The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Public Health Plan – Tea Leaves

Posted by Alan on May 12, 2009

President Barack Obama’s stated goal is to pass comprehensive health care reform by the end of this year. With a Democratic Congress and muted opposition (relative to those that opposed President Bill Clinton’s similar effort) President Obama has a good chance of succeeding. It won’t be easy, especially given the cost and the state of the economy, but the stars seem to be aligning.

Consider: Health care costs are a huge burden on America’s struggling manufacturing base. Health care reform would ease this burden. The public supports substantive change. Previous opponents to reform (doctors, hospitals, drug companies, insurance plans and the like) have lined up to promise to reduce health care costs by $2 trillion dollars by 2019. Voluntarily. Harry and Louise would be so proud. And President Obama has perhaps the most potent grass roots political organization ever assembled.

Hold that last thought.

One of the most controversial elements of the President’s health care reform package is the creation of a government-run health plan to compete with private carriers in the traditional market place. I’ve written on the controversy several times, so to oversimplify: liberals tend to think a public plan is essential to assure fair competition in the marketplace. Conservatives see it as the first step toward a single payer system. Many moderates, including centrist Democrats who appear to hold the balance of power on health care reform plan, seem skeptical about the idea.

Then candidate Obama campaigned strongly on the need for a public health plan. While he’s always expressed a willingness to compromise on the issue, in the past it has usually been about how a public plan would operate, not whether there would be one.

Hold this thought, too.

Now, let’s bring those two held thoughts together. Ben Smith over at is reporting on an email sent out by President Obama’s grass roots organization, Organizing for America, on the issue.  The letter urges supporters of the President to pledge to support three broad principles for health care reform. These principles are:

  1. reduce costs;
  2. guarantee choice; and
  3. ensure all Americans have quality affordable health care.

That’s it (the full email is printed on Mr. Smith’s blog). No mention of a public health plan. Zip. None.

Organizing for America’s call to action is focused on the right principles, too. Some of commented that the Administration’s emphasis seems to be more focused on health insurance reforms than on containing medical costs. I confess, I write more about the former than the latter, but that’s in part due to the nature of this blog and it’s because market reforms have been more controversial — so far. The reality is that President Obama has consistently worked to emphasize the need to rein in the escalating cost of health care in this country. In many ways he’s been successful in gaining consensus on those aspects of his plan.

Which means the question becomes whether he’ll fight to keep a government-run health plan in the mix even if it means jeopardizing the progress he’s made along other fronts. I don’t want to read too much into one email. But the fact that Organizing for America’s call to arms doesn’t mention public health plans may, just maybe, mean the Administration is willing to deal on the issue — or may be recognizing that the votes for a public plan just aren’t there. It’s too early to tell.

But look at it the other way: if the email had included the creation of a public health plan as a core principle, it would be very hard for the Administration to later back down on the issue. By side-stepping the opportunity to make such a plan a core principle of reform, at the very least President Obama is leaving the door open on whether a public plan needs to be part of the final package.

That’s the kind of flexibility he’ll need to pass comprehensive health care reform. And it’s why I personally believe meaningful reform is indeed likely to pass this year.


6 Responses to “Public Health Plan – Tea Leaves”

  1. mkirschmd said

    You can’t migrate back to private plans if they are driven out of business by the government’s plan. I fear that single payer is Obama’s unstated endgame for health care reform. When the goverment runs something without competition, it doesn’t run well. Have you been to the Division of Motor Vehicles lately?

  2. If the govt plan is anything like Medicare, I imagine doctors will not be overly enthusiastic with it. Thus, if you elect to join the govt pool (should one come into existence) then you might find that your care is sub par. If that’s the case, then folks might migrate back to private insurance so as to sidestep this potential pitfall.

  3. mkirschmd said

    I think that the White House ‘tea party’ this week between Obama and various medical groups was more theater than policy change.
    We are viewing the opening moves of a long chess match that is more likely to end in a stalemate than a check mate.

  4. doctorblue said

    Obama could gain more support for his proposed health care reforms, if the government actually enforced its existing laws.

    Under our current system, I believe medical insurance companies have vicarious liability for the negligence of their network providers. Calling the insurance companies to the carpet for the negligence of its providers would expose reasons for the high cost of private for-profit health care and the low quality of care.

