer and activist, and the Deputy Director of Online Campaigns for Health Care for America Now! Dr. McCanne will be presenting the "single-payer" point of view, and Mr. Rosenbaum will be presenting the "public competitor" point of view. You can read the first day's exchange here.
This is Mr. Rosenbaum's answer to the question: Is there anything valuable that private insurance brings to the table which, with far more muscular federal regulation, would enhance an American universal health care system?
Read Dr. Don McCanne's answer to this question.
There is no question that the health insurance industry in America has failed at their ostensible goal: To provide health insurance to the people in this country. Their products are not affordable, they waste far too much money on administrative overhead, profit, and marketing, and they spend their days figuring out how to deny people the care they paid for. They will always put their profits over our health.
It is tempting to imagine doing away with the entire industry, as single payer supporters advocate. However, the health insurance industry is a trillion dollar industry that employs hundreds of thousands of Americans. Though they may be the very picture of evil big business, it is unrealistic to propose wiping the entire industry out of existence with the stroke of a pen.
As Atul Gawande, noted physician and veteran of the Clinton White House, put it in the New Yorker, we must build on the system we have to get to quality, affordable health care for all:
It won’t necessarily be clear what the final system will look like. Maybe employers will continue to slough off benefits, and that lifeboat will grow to become the entire system. Or maybe employers will decide to strengthen their benefits programs to attract employees, and American health care will emerge as a mixture of the new and the old. We could have Medicare for retirees, the V.A. for veterans, employer-organized insurance for some workers, federally organized insurance for others. The system will undoubtedly be messier than anything an idealist would devise. But the results would almost certainly be better.
Jacob Hacker backs this up, arguing a combination of public and private insurance may actually be stronger than the two alone:
Public and private insurance each have distinct strengths. Private insurance has been quicker to provide new benefit options and offers greater flexibility in benefit design and payment strategies, while public insurance has proved more stable and better capable of controlling costs while ensuring access, especially for the most vulnerable. Acting alongside each other, with enrollees able to choose between them on a level playing field, public and private insurance can serve simultaneously as a safety valve and a spur for improvement for each other.
This is not the time to be idealistic; health care in America is too much of a crisis. If we can create a system that gives a guarantee of quality, affordable health care for all - and that system can pass through Congress - I hope everyone can get behind it, even if it doesn't do away with private insurance.
I would agree with Don McCanne that hefty regulation is key to making this kind of system work. Private and public health insurance would have to compete on a level playing field, offering a minimum level of benefits open to anyone that would cover higher-cost customers adequately, effectively outlawing unfair risk-pooling. And I would hope Don would agree that such a plan would require a robust public health insurance option, open to all and affordable based on income, to effectively compete.
If such a plan were to be put before Congress, as seems likely given what President Obama campaigned for and what the leaders of the relevant Congressional Committees have been saying, I would hope single payer advocates would join in common cause to make sure that plan doesn't get watered down, is passed, and is signed into law. It might not be a plan an idealist would devise, but it will get us to quality, affordable health care for all. And isn't that the ultimate point?
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