Cath Lab Digest

Government-run Insurance Seen as Step Toward Nationalization

Stakeholders are united in their support for healthcare reform, but the proposal to create a public, government-run health plan has become a major point of disagreement, with private insurers asserting that they could not compete with such a plan. Critics of the public option say it will move the country toward a single-payer system by eroding private enrollment and exacerbating cost shifting, but defenders say competition will be beneficial and that individuals and businesses could still choose private insurance if they prefer. Statements made by advocates of single-payer healthcare, however, have cast doubt on whether supporters of a public plan are sincere about preserving the private system.

As a candidate, President Obama said he would favor single-payer healthcare if he were designing a completely new system, but he now supports a public/private hybrid that includes a new government-run plan to compete with private insurers. The president says that healthcare reform and economic recovery are inextricably linked, and Kathleen Sebelius, his appointee as Health and Human Services (HHS) secretary, has also endorsed a public plan.

Additional support for a public plan is being provided by an organization called Health Care for America Now (HCAN), which lists a public insurance option as one of its principles for reform. HCAN says its principles are supported by >190 members of Congress, and the group has >850 member organizations in 46 states. Howard Dean, MD, former chairman of the Democratic National Committee, told participants in a conference during the first week of May that, “What makes it real reform is if there is a public insurance option.” Dr. Dean added, “If there is no public insurance option…then this is not reform at all.”

Nudge Toward Nationalization
For some healthcare reformers, creation of a public insurance option is not enough. In a video segment from a speech she delivered to an audience of single-payer supporters, Rep. Jan Schakowsky (D–IL) recounted a conversation with a health insurance executive who expressed his concerns about a public plan. Rep. Schakowsky said his assertion that a public health insurance option would put the private insurance industry out of business was correct. “The goal of healthcare reform is not to protect the private health insurance industry,” she said, “And I am so confident in the superiority of a public healthcare option, that I think he has every reason to be frightened.”

The congresswoman from Illinois also said that supporters of a public plan are, in fact, committed to single-payer healthcare but are willing to support a public plan because it will act as an intermediate step that sets the stage for single-payer healthcare. “Many of you here today are single-payer advocates, and so am I,” Rep. Schakowsky said. “And those of us who are pushing for a public health insurance option don’t disagree with the goal. This is not a principled fight. This is a fight about strategy for getting there, and I believe we will.”

In an interview with Managed Care – First Report (MC-FR), Greg Scandlen, senior fellow and director, Consumers for Health Care Choices, Heartland Institute, reacted to Rep. Schakowsky’s remarks. “She essentially said that this is an excuse for a method of getting to single-payer,” Mr. Scandlen said. “That was one of the few honest things that have been said in this debate.”

Also asked to comment on Rep. Schakowsky’s statement, Robert Zirkelbach, spokesman for America’s Health Insurance Plans (AHIP), told MC-FR, “If that is the strategy, we think that they should be up front about that. We need to have an open discussion as part of healthcare reform.