Business Roundtable, a group consisting of CEOs from some of America’s leading companies, has put together a health care reform proposal. This group of business leaders has a vested interest in seeing some improvements in our health care system, since they collectively provide health insurance for 35 million Americans through their employer-sponsored group health insurance policies.
Their health care reform proposal includes four main ideas. First is a need to create greater consumer value in health care. This includes using uniform information technology in health care (something we’ve written about at the Colorado Health Insurance Insider in the past), providing consumers with easy-to-compare information on the price and quality of health care options (this was supposed to happen with the launch of HSAs, but our own experience has shown us that true comparison shopping in health care is still woefully unavailable), and changing our health care payment systems to reward quality of provider services, rather than the number of patients seen or procedures performed (again, something we’ve written about, and something that I think most doctors would applaud if it were actually implemented).
The second tenant of the proposal calls for providing more affordable insurance options for all Americans. They support the continuation of the existing employer-group model of health insurance, which currently provides health insurance to 62% of Americans under the age of 65 (so I presume that means they are not in favor of McCain’s health care plan). They also support opening up the health insurance market to multi-state regions, as opposed to the current fragmented state-by-state system that we have now. (it’s important to note that Medicare and Tricare use multi-state regions, and have much lower administrative costs than our current private state-by-state health insurance carriers). Such a move could absolutely increase competition, spread claims over a much larger group, and lower administrative costs. But it would have to be well-regulated by the federal government, in order to make sure that consumer needs and rights were actually being met. Currently each state has an insurance commissioner who oversees the state’s available policies, makes sure health insurance carriers and agents are in compliance with state regulations, and responds to consumer complaints. I agree that the state-by-state nature of our health insurance system is cumbersome, limits competition, and can be highly problematic for people who move across state lines. But my concern with opening up the market to larger regions is that it would be more difficult for regulators to oversee the industry, and consumers could end up getting the short end of the stick. Business Roundtable’s idea is to allow health insurance carriers to offer plans within a region that do not have to include current state mandated benefits, but which must “offer a minimum actuarial value plan.”
The third aspect of the Business Roundtable proposal calls for making health insurance mandatory for all Americans. It does make sense to mandate health insurance coverage. But people tend to resist changes like this, and prefer to make their own decisions rather than be told what to do. Mandatory health insurance coverage was a major part of Hillary Clinton’s health care reform package, and she didn’t win the primary. While I do still support mandatory health insurance, I’m realistic enough to know that this is unlikely to come to pass unless health insurance were to become a national single-payer system, with premiums taken as taxes. The Business Roundtable proposal doesn’t address the people who would like to have health insurance but don’t have access to an employer plan and are not healthy enough to qualify for an individual health insurance policy. Not all states have guaranteed issue high risk pools, and for people with illnesses that make individual health insurance unavailable, it doesn’t matter if we mandate coverage or not – they still won’t be able to qualify.
The fourth aspect of the proposal would provide for financial assistance for low income families to purchase individual health insurance or pay for employer-sponsored health insurance. The cost-savings that would be generated by creating greater value in health care (the first piece of the puzzle) could be funneled into programs to help low-income Americans pay for health insurance. We already help the poorest Americans obtain coverage through our Medicaid system. But as increases in health insurance premiums have far outpaced increases in wages, more people have found themselves in the painful position of having to choose between rent and health insurance. There’s a chunk of the population who are stuck – they make too much money to qualify for Medicaid, but they don’t make enough money to pay for health insurance, and these are the people who would be helped by the Business Roundtable’s proposal.
All in all, I think that the proposal has some good ideas. Providing financial assistance for people who are unable to afford health insurance premiums, lowering costs by implementing modern technology, and making health insurance mandatory would go a long way towards reducing the number of uninsured Americans. The system didn’t break overnight, and it’s not going to be fixed overnight. Although I think that we need to remove the profit aspect from our health care system in order for it to truly function efficiently, I doubt this will happen any time soon. So I’m glad to see any steps in the direction of change, no matter how small they may be.
