Daschle's New Health Insurance
When Tom Daschle shows up for a confirmation hearing, senators are likely to grant him all the courtesies due a former Senate majority leader.
A series of profiles of potential members of President-elect Barack Obama's administration. But that does not mean Mr. Daschle should expect only softball questions. Lawmakers will most likely question him sharply about one of the most contentious aspects of President-elect Barack Obama's domestic agenda: his call for a new public health insurance plan to compete with private insurers.
No other proposal so clearly defines the political and philosophical differences between Mr. Obama and Republicans, or provokes such deep disagreements.
Mr. Daschle, the point man for Mr. Obama's campaign to revamp the health care system, supports the concept of "a government-run insurance program modeled after Medicare." It would, he says, give consumers, especially the uninsured, an alternative to commercial insurance offered by companies like Aetna, Humana and WellPoint.
But the proposal is anathema to many insurers, employers and Republicans. They say the government plan would have unfair advantages, like the ability to impose lower fees, and could eventually attract so many customers that private insurers would be driven from the market.
"The public plan option is a terrible idea — one of our top concerns in the health reform debate," said James P. Gelfand, senior manager of health policy at the United States Chamber of Commerce.
The public plan, as conceived by Mr. Obama, would vie with private insurers to provide better benefits and better customer service at a lower cost. Without such competition, Democrats say, private insurers cannot be expected to control costs much better than they do now.
Jacob S. Hacker, a professor of political science at the University of California, Berkeley, said the new option was essential to the success of Mr. Obama's effort to rein in costs and make coverage available to all Americans.
"Public insurance has a better track record than private insurance when it comes to reining in costs while preserving access to care," Mr. Hacker said. "The public plan would set a standard against which private plans must compete."
Jeanne M. Lambrew, an associate professor at the University of Texas who is in line to be deputy director of a new White House Office of Health Reform, asks: "Why should policy makers give private insurers the exclusive right to cover Americans? If private insurers can better meet our goals for the health system, why object to a level competition with public plans?"
The idea of a public plan has been endorsed by two Democrats with a decisive say on health legislation: Senator Max Baucus of Montana, chairman of the Senate Finance Committee, and Representative Pete Stark of California, chairman of the Ways and Means Subcommittee on Health.
Two of Mr. Obama's rivals for the presidential nomination, John Edwards and Hillary Rodham Clinton, also wanted to give people a choice between private insurers and a public plan modeled after Medicare.
"Over time," Mr. Edwards said, "the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."
That is what worries insurers, employers and Republicans.
"Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program," said Senator Michael B. Enzi of Wyoming, the senior Republican on the Health, Education, Labor and Pensions Committee, before which Mr. Daschle will testify on Thursday.
Senator Olympia J. Snowe of Maine, a moderate Republican, shares some of that concern. "Creation of a government plan is no panacea," she said, and "could disproportionately shift costs from private plans to the public."
Mr. Gelfand, of the Chamber of Commerce, said: "People would gravitate to the public plan because it would look cheap. Instead of paying the full cost of care, it would shift costs onto private insurance plans. It's our employees, American workers, who would pay the price."
In a report to Congress last year, the Medicare Payment Advisory Commission, an independent federal panel, said Medicare paid doctors 19 percent less than what private insurers paid, on average. For hospitals, the gap was similar.
Mr. Stark said he did not accept the argument that Medicare was grossly underpaying doctors and hospitals.
"Many of the private plans are poorly managed," he said. "They are the General Motors of medical care delivery. Medicare is paying the right amounts. To suggest that a heart surgeon has to make $600,000 or $700,000 a year, as opposed to only $400,000 under Medicare fees, does not get much sympathy from me."
Linda J. Blumberg, a health economist at the Urban Institute, said: "Large insurers do not seem to use their market power to drive hard bargains with health care providers. The presence of a well-run public plan could constrain private spending because private insurers would have to compete on price, in a way they do not often do today."
Karen M. Ignagni, president of America's Health Insurance Plans, a trade group, said the consolidation of the hospital industry in the last seven or eight years had increased the market power of hospitals, thereby reducing the ability of insurers to negotiate discounts.
Democrats say a public plan could use its purchasing power to secure better value for patients and taxpayers.
"Together with traditional Medicare," Mr. Daschle said, "this new program would have tremendous clout to bargain for the lowest prices from providers and push them to improve the quality of care."
Republicans say that Medicare rates, the prices paid for everything from wheelchairs to brain surgery, are set not by negotiation or competition, but by a web of federal laws and regulations.
Scott P. Serota, president of the Blue Cross and Blue Shield Association, whose member companies insure one-third of all Americans, said: "I'm not worried about our ability to compete on a level playing field. I am worried that a public program would have marketplace advantages that make private plans noncompetitive."
HERE IS A QUESTION -- Are Discount Prescription Drug Cards A Form of Affordable Health Insurance?
In all likelihood, you have probably seen them - whether you are at Walgreen's, CVS, or any various pharmacy across America, discount prescription drug programs seem to be offered everywhere. You can peruse an array of discount prescription programs online, and emails are often sent to elicit enrollment into different plans. So, what exactly are discount prescription drug cards?
Let us take a look at Walgreens as an example. Called the "Walgreens Prescription Savings Club," members have access to discounts on over 5000 brand name and generic medications. More specifically, 400 of the generic prescriptions are priced at $12 for a 90 day supply. For $20 a year, an individual can receive reductions in the cost of many of the medications he or she already uses. An entire family would pay only $35 a year.
Other discount prescription drug programs do not charge any fee. For instance, YourRxCard allows you to download a free prescription drug card online, instantly providing you access to savings up to 75% off all FDA approved drugs at 57,000 pharmacies across the United States. This site lists the following as the benefits of the program:
* No deductibles
* No waiting period
* No pre-existing exclusions
* Everyone qualifies
* Instant activation
YourRxCard even offers a medication pricing tool to find out how much your prescription will cost, as well as a pharmacy locator to find pharmacies in your area that participate in this program. Are programs such as the "Walgreens Prescription Savings Club" and YourRxCard considered a form of affordable health insurance?
The answer is, quite simply, no. Although discount prescription drug cards provide a savings for individuals and families who require an assortment of medications, they are not really a form of affordable health insurance. Instead, they are more of a supplement to existing health insurance. However, even if one does not have health insurance, he or she still can utilize the benefits from these types of programs in order to receive lower costs for prescriptions that are necessary to obtain.
Not all discount prescription drug cards are for everyone. Some find a significant savings while using one of these cards, while others find little to no saving at all. Some programs have restrictions, such as income limits and age limits, while others claim to provide discounts to everyone with no constraints. Some discount plans can be used in addition to one's health insurance, while others can only be utilized if the person or family does not already have access to prescription benefits in existing insurance coverage.
Although discount prescription drug cards are not considered a form of affordable health insurance, it may prove to be a wise decision to use them as additional coverage that will reduce the costs of medications. This is especially the case for those who find their monthly prescription bills to be very costly.
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