James Roosevelt Jr., president and CEO of Tufts Health Plan and co-chair of the policy committee of America’s Health Insurance Plans, hijacks Atul Gawande’s argument that national health reform must build on the fundamentals of existing programs to argue that we can’t afford a public health option:
[E]ven if a government-run plan could be designed in a way that preserves choice for most Americans, it would delay the start of universal coverage for years. As a nation, we simply cannot afford to wait for the kind of accessible, portable, universal healthcare coverage that we have available to us today in Massachusetts, or to employees eligible for coverage through the Federal Employees Health Benefits Plan, which was touted during President Obama’s campaign.
Jacob Hacker’s plan addresses this argument: his public plan proposal builds on the existing infrastructure of Medicare while simultaneously “safeguarding and improving the Medicare model.”
Rather than delaying health care reform, a program that builds on the Medicare system guarantees patient familiarity with the plan, simplifies the enrollment process, “ensure[s] continued enrollment across state lines, facilitate[s] interactions with multi-state employers, and build[s] on what already exists.” By pioneering new payment methods — paying primary physicians more, moving way from fee-for-service and towards bundled payments for episodes of care — the new public plan could lower health care costs (encouraging its competitors to adopt similar efforts) and ensure that ‘the best laid plans’ of health care reform are sustainable over the long-term.
In fact, a new Medicare-like model is likely no more disruptive than the Massachusetts Exchange of regulated private ensurers. As Atul Gawande himself explained during an interview with Charlie Rose, “we will have to take the solutions we’ve got and we will build off of them. We won’t blow up the system. We are going to ask ourselves, are we going to build on a program like Medicare or Medicaid or are we going to build on our private insurers and try to subsidize more people to have more private insurance. And that’s actually achievable turf”:
On January 1, 2011 we can have an online choice of four or five private insurers, or we can have a Medicare option, or maybe we’ll have both. But there is no reason we can’t create that within weeks.