Tuesday, June 09, 2009

Two left organizations, Democratic Socialists of America, and the independent union UE have recently issued positions papers on health care. Both are supporters of a single-payer system. However, judging this to be a unique political juncture, they also put forth demands for an acceptable public plan,

DSA says

the current political situation provides the best opportunity for serious health-care reform in a generation. We do not accept the position that unless we get everything we want, we are willing to see that opportunity disappear. We do believe, however, that the insurance industry is powerful enough that the current political dynamic could result in a “health care reform” that is, in fact, worse than nothing at all, because it would create a public plan that is designed to fail.

Therefore, even while we do everything we can to ensure that single payer gets a fair hearing, we must state our minimum requirements for possible alternatives to single-payer health insurance. Our minimum position is that any plan must include a strong public-provision component, one that can compete with the private insurance options. In evaluating proposed plans, the devil is, unfortunately, in the details.

Among the criteria to be considered:

  • All employers and individuals must be eligible to choose the public plan, possibly during an annual open-enrollment period
  • .The plan must be government run, operated by the Centers for Medicare & Medicaid Services or by a similar agency.
  • The public plan must have the ability to negotiate drug prices.
  • The public plan must be allowed to negotiate reimbursement rates, possibly pegged to Medicare rates.
  • The public plan must, like Medicare, allow participants to choose their own doctors.

Short of these provisions, whatever comes out of Congress will not be real reform. Health care is a human right and must be available to all without economic barriers.

The UE says

Since the likelihood is growing that such a proposal may be adopted, we need to spell out what provisions would be acceptable to our union in such a plan, and what we would find unacceptable.

A public plan must be open to all workers and their families, and all employers must have the option of insuring their employees through the public plan rather than private insurance. This will allow more workers to share in the benefits of lower-cost public healthcare, and the savings to employers from the public plan will remove a major incentive for corporations to move jobs overseas.

Premiums for the public plan must be indexed to income and affordable for working class people. We oppose any effort to force the public plan to charge artificially high premiums for the purpose of bailing out the private insurance companies. If the private insurers cannot compete with a public plan on a level playing field, perhaps they should get out of the healthcare business.

A public plan must have the ability to bargain with providers over rates for services, and over prescription drug prices. Such bargaining would be one of the public plan’s most powerful tools for bringing down healthcare costs overall.

We reject the inclusion of “user fees” such as co-pays, deductibles, and out-of-pocket expenses in a public plan. Those who need care should not be penalized and forced to pay more than those who are healthy.

We oppose any effort to contract out the administration of the public plan to private profiteers. This would be a waste of resources that should go into providing healthcare, diverting some of those resources instead into cultivating a new crop of millionaires and billionaires. Such privatization would put people in charge of the public plan whose motives are in opposition to the public good.

If we are to have a system where a public plan competes with private insurance companies, consumers must be empowered to choose their coverage by evaluating objective information on the merits of each plan.

Marketing must be strictly limited; companies should not be trying to lure customers through costly advertising campaigns, nor such gimmicks as paying to name sports arenas after themselves.


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