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Comments by YACCS
Monday, January 31, 2005

First social security, then health insurabce

It's not just social security my pretties....

Healthcare Overhaul Is Quietly Underway

By Ricardo Alonso-Zaldivar Times Staff Writer

WASHINGTON — Emboldened by their success at the polls, the Bush administration and Republican leaders in Congress believe they have a new opportunity to move the nation away from the system of employer-provided health insurance that has covered most working Americans for the last half-century.

In its place, they want to erect a system in which workers — instead of looking to employers for health insurance — would take personal responsibility for protecting themselves and their families: They would buy high-deductible "catastrophic" insurance policies to cover major medical needs, then pay routine costs with money set aside in tax-sheltered health savings accounts.

Elements of that approach have been on the conservative agenda for years, but what has suddenly put it on the fast track is GOP confidence that the political balance of power has changed.

With Democratic strength reduced, President Bush (news - web sites), Senate Majority Leader Bill Frist (R-Tenn.) and House Ways and Means Committee Chairman Bill Thomas (R-Bakersfield) are pushing for action.

Supporters of the new approach, who see it as part of Bush's "ownership society," say workers and their families would become more careful users of healthcare if they had to pay the bills. Also, they say, the lower premiums on high-deductible plans would make coverage affordable for the uninsured and for small businesses.

"My view is that this is absolutely the next big thing," said former House Speaker Newt Gingrich, whose consulting firm focuses on healthcare. "You are going to see a continued move to trying to get people involved in the process by owning their own health accounts."

Critics say the Republican approach is really an attempt to shift the risks, massive costs and knotty problems of healthcare from employers to individuals. And they say the GOP is moving forward with far less public attention or debate than have surrounded Bush's plans to overhaul Social Security (news - web sites).


A study released Thursday by the Commonwealth Fund, a private foundation that supports research on healthcare policy, found that people with high-deductible policies were more likely to have trouble paying medical bills than those in traditional insurance plans. They were also more likely to skip care because of cost.

The study did not look at the combination of high-deductible plans with HSAs, but the report cautioned that the savings accounts might not solve all the problems.

Many experts believe HSAs could quickly become one of the main ways to obtain health insurance for people working in small companies or buying coverage on their own.

Workers at large companies with standard health plans may be less likely to experiment with HSAs, although many large employers are already requiring their workers to shoulder a bigger share of health insurance costs. The existence of a government-sanctioned alternative to the traditional system might accelerate that trend.

"We are not trying to do one big change for the whole country, all at once — like what sunk Hillary-care," said Grace-Marie Turner, president of the Galen Institute, a research organization that promotes conservative, market-based health reform.

"We want to let people choose this if it meets their needs, and not rip out the underpinnings of the current system."

But even the most ardent backers of HSAs concede that the country is not fully ready for them. They say critics such as Stark are correct to point out that there is little information available to consumers for comparing the costs of various medical options.

In a recent article in the New England Journal of Medicine (news - web sites), Frist called for what would amount to a healthcare information revolution. Within the next decade, he said, patients should be able to gain online access to performance rankings and prices for doctors and hospitals.

"Increased access to more accurate information about care and pricing will make possible … the transformation of the healthcare system," Frist wrote. "Whether selecting their physician, hospital or health plan, consumers must be able to choose what best meets their needs."

A comprehensive system of healthcare information would be costly to create, and perhaps challenging for patients to navigate. On Thursday, Bush proposed some initial steps, such as computerized medical records and standardized information technology for medical offices.

His vision of an empowered patient calling the shots may stand little chance without a new information infrastructure.

Gingrich acknowledged: "You can't have an informed marketplace in a setting where you don't have any information."

What about drug costs? This kind of insurance plan can leave people vunerable to routine, chronic illnesses and once again, shifts the risk from the employer, who can moderate it, to individuals, who cannot. Health insurance allows people to get top quality care without regard to expense. If you have a market-based system, patients will choose the cheaper option, even if is not the best one medically. People already have to beg for expesnive care. Without some kind of universal, federally-run health care system, we will just make these problems worse. The US is the only western country where health care is not a fundamwental right of residency. Instead of creating an incentive for preventative care, this is designed to drive people even further away from treatment.

Why doesn't Congress try this first, and tell us how it works.

Any plan which relies upon people saving money, in a society where many workers already have to forgo company health insurance because they can't afford the plans, is aksing for a disaster. Any discussion of savings should start with "Americans have $8000 in credit card debt".

posted by Steve @ 2:13:00 PM

2:13:00 PM

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