OPINION: Delicate private-public insurance balance provides strength

Breathe. The health care debate pauses while we take a breath and consider what needs to be done.
The haste with which Congress went after this huge project is scary. It reminded me of the story about Yogi Berra and Mickey Mantle riding in a car to someone’s house. After a while Mickey looked up from his directions and told Yogi, “We’re lost.” Yogi replied, “Yeah, but we’re making great time!”
We must move with deliberation and precision in this huge undertaking, changing that which should be changed without imposing changes the American public will not accept. Breathe.
We have the finest health care quality and delivery. We are a diverse nation of 300 million, and we, as Americans, expect services to be performed on demand.
The role of the government in health care has evolved to a delicate balance between private and government financing. It is not always pretty, but it has served us through the years.
The government uses a Single Payer System to insure people in the Medicare system. Since the poverty threshold differs by state it is left for the states to manage Medicaid, with matching federal funds.
The rest secure coverage through the private sector. Most often this is achieved through employer plans. There are also individual and association policies for those without access to employer plans.
Government pays less than cost for procedures and the private sector pays more. This is the little secret that provides balance. The fairness of this is predicated on the fact that we pay more during working years to help pay for retirees (Medicare) and the indigent (Medicaid).
I submit to you the proposed government option upsets this delicate balance and will decrease services.
In Northeast Mississippi, for an echocardiogram in office (code 93306) Medicare only allows and pays $234.77, which is only 21 percent of the charge. For the same procedure one of the leading insurers in the state has negotiated a fee of $403. For a heart catheterization (93510-26), Medicare pays only $234.78 while the same insurer’s negotiated fee is $547.
Under the House Bill, the government option payment for the heart cath would be $246.52, far below cost.
The population in the private sector plans is large enough to offset the below-cost reimbursement from Medicare and Medicaid.
When the balance shifts and we have more people in the government option, our doctors and hospitals cannot make up the deficit that below cost reimbursements produce.
Cutting costs is always important. However, forcing medical services to be delivered at less than cost limits services and access. There is mathematically no way around that.
This balance can be maintained with the current system. But, when you force any group to deliver services below costs, those services become rare and ultimately unavailable.
In Sweden, a country often upheld as having one of the best health care systems, Gorann Persson waited eight months during 2003 and 2004 for hip replacement. Persson was not a pleasant person to begin with but he became grumpier as he developed a limp waiting his turn. Despite the Swedish Government’s promise that no wait would be more than 3 months, 60 percent of hip replacements wait longer. What makes this unique is that Gorann Persson was Prime Minister of Sweden at the time.
Even with the trappings of power the prime minister of Sweden has, I wouldn’t trade health plans with him! And I do not want our Congress to do that now.
We need to concentrate on cutting costs with the emphasis on both fairness and quality. We have fixable issues that don’t jeopardize the whole system. This would include but not be limited to more use of accreditation and an insistence on appropriate and effective care.
Also, COBRA (a federal continuing insurance program) has helped many people and it should be expanded, especially in the current jobless recovery.
We also need to eliminate pre-existing limitations language. Recently Blue Cross of Mississippi announced it had eliminated the exclusion for small employers.
The biggest impact on health care comes from improving our own health. This is especially true for Mississippians.
Bottom line is we can improve without giving up the unique innovation and access we as Americans treasure.

Paul E. Mize, Jr., is a senior vice president of Ross & Yerger, an insurance corporation headquartered in Mississippi. Mize resides in Tupelo, where he is a community activist. Contact him at pmize@rossandyerger.com or write to him at P.O. Box 1668, Tupelo, MS 38802.

Paul E. Mize, Jr.

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