I’ve written a few times about the idea of a public health insurance policy that would work in tandem with our private health insurance policies and the existing public plans (Medicare and Medicaid). So I was particularly interested in a recent article by Jeffrey at Nuts For Healthcare about striking a middle groud in a public health plan.
Jeffrey’s article is a detailed, in-depth analysis of the possible outcomes that might result from a combination public/private health insurance system in the US. He references Jason Shafrin and Joe Paduda, two well-respected health care bloggers, who provide opposing viewpoints on whether the introduction of a public health insurance program would allow the private health insurance market to survive.
When I got to the end of the article, I felt like Jeffrey had said just about all that could be said on this topic. He addressed both sides of the issue, and summed things up by mentioning the often-repeated notion that without some mechanism for cost control, health insurance premiums aren’t going to become more affordable anytime soon. If the government steps in with subsidies, premiums will go down, but what will happen to taxes? Or other public programs that get the axe so that health care can get funding? We can shift costs around, but unless we lower them across the board, we’re not going to see much relief in terms of health insurance premiums paid by individuals and employers.
In the debate about private and/or public health insurance, health care costs are an integral part of the discussion. Controlling them, dictating them, negotiating them… there are a lot of angles that the discussion about costs can take, and it’s reasonable to assume that the various opinions on the subject might be tied to what side of the health care system one is on (provider or patient, since we pretty much all fit into one category or the other). One can assume that providers are still making profits with the network negotiated prices they have with private health insurance carriers (I am not sure if that is the case with Medicare and Medicaid, but that’s for another post). And yet people who don’t have health insurance – often because they can’t afford it – end up with higher medical bills for the same services than people with health insurance.
It’s sort of like the idea that if 200 people are on an airplane, there are probably 200 different ticket prices that were paid for the seats. Everyone will be arriving at the same location at the same time, and yet depending on how and when they bought their tickets, they each paid a different amount. Healthcare is very similar: the price for a particular procedure depends on where you are, whether you see a specialist or a primary care doc, whether you have health insurance, and what insurance network you’re on. But in the case of airplanes, often the poorest people on the plane paid the lowest prices (standby, for example) while the people with more money might be flying business or first class, or they might have taken the first ticket price they saw, choosing convenience over savings. Unfortunately, health care doesn’t work that way. Even though it’s a more necessary service than air travel, people who can least afford healthcare (and thus are uninsured) end up with the highest bills because they don’t get insurance network rates.
Obviously healthcare costs are not set in stone. They vary from one doctor to another, from one patient to another, and from one health insurance carrier to another. Controlling costs isn’t going to be an easy process, and there’s no simple solution. But without an across the board reduction in costs, it seems unlikely that we’ll see a significant increase in access to healthcare or the number of people with quality health insurance coverage.
I found Jeffrey’s article in Grand Rounds, hosted by Leslie at Getting Closer To Myself. Leslie did a fantastic job of putting it together, and there are a lot of personal stories that are very much worth the read. Head over and check it out.
