GRAY MATTERS: Plenty of questions, few answers on health care plans

If you're wondering what's going on with health care reform, you're not alone. The Democratic Congress and the Obama administration seem poised to give the nation some form of universal health insurance, but no one seems to know whether or when i...

If you're wondering what's going on with health care reform, you're not alone. The Democratic Congress and the Obama administration seem poised to give the nation some form of universal health insurance, but no one seems to know whether or when it will happen or what it will look like.

What's more, most of the major players won't say what, precisely, they favor. That includes the president, House Speaker Nancy Pelosi, Senate Democratic Leader Harry Reid, Senate Finance Committee chairman Max Baucus, Sen. Edward M. Kennedy and the heads of other relevant committees, all of whom pledge to pass health care reform this year.

I've tried but failed to get various interest groups to tell me, specifically, how health reform should insure the 50 million Americans who are uninsured. These include the American Medical Association, the consumer oriented Families USA and AARP. But instead of specifics, AARP appeals to members with generalities, such as "ensuring all people have access to affordable coverage regardless of any pre-existing health conditions. . . . Requiring insurers to provide a standard benefits package."

The AMA tells us we should: "Make it easier for individuals to choose and own their insurance to fit their needs. Provide low-income Americans with the means to purchase health insurance; establish fair insurance rules that include protections for high risk patients and make individual insurance more affordable."

And the liberal Families USA, which has been a health care consumer advocacy group, has surprised its allies by joining with business groups, including the Pharmaceutical Research and Manufacturers of America, in an effort to "find common ground."


All this is important for people on Medicare, which could get caught in the middle of this battle. Baucus, for example, has proposed changing Medicare's payment structure and suggested that the Centers for Medicare and Medicaid Services may not be adequate to run a new health care program. AARP says Medicare would be endangered by a government-run program.

A friend at AARP explained: "It's hard to come out for something that isn't yet introduced or even defined. What would the benefit package look like? What are the premiums? Who governs it and how would it be different than Medicare, which is nitpicked to death by the Congress? I think until we see a proposal, it's simply not possible to comment intelligently."

Another, more cynical friend at the New York-based Medicare Rights Center, which champions the extension of Medicare for all Americans, said, "Whatever happens, AARP will say they were for it." What is clear, however, is that the AMA, AARP, Families USA, the drug companies and the insurance industry oppose a single, publicly financed, government health plan, although it's widely supported by the American people and health care professionals.

Many liberals in the House and Senate, and leading advocacy groups favor some form of a single-payer system run by the federal government such as the Medicare for ALL proposal (House bill H.R. 676) in which providers -- doctors, hospitals and labs -- work for themselves.

The benefit would be uniform, and paid for through taxes and premiums, but it would eliminate the need for private health insurance, which is paid by individuals and/or their employers. And it would replace Medicaid, the State Children's Health Insurance Program and other costly, overlapping federal and state health programs.

Despite furious lobbying by liberal organizations and health care advocates, including the 15,000 doctors of Physicians for a National Health Program, thousands of nurses and health care workers, and most labor unions, Pelosi and Baucus, have declared "single-payer off the table," largely because they believe opposition would be too great from the health care insurance industry as well as the AMA and other business groups and conservatives who mistrust government-run programs.

Obama once supported a "single-payer" plan, and Pelosi acknowledged she personally favors such a plan. But Obama said more recently that he does not favor a European-style health care system, and Pelosi does not believe it could pass. Families USA, declined to say why it opposes single-payer. AARP, which says consumers should have private insurance choices, earns nearly $700 million a year from insurance royalties.

As a fallback, advocates and lawmakers who call themselves "progressives," insist that if a single-payer plan cannot pass, they will not support any health care reform that does not include a strong Medicare-like public plan.


They delivered that warning last month in letters to Pelosi from 77 House members and to Kennedy and Baucus from 16 Democratic senators (including both New Yorkers).

The nonpartisan Center for Medicare Advocacy said, "It is essential that any health care package include a public health care plan. A public plan, standing alone or in combination with an offering of private plans, offers many benefits to the public . . . . A public plan means a plan that is available to all within the designated insured population, that is administered by the federal government."

Republicans, free market conservatives, the AMA and the insurance and drug industries object that a public plan run by the government would only be a subterfuge to move toward a single-payer system because it would be the better, cheaper choice.

(Saul Friedman writes Gray Matters, a personal finance column directed at older Americans, for Newsday. He can be reached at .)

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