Kentucky voices

Ky. Voices: Health law good; government plan would have been better

October 4, 2013 

Doug Epling of Lexington is an independent health-care technology consultant.

Kudos to Gov. Steve Beshear for speaking out in support of the Affordable Care Act in his Sept. 27 op-ed in The New York Times. With this, Beshear provides much-needed leadership through the fog obscuring health care public policy development.

When you frame such an incredibly complicated issue into inflammatory sound bites such as "government takeover," it causes an oversimplification that precludes effective policy development.

While the law is a step forward, other approaches that could not pass Congress would have been better.

Without question, the best policy to address the challenges facing Kentucky's workers and job creators would have been a single-payer system. Such a government program would have completely relieved job creators, as well as workers, from any concerns.

The next best thing would have been a public option, a government or quasi-government sponsored insurance plan. It would have existed alongside of and competed with commercially available options. Public option plans would be accountable to elected officials instead of shareholders.

This would mean workers and job creators would choose whether they would rather pay the state for coverage or pay a private insurer — just like when they choose whether to buy Toyota or Chevrolet.

While all three major 2008 Democratic presidential candidates fielded plans that included a public option, it was perhaps disgraced candidate John Edwards who articulated it best.

He wanted to create a public option to compete with private coverage and to let consumers decide which offered the best health care for the lowest price.

The original bill introduced in the 2009 U.S. House contained a public option. Modeled after Medicare, it offered to pay doctors a 5 percent premium over existing Medicare prices. The Congressional Budget Office estimated this Medicare-based rate system would save $110 billion over 10 years.

That talk about a public option introduced a broad, multifaceted yet nebulous policy alternative into the public discourse.

With very little, if any, definition etched in stone, there was incredible potential for bipartisan tweaking into something workable.

And then, Michael Steele, then-chairman of the Republican National Committee, publicly reduced the public option to "socialism." Is it any wonder that workers and job creators now feel besieged?

It was not just Republicans. Many moderate Democrats were unwilling to sign off on a public option. And ironically, small-business champions the Chamber of Commerce and the National Federation of Independent Businesses were among the most vociferous opponents.

The public option was TKO'd in the Senate by threats of filibuster from Joe Lieberman, an Independent, as his wife was sitting on the board of directors of mega health insurance company WellPoint.

There was a difference of opinion on whether a public option would best be implemented at a federal level or at the state level. Some states with functional legislatures could have created an in-house public option or provided grant money for non-profit start-ups.

A publicly funded health plan would charge participants premiums and co-payments, set coverage and prices for types of care and, perhaps, negotiate with hospitals and doctors on pricing. It could be managed to be revenue neutral.

It also could fine-tune financial incentives for those insured. These incentives might be directed toward controlling and preventing diabetes, for smoking cessation, reversing obesity and so on. All these are examples of conditions that incur huge costs in chronic and end stages.

That is the unspoken spirit of Obamacare.

It's not just cheaper health care. It's not just more health care. It's better health for everyone and the systemic benefits that our state, our country and our society as a whole will reap.

Doug Epling of Lexington is an independent health-care technology consultant.

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