    I’ve been disabled the last five years because the many providers I saw while insured by Cigna didn’t have time to read the test result reports. Cigna rewarded its providers with year end bonuses for having more healthy patients, so my doctors “saw” more patients as healthy regardless of the patients’ actual condition.

    On the other hand, using these same records and independent examination, the Social Security Administration’s employed physicians — whom, I suspect, have more time to read and analyze reports — found that I was disabled due to degenerative disc disease caused by untreated infections.

    Based on this experience, I assume that I might have a better chance of getting government paid doctors to listen to me and provide the needed care for a few reasons. 1. There might be more accountability for satisfactory patient outcome. 2. Doctors wouldn’t be paid based on the number of patients seen per day, but on the service provided the patients they did see.

    Insurers who advertise and promote a patient’s bill of rights in SEC filings shouldn’t get away with dismissing and ignoring member complaints, which is exactly what CIGNA did in my situation. I have written correspondence to CIGNA, my primary care physicians and referred specialists complaining about their failure to take my health concerns seriously. (Since I have been disabled the last five years, I think I have a point.)

    My blog #8 “Search For A New PCP” provides details about my experiences dealing with CIGNA customer care and the numerous, repeated phone calls it took to correct multiple billing and coding errors and to get approvals for CT scans and diagnostic procedures. Surely, insurers should be corporately liable for failure to properly oversee staff and correct quality related problems, and for breach of good faith and fair dealing in failing to provide the insured appropriate care, as well as for breach of fiduciary duty for failure to monitor, investigate and oversee its management system.

    Yes, I got my CT scans, MRIs, SBFT, colonoscopy, etc. — all showing abnormalities that the insured’s providers chose to ignore, overlook, downplay…What good are they if no one is there to read and properly analyze the scans to form a proper diagnosis?

    The referred specialists made mistakes and the referring doctors chose to side with the specialists without examining the evidence–the reports in my patient records. None of the doctors were receptive to my repeated attempts to convince them to reconsider their decisions. Try finding a medical malpractice attorney to represent the injured party once the patient is broke and disabled.

    Perhaps CIGNA is the anomaly among all the other more proficient insurers, but I think not.

    If you read my post #19 “Virginia Workers Compensation Claim,” you’ll see that I didn’t get the lifetime medical care and hand surgery I was awarded due to surgeons’ fear of 1) not being paid by the insurer under Workers Comp, and 2) differing opinions on the surgical procedure needed. Aetna was the employer’s insurance company.

    We didn’t change civil rights until the courts got involved. We can’t legislate how people feel. But we can adopt laws that protect the rights of harmed individuals. Health care won’t change until the government mandates action through regulation. At least a government-run system would provide an option for obtaining competent medical care, which I don’t have now and didn’t have when I had medical insurance.

    • The Pharmaceutical Research and Manufacturers of America (PhRMA) agrees that reducing health care costs in America is important. In our “Platform for a Healthy America,” we call for declaring war on chronic diseases, which account for 75 percent of all health care spending. It is essential that we find ways to prevent these illnesses and better manage them when they occur. A key feature of taking on chronic medical conditions should be a new nationwide public health campaign against obesity, which accounts for fully a quarter of health care cost increases over the last 20 years. We should be more aggressively promoting healthy lifestyles and supporting comprehensive employer-sponsored wellness programs. For patients, more effective treatment of chronic diseases means better health and quality of life and for the economy, it means a more productive workforce and less costly health care. We also share the sentiment of the president and Congress that it is critical that all Americans receive high-quality, affordable health care insurance coverage and services. PhRMA believes that providing health insurance for all Americans should primarily involve expanding access to private health plans. The key to more affordability and access is to give patients choices among diverse competitive plans that have appropriate consumer protections and rules. PhRMA’s “Platform for a Healthy America” can be found at

  5. David C said

    If they weren’t talking about a public program, what do you think they meant by goal 2: guarantee choice? They’re just trying to galvanize support around their message without having to discuss specifics. Standard political messaging. If they can get people to use the words “guarantee choice” frequently when talking about health care reform, then they can tie guaranteeing choice in with a public program. After all, a public program is a way to increase choices, right?

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