This week, Congressional committees have begun the debate over health care reform. It’s one of the most important debates in my lifetime. Unfortunately, the Democratic majority has insisted on pushing for the creation of what they call a “public insurance option.” As a Tennessee physician who experienced first-hand the disastrous result of a similar previous experiment with a public option, I thought it might be helpful to explain why many are so strongly opposed to the idea.
The case Democrats are making for a “public option” closely mirrors the debate we had in Tennessee 16 years ago. In 1994, Tennessee had rapidly-expanding Medicaid costs and had a huge uninsured population, so our state applied for a Medicaid waiver to create a new program to provide universal coverage through a program that became known as TennCare. The program’s goal was noble – to expand health coverage through a government managed care option, which at the time was thought to be capable of delivering quality care while controlling costs. The construct was very similar to the Administration’s current idea of the Exchange program – private insurers would compete with the state Medicaid plan to provide insurance.
To ensure that the idea was attractive, TennCare promised a rich benefits package. The program achieved its goal of expanding coverage, but it nearly bankrupted the state, resulting in the most expensive Medicaid program in the country. Rather than injecting competition into the marketplace, TennCare resulted in huge cost shifting. Within a matter of years, forty-five percent of the individuals on TennCare had previously been insured by their employers. The employers had made a perfectly logical decision: they could reduce costs by putting their employees into the public plan. When the rolls swelled, Tennessee legislators were left with no other choice but to reduce benefits, cut payments to physicians and finally, limit eligibility. The central theme of our Democratic Governor’s 2002 platform was “fixing TennCare.”
This national plan will have generous benefits and will receive start-up funds from Congress. It will not have to pay the cost of providing care and will have the federal government strong-arming providers to accept the program. The next steps are familiar to those of us who have seen this play out before. Employers who are paying twelve percent of their costs now to their employees’ health care will look at the new program’s eight percent penalty for employers who don’t provide care and immediately dump their employees into the Exchange to save four percent. Those on private insurance – which pays more than the cost of care to subsidize Medicare and Medicaid – will be required to pay more to subsidize the new public plan.
Over time – it may be three, five or ten years – private insurers won’t be able to compete with a government-run plan, resulting in the fact that the majority of Americans will simply end up with one government-run program. As a physician, the problem I see with government-run healthcare is that care must be rationed to meet the budget.
Consider that here in America, the five-year survival rate for breast cancer has increased from fifty percent to ninety-five percent, largely because of education, early diagnosis and sophisticated medical treatment. But in England, which has a national health system, the highest survival rates I’ve seen are seventy-eight percent. They’re no longer covering routine mammograms because too many false positives resulted in more costly biopsies being performed. While it’s less costly to wait for a lump to develop, no American in their right mind would think this is a reasonable approach to providing care. But these are the choices that have to be made in a public health plan funded with taxpayer dollars.
If Democrats drop the idea of creating a health care system run entirely by Washington bureaucrats, I stand ready to work with them to ensure individuals can get the care they need at a price they can afford. I truly believe that Republicans and Democrats can find common ground on insurance reform and prevention care to make a significant difference in our nation’s health care system. If not, any reform delivered will be short-lived rather than transformational.
