Here's an article from the NY times about breaking news in Health Policy. Man, this stuff gets me so excited about the future. Right around the time we'll be breaking in, this whole mess is gonna reach a crescendo and, god-willing, we'll be there to make sure it gets set on the best long-term course..
December 7, 2002
Some Tentative First Steps Toward Universal Health Care
By MILT FREUDENHEIM
Worried that the growing number of uninsured patients will undermine the
nation's health care system, insurance executives across the country are
pressing for new steps toward universal health care.
Many health plans are developing or offering insurance with lower
premiums and slimmer coverage to attract customers who cannot afford
more comprehensive policies. Executives at Blue Cross Blue Shield of
Montana are pressing state legislators to raise the cigarette tax to
subsidize basic coverage. Another insurer, Blue Shield of California,
proposed a plan this week for health insurance for all state residents.
And Dr. William W. McGuire, chief executive of the UnitedHealth Group,
the largest private insurer, has written to every member of Congress
calling for "essential health care for all Americans."
Health insurers, which have long ranked high among the country's most
disliked businesses, frame many of their proposals in public policy
terms. But they also have strong business reasons to become involved in
the debate over helping the uninsured. They want to add young, healthy
members to their insurance pools to spread the cost of caring for the
sick. They are also eager to add members whose premiums would be paid
with tax money or government subsidies.
Several insurance executives also said pressures generated by the
uninsured were raising a threat to the system that could lead to
government intervention if insurers did not develop a plan first.
"If we don't do something in a darn hurry about the uninsured, the whole
health care system in this country is going to collapse and the
government will step in," said Chuck Butler, a vice president of Blue
Cross Blue Shield of Montana. "People will say, enough is enough."
Dr. Jay Crosson, executive director of physician groups at Kaiser
Permanente, the largest nonprofit insurer, said, "As insurance becomes
less affordable, more and more people will be upset and frightened, and
the industry will find itself drawn into the political process."
Most health insurers are thriving, keeping ahead of rising hospital
charges and doctor fees by raising premiums as much as 30 to 40 percent
a year for small companies and 17 percent and higher even for large
employers. But the increases, combined with disappearing jobs, are
leading many people to drop health insurance and, not incidentally,
adding to the unpopularity of insurance and managed care companies.
Each 1 percent increase in costs adds 300,000 to the 41 million
uninsured, according to the Lewin Group, a health care research
organization. Many of the uninsured are young and healthy workers in
small companies. When they go without health insurance, costs per person
soar for the sicker people who remain.
People who need care keep the coverage like "people buying fire
insurance when the house is on fire," said Randy Kammer, a vice
president of Blue Cross and Blue Shield of Florida.
Some health insurers in the Southeast are finding that as many as one in
10 small-business customers are not renewing their coverage, according
to Brian Klepper, executive director of the Florida-based Center for
Practical Health Reform, a group of insurers, hospitals and employers.
But uninsured patients still go to hospitals, which then pass along the
cost of unpaid bills in higher charges to health plans.
"The tragedy of our nation's health care system," said Dr. McGuire of
UnitedHealth, "is that in spite of its many impressive features, it has
ultimately failed to make even basic care consistently available to all
of our citizens."
Dr. McGuire is calling for building universal coverage around an agreed
national definition of what constitutes basic acceptable coverage,
"based on firm evidence" of the effectiveness and cost efficiency of the
care. He has written to every member of Congress and dispatched
UnitedHealth officials to promote his plan in Washington, D.C., and in
Minnesota and other states.
On Tuesday, Bruce G. Bodaken, the chief executive of Blue Shield of
California, one of the largest health plans in the state, called for a
statewide universal health care system, to be financed by employers,
individuals and a new tax, which he said could be a model for the
nation. More than six million California residents have no health
insurance.
Mr. Bodaken said in an interview and a speech at the Commonwealth Club
in San Francisco that under his plan, all except the smallest employers
would be required to offer basic coverage. Individuals who could afford
it would have to buy their own policies, and a new tax would subsidize
those unable to get coverage.
Blue Shield has commissioned an independent study of taxing
alternatives, including raising the state income tax, sales tax, a tax
on health insurance premiums or hospital and doctors' fees and the
tobacco tax.
"We absolutely have to solve this problem," said Helen Darling,
president of the Washington Business Group on Health, a group of large
self-insured companies. "The number of uninsured will inevitably grow
because of the rapid rise in health care costs. We know it's going to
get much worse."
In Florida, 30 insurers, working with Tom Gallagher, the state insurance
commissioner, plan to introduce several lower-cost standard and basic
policies in the spring to attract small groups that have been dropping
coverage. Some policies will include high deductibles and fewer
state-mandated provisions like numerous visits to occupational and
physical therapists, said Ms. Kammer of Blue Cross and Blue Shield of
Florida.
In Montana, insurers have lined up bipartisan support in the legislature
to raise cigarette taxes at next month's session to subsidize health
care for the uninsured. The package includes tax credits for employers
with two to four workers, coverage for schoolteachers and for more
children in low-income families, as well as prescription drugs for
low-income elderly people, Mr. Butler said.
Only 2.9 million New Yorkers are uninsured, reflecting the state's
extensive public assistance programs. But Howard Berman, chief executive
of Excellus, a Blue Cross holding company in Rochester, said that with a
projected budget shortfall exceeding $6 billion, the state will be hard
put to help if more residents lose their coverage.
"We need new products for middle-class people who have been priced out,"
he said. "And we need more efficiency in the system to reduce costs."
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