File that anecdote away for a moment. Now, I want you to close your eyes and imagine something rather fanciful. Wait. Open your eyes again. OK, forget the part about how closing your eyes means you can’t read what I'm writing. Just imagine something along with me. Imagine a healthcare system in a society that is entirely government run. Patients report to government-sanctioned hospitals, see physicians only within the government-approved network, and pay fees mandated entirely by the government. There’s more: the government sets what drugs within each class can be prescribed in this system (and makes it more difficult to obtain so-called “non-formulary” drugs, those that are basically not as cheap as the ones the government gets after negotiating with drug companies), it utilizes its own electronic medical record, and it inserts an oddly musky smell into the hallways of the hospitals it runs.
Is this a nightmare? A dream? A reason to transform into a screaming lunatic, unable to articulate even the most remotely intelligible thought while narrowly avoiding the rupture of every bulging vein in his increasingly sweaty forehead? Well, I got some news for you – what I just described isn’t some sissy Scandinavian healthcare program or a totalitarian Soviet-era monstrosity, it’s the Veteran’s Administration healthcare system that I’ve worked in as a medical student and a resident, and it has been around for a while. And let me tell you something even more earth-shattering, another government-run program that includes parts of what was described above is something called…Medicare. The point of this exercise is to dispel the myth that government has no place in healthcare, or that it is not already heavily involved in our healthcare. I thought people already knew this, but all those “keep the government out of my Medicare” quotes reaffirm how dense many of us are.
With that background, let’s take a look at the next semi-interesting part of the health care bill, Section 221 – Establishment and Administration of a Public Health Insurance Option as an Exchange-Qualified Health Benefits Plan. In this plan, the Secretary of Health and Human Services “shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the `public health insurance option') that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care.” In other words, this plan is intended to serve as a check on the world of for-profit private insurance - our modern day Doughboy - that currently rules the health-o-sphere. On the surface, at least, this sounds like a good thing…unless you are in the health insurance company loving camp, which I suspect is less popular than a Brett Favre jersey at Packers camp. Let’s dig further at what this offers:
- “Ensuring a Level Playing Field” – In other words, requiring that the public option be held to the same rules that all of the other insurance options. Reasonable.
- “Provisions of Benefit Levels” – Here it is described that you can choose between “basic, enhanced, and premium plans”, as well as a potential “premium-plus” plan. Wait, I thought the point was that everyone should have access to the same affordable healthcare? This implies that there will be differences in the type of coverage one gets…or does the “enhanced” plan simply refer to the free Enzyte that comes with a subscription (in which case, sign me up!) . Admittedly, this smells fishy, but would not be a significant departure from the way the VA works in terms of service-connection, so I can handle it.
There are various other smaller details in this plan that are not all that interesting (unless you find “data collection” interesting, in which case I have a used life-size Britney Spears blow-up doll for you). I’d like to go back to the imagery put forward earlier in this piece, because it represents not only a government-run system, but also the health care plan we give to our troops we entrust to defend our freedom. I know first-hand that it is not a perfect system, and that there are many ways it could be improved (nurses who give a shit would be a good start). That said, it is at worst comparable to the private insurance plans out there and often much better. Better in terms of access to basic care and specialist services, to evidence-based therapies, and to integrated systems that move with the patient. Since private insurance companies (who have no access to this small market of veterans seeking health care) currently have no competitive interest to provide these services to the much larger population that they supposedly serve, perhaps a bit of competition might actually be a good thing - it appears that in the realm of healthcare, the government is the only party willing to and big enough to play the role of Ben & Jerry. We already have many public universities competing with successful private ones and public mail systems competing with private mail services, all leading to better options for you, the consumer.
After all, what is the doughboy afraid of?