Chris T. Pernell
Doctor and Clergywoman

Chris T. Pernell

Chris T. Pernell is a doctor and an ordained clergywoman in New Jersey. Two of her recent projects include a prison-based wellness program and a faith-based childhood obesity initiative.

Separate and Unequal Rights

With the President out in front, jockeying for health reform and lawmakers proselytizing for change at nationwide town halls, trench warfare has ensued. At stake: the direction and scope of health-care legislation. Sadly, propaganda and political aggrandizing have muddied the facts. Indeed the public option caveat has fueled much of the vitriolic debate over purported government takeovers and cries of socialized medicine. As such, detractors warn that the public option is too incendiary an idea to garner widespread support, and, for some, suspiciously un-American.

Those advocating for a public plan have been ridiculed as being in favor of government bureaucrats seizing health care. Opponents decry the public option as a sham or forerunner for a single-payer system. Not true. Though I am in no way a big government zealot, or naively misguided to think that government action will be flawless, on the other hand, I am not frightened by a public-private partnership. Yet, while Americans, mainly those with acceptable coverage, are growing hostile to any government-sponsored program, many overlook the government's role in the current health system.

Members of Congress receive taxpayer-subsidized health insurance. Employer-provided coverage has been made possible by tax advantages secured by federal laws. Then there is Medicare, Medicaid and the Children's Health Insurance Program, as well as a federally-controlled single payer system for veterans. Before these programs were created, many seniors, the poor and children went uncovered. Even with their respective defects, government intervention, in these cases, has been necessary. If a government funded plan is good enough for our legislators, then why not for those who elected them?

Rhetoric to the contrary smacks of a double-standard. Dare I say, separate and unequal. The American public should be given the choice to participate in a national health exchange and allowed to access health plans previously available to senators and representatives. Initially, federal start-up money would be used, followed by financing provided from premiums paid by new enrollees. Would this create an unfair market, even if public and private entities are held to the same laws and regulations? Rather, the private insurance sector would be disciplined and forced to compete instead of the oligopolies which are allowed to dominate and discriminate through nefarious practices.

To counter a public option, some lawmakers have promoted nonprofit cooperatives or interstate insurance plans, but I am unconvinced that either will have the muscle to instigate reform and mandate quality care. Without such assurances, these alternatives could prove too costly. Instead, more appropriate compromises may be a trigger option (where if certain benchmarks were not reached in a short time frame, then the public program would kick in) or possibly an abort clause, a fail-safe mechanism of sorts preventing major catastrophe like in major research studies. Or what if we just do the right thing in the first place?

By Chris T. Pernell  |  August 4, 2009; 8:51 PM ET  | Category:  Health Care Reform , Health costs , Public option Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
Previous: Getting Everyone Covered Efficiently | Next: Public Option: The House Always Wins

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By the "poor" I meant the millions of uninsured and underinsured who cannot afford a worthwhile insurance plan.

If we picked up the savings from the waste of private insurers, we could indeed investigate if Medicare rates need to be changed and then change them if necessary. My doctors would gladly take less from Medicare because the adminstrative costs are so high with private insurers.

My point is that you still have not told me what benefit we get from the extra $400 Billion we pay for profit insurers. Nor have you provided a valid objection to giving Medicare to everybody.

Posted by: lensch | August 7, 2009 10:17 AM
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Thank you for your feedback. It is a misconception to believe that the only people who will make use of the public plan will be the sick and the poor. The poor currently have access to Medicaid. I do not disagree that less healthy individuals will jump at the chance to get medical insurance, but then there is a considerable number of individuals and families who do not qualify for Medicaid, because we are not poor, who have been priced out of the individual insurance market because of exorbitant fees.

While Medicare has been beneficial to the community it serves, however, reimbursement practices are less than desirable for health care providers. It would be unfair to perpetuate this by adding more patients without proper compensation, making the provider's job unsustainable. What we need to do with Medicare is continue to root out waste, promote efficiency and remedy the inequitities with prescription coverage.

I am in favor of a public option, in addition to making Medicare more efficient, taking the private insurance industry to task and challenging pharmaceutical companies to lower prescription medications.

It would be reckless, I believe to go forward without addressing all of these issues.

Posted by: chrispernell | August 5, 2009 11:29 AM
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The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 Billion each year in high overhead and physician and patient compliance costs. There is another $100 Billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 Billion each year can be used to pay for the extension of Medicare to everyone. If you simply add a public plan, you are leaving the $500 Billion on the table. You are simply adding cost. This is not smart .

In addition, there are technical reasons just adding a public plan is foolish. In Day 1 of Insurance 101, you are taught that the larger the pool, the more efficient the plan. Medicare for All has the largest possible pool. A public option just adds yet another pool, and at least at first it will be a very high risk pool--the sick and the poor. Most people have no choice; they get their insurance through their employer who will be loathe to change to a new untried public option plan. In addition if you cover pre-existing conditions, you will increase the number of the self insured or if there is an individual mandate, the minimally insured. After all why not pay low premiums for a $500,000 deductible policy if you can switch to a better one if you get sick.

Paul Krugman has pointed out the the goal of a well run corporations is to make money for their shareholders not to proved good efficient health care. If requiring a doctor to fill out a 40 page form saves them a buck, they will require it. The whole idea of "medical loss ratio" which companies try to minimize shows that the system simply doesn't work. Look, the House bill is 1,000 pages long because it is trying to fix an essential bad system. HR676 is 70 pages long

Posted by: lensch | August 5, 2009 10:16 AM
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