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Dear Congressman Taylor: I appreciate your past support for reforming the way health care is delivered in our country. HR 684, changing Medicare Plan D to allow negotiation of prescription drug prices and create an appeals process for those denied access, along with HR 1583, amending the McCarran-Ferguson Act to eliminate anti-trust exemption for insurance companies when state regulation leaves gaps, are both good ideas. Both bills, though, seem stuck in ways that may, unfortunately, signal the end of those ideas as they appear in that proposed legislation. They may suffer from what ails many current Republican proposals for health care insurance reform. In taking an approach structured in small increments, they are overwhelmed by the size of the job – genuine and lasting reform of the way we insure health care for Americans. Designed to nibble in from the edges of the problem, such proposals lack the big bite needed to take on a big problem. I urge you to reconsider withholding support for the plans/bills soon to appear in Congress, and do what you can to help craft final legislation that can genuinely reform health care delivery. You know from your long fight for multi-peril insurance, and personal experience post-Katrina, that without regulation, insurance companies (however they may spin it) have as their main interest the maximization of profits, and that too often that means denial of coverage, or accepting premiums from those who can still afford them, and denying claims or canceling coverage when the consumer invokes that contract. I do not fault the profit motive. I fault a distortion of the profit motive that places quarterly earnings above long-term stability and puts service to one set of stakeholders, investors, ahead of all other stakeholders – customers, the communities that support such business, and employees. This is the natural outcome of an environment where regulation, when it exists at all, is geared toward protecting that same small segment of stakeholders. HR 684 and HR 1583 would help improve such an environment, as you point out, but I do not see hope for any movement on either bill. I urge you to reconsider your position and support a public option in any bill for the reform of health care insurance. Such an option could lower costs over time, for taxpayers and consumers, by assuring a cost-effective alternative. The high curve of future inflation that so rightly concerns fiscal conservatives will result from the very pressures