Diagnosing Proposals for Healthcare Reform
(Photos by Robin Holland)
This week on the JOURNAL, Bill Moyers spoke with two leading healthcare journalists, Trudy Lieberman and Marcia Angell, M.D., seeking their perspectives on the current health reform debate in Washington. Lieberman and Angell each addressed whether the “public option” proposed by President Obama would actually serve to insure all Americans and who in the private health industry stands to benefit from the reforms under discussion.
Trudy Lieberman said that Obama’s proposed “public option,” in which the federal government would set up its own insurance option to compete with private insurance plans, has not been explained in detail and would likely not be effective in containing costs:
“From my vantage point, I don't see that the solutions for controlling costs, that will really control costs the way other countries do, are really in place... We hear about preventive care as saving costs, because intuitively it sounds like it's going to work, but the academic studies show that more preventive care actually raises costs. That doesn't mean it's a bad thing to do, but it's not a good cost saver in the system... [Obama] has been vague right from the very beginning, we have not known exactly what the Obama health plan has been... I see an administration that is trying to keep this playbook going as long as possible, and to commit to as little as possible until the eleventh hour. By then, it’s going to be too late for the American people to know what’s going to await them... As a journalist, that troubles me.”
Marcia Angell argued that the “public option” would not create the change needed in the American healthcare system and that reformers should advocate for a “single payer” system, in which a single federal agency would replace and eliminate the private health insurance industry:
“What [Obama] has essentially advocated is throwing more money into the current system. He's treating the symptom and he's not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as the average of other advanced countries, and we don't get our money's worth. So now he says, ‘Okay, this is a terribly inefficient, wasteful system. Let's throw some money into it...’ Obama said in his press conference [that] the worst thing we can do is nothing, the most costly thing we can do is nothing. I disagree with that – you can throw more money into this system and make it even more costly... I think we have to start all over on this, I really do. I think we have to go for a single payer system.”
In his recent appearance on the JOURNAL, Clinton administration Secretary of Labor Robert Reich agreed that “single payer” is the best idea, but said that it is politically impossible and that the “public option” should be enacted anyway:
“[The public option] means that average members of the public have a choice, if they want it, of either their private-for-profit insurers like they now use or a public not-for-profit insurer. That public insurer would resemble ideally Medicare, [with] low administrative costs and it would have the economies of scale. It would be so large that it could actually negotiate low drug prices and very low premiums. That’s what the private insurers are scared of, because that means that their profits will be squeezed... Unless they are going to be genuinely pressured to reform through a public option, there is nothing that’s going to change them... The single payer system would be the best of all... Unfortunately, we can’t get there from here because the political forces are just too strong against single payer.”
What do you think?