from modernmedicine.com
For the first time in decades, health insurance companies are panicking a bit lately. For years, too many of them have gotten away with cherry-picking those they choose to insure; denying coverage for preexisting conditions; making insurance virtually unaffordable for the self-employed, underemployed, and unemployed; underpaying physicians and other providers for the services they perform; subrogating the accident claims of those they insure; refusing or delaying payment for legitimate claims; and influencing legislation favorable to their industry—all while making billions in profits.
So why the panic? Congress is likely to push for a public plan as part of a comprehensive healthcare reform package. The intent of a public plan is to offer Americans an affordable and accessible option to private health insurance. Health insurance companies argue that a public plan would put them out of business and would be the first step toward a universal, single-payer health system. Not really. A properly constructed public plan would force private insurance companies to compete in the marketplace. And if they do that, private and public health insurance options can coexist.
Last month's meeting between President Obama and executives from major health industry groups representing insurers, hospitals, unions, and pharmaceutical companies gives cause for cautious optimism. The executives promised to reduce healthcare spending growth over the next decade, perhaps by as much as $2 trillion. But one can't help but hear the whispers of the Greek chorus: If it's not codified in law, it doesn't mean anything.
In the coming months, Congress will be center stage for the future of healthcare reform. One of three scenarios is likely to unfold:
1. Various congressional committees will hold hearings ad infinitum. Charges and countercharges—including who really is and is not a socialist, who will and will not bankrupt America, and who is standing and not standing between Americans and their doctors—will be flung back and forth, and nothing will be passed.
2. A bill will emerge with some concessions to healthcare consumers, but no fundamental healthcare reform.
3. A bill will emerge most likely with a public plan option and other major reforms of private health insurance.
In order for the third option to emerge, the Obama administration and its supporters in Congress will need to ensure that the public plan and private health insurance reforms do not create a tidal wave of more red ink. In addition, consumers—voters—must be convinced they will be able to select their doctors, that they and their doctors instead of a government (or, for that matter, a private insurance company) functionary will determine the treatments they receive, and that they won't have to wait weeks or months for tests and procedures.
Healthcare reform also must do away with the yearly government habit of threatening to reduce physicians' reimbursement. This January, unless Congress acts, physicians are scheduled for a 21 percent cut in reimbursement under Medicare. Not only must this practice be changed for Medicare, but any reform package must provide appropriate funding to fuel reimbursement for physicians. Otherwise, this country will see further shortages of primary care physicians, as medical students opt for high-income specialties and primary care doctors fold up their tents in disgust.