It's very important for dental insurance to be included in this Health Care Reform discussion.

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The Progressive Change Campaign Committee, which supports the creation of a public plan option in health care reform, is running an ad juxtaposing polling numbers from a June 8th Wall Street Journal/NBC News poll--showing 76 percent support for a public health care plan option--with the seven-figure campaign contributions received by seven centrist Democrats reluctant to back such an option. Regards, Mary cna and free cna training

The Chamber of Commerce is expected to spend around $200 million on political campaigns this fall, targeting mainly open seats and "vulnerable Democrats like Sens. Michael Bennett in Colorado and Blanche Lincoln in Arkansas." The Chamber has typically supported Republicans, but its leaders maintained an "uneasy" relationship with the Obama White House last year until breaking over health care and climate change legislation (Rosen, 3/11).

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The PUBLIC PLAN PROPOSED BY THE HOUSE SHOULD BE FULLY RESPONSIBLE AND LIABLE FOR ANY MEDICAL MALPRACTICE SUIT brought against a physician by the patient for the particular health care encounter charged to the Public Plan.

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The Health Reform Bill should really be a "REFORMED" bill and not just a bill to extend the existing dysfunctional system to all (“The Baucus-Grassley Health Insurance Companies Preservation Act”). A SINGLE PAYER, NON-FEE FOR SERVICE FIXED PAYMENT, NON-PROFIT, INCOME TAX FUNDED SYSTEM IS THE IDEAL SOLUTION. Short of such a system the following is an absolute minimum:

1.       The PUBLIC Plan as proposed by the House is absolutely essential to controlling the spiraling costs of health care.  The Public Plan should be a robust plan which specifies explicitly and quantitatively exactly what is covered and what is not with a yearly cap on patient deductibles and no lifetime limits. The Public Plan should be the same STANDARD PLAN offered in ALL states – no “basic”, “enhanced”, “premium”.  This is not cable TV service. 

 2.       Next the Public Plan should NOT be a FEE FOR SERVICE plan but a FIXED PAYMENT PLAN - based on a schedule determined by the diagnosis and treatment recommended by a new Public Plan Medical Board (based on current medical knowledge and practice). Each type of diagnosis for the disease detected should have a standard recommended treatment with well defined procedures - which should have a standard FIXED payment. This is absolutely necessary to make any impression on current costs. Some flexibility should be allowed when the diagnosis is not clear-cut – medical science is not an exact science. Only recommended procedures and generic drugs should be covered. To get extra treatment, tests or brand name drugs the subscriber should purchase SUPPLEMENTARY INSURANCE from the PRIVATE sector. 

 3.       It is crucial that the Public Plan should be open to every individual and all businesses regardless of size and revenue (e.g. Sen. Ron Wyden’s “Free Choice Act”). It is very important that the Public Option should be available to everyone – EVEN TO THOSE WHO CURRENTLY HAVE INSURANCE. There should be no “firewall” – otherwise it will fail to provide any competition to the private insurance companies (“keep insurance companies honest”) and defeat its main purpose of reducing insurance costs. Without this the Public Plan becomes very weak and cannot compete with the private plans. It will then only serve as a dumping ground for all those with a weak health record and condition. The Public Plan should not mimic the private plans. THE PUBLIC PLAN SHOULD BE A CENTRAL PART OF THE HEALTH REFORM PACKAGE - DO NOT USE IT AS A BARGAINING PLOY TO BE CASHED IN TO GAIN THE SUPPORT OF REPUBLICANS AND BLUE DOG DEMOCRATS.  Without a robust Public Plan all we are doing is forcing everyone into the clutches of the greedy for-profit private plans whose primary purpose is to make money rather than provide meaningful coverage (they are not charities) – which all the current bills in Congress are doing by mandating all employers and individuals to get coverage. This mandate is the reason why the AMA, hospitals and pharmaceutical companies are supporting the reform as it means more business for doctors, hospitals and drug manufacturers without themselves making any sacrifices. This will only make matters worse for consumers as regards affordability. DO NOT DEFANG THE PUBLIC PLAN!

 4.       There is one very effective way to make the Public Plan attractive and acceptable to physicians and their lobby (AMA). It is as follows:

 The PUBLIC PLAN PROPOSED BY THE HOUSE SHOULD BE FULLY RESPONSIBLE AND LIABLE FOR ANY MEDICAL MALPRACTICE SUIT brought against a physician by the patient for the particular health care encounter charged to the Public Plan.  Therefore the physician has no need to order unnecessary tests and procedures to protect her from any future malpractice suit if this occurs under the Public Plan. This solves the overtreatment problem (for the Public Plan) which is a major contributor to current health care cost. This method of malpractice support will only work if the Public Plan is also NOT A FEE FOR SERVICE but a FIXED PAYMENT type plan (as indicated in paragraph 2). However, malpractice support should only apply to individual physicians – not hospitals and other providers.   Extending this facility of malpractice support to hospitals and other providers may have the undesirable effect of lowering standards of care in hospitals – the effect on health care delivered is different from that of individual physician behavior.  A hospital, diagnostic center etc only provides the services requested by the physician (the “order”) - either in a physician's practice or in a hospital.  So IT IS THE PHYSICIAN WHO INITIATES AND CONTROLS THE TREATMENT AND HENCE THE COSTS.  The PHYSICIAN IS THE PRIMARY GENERATOR OF COST!

 5.       To pay for the Public Plan impose a Public Plan premium (e.g. increased Medicare tax) from the federal income tax as a percentage of income in progressive bands (e.g. Federal 1040).

 6.       The Public Plan should be a Primary Care centric plan and should support a Primary Care controlled treatment model in which the Primary Care physician(s) control and co-ordinate a particular health incident by exchanging information and co-coordinating events between specialist and hospital care to eliminate duplication and waste (using electronic medical records). INCREASE PAYMENT TO PRIMARY CARE PHYSICIANS FROM CURRENT LEVELS – this is vital. Also provide hefty education subsidies to medical students who wish to train and pursue a career in Primary Care medicine.  Also provide similar support for nurses training for RN.

 7.       Finally, the private nonprofit health insurance cooperatives (e.g. in Washington state) being proposed in the Senate Finance Committee bill (“The Baucus – Grassley Private Insurance Companies Preservation Act”) are a poor substitute. Most of them have very high deductibles, some as high as $20,000 - $40,000. In effect you are not really buying insurance at all, only a false sense of security. Such a plan will bankrupt most middle class subscribers in the event of a serious illness.

 But even a strong Public Plan is only a temporary fix. The real problem of the US Health Care system is the employer provided health care. This is absolutely the central cause of the high cost of health care in USA and the major factor in the stagnation of middle class wages - employers reduce wage increases to compensate for increases in healthcare premium payments to insurance companies. The insurance companies, doctors and hospitals just pass on the higher costs to the employer and employee and do just fine! Even with Health Care Reform,  with the passage of time,  employers will be able to cover less and less people after an initial period of stability. This is because the reform being considered both in the House and Senate does not address the root causes of the failure of the current US healthcare system – it only makes the broken system accessible to more people under the term Universal Health Coverage. The Health Care Reform package being offered in both the House and Senate is really a Health Insurance Company Preservation Act - for private health insurance to survive it is necessary to have employer provided health insurance. Last but not least, the unemployed have no coverage – most unemployed cannot afford COBRA coverage. Health care should not be employer provided - only a single payer system will really work and can be sustained in the long run (a la Canada).  So, for political reasons, right now a strong Public Plan is all we can do. But  in fifteen to twenty years (or even earlier) we will again face a crisis and then a Single Payer Fixed Payment Income Tax funded non-profit health care system will be the only option left – we would have played all our cards in the current Obama Health Care Reform (if it ever passes in the House and Senate).  

I think this is an excellent summary of the Act. Of all the the potential legislation related to business, this is certainly one of the most important. Personally I'm in favor of it. I can see the potential drawbacks, but I feel that it's less a conclusion based on sober analysis of facts and rather a reaction to any attempt by the government to touch business in any way. Arguing that adding another option somehow cuts down on competition is legitimately backwards thinking, and if the healthcare is indeed substandard as others would claim, then the same standard that laissez faire capitalists say can be applied to any business to create a self-regulating market can be applied here and people simply won't take the public option.

Overall, I feel this is the same paranoia that was afforded the Small Business CHOICE Act of last year which I wrote about on my blog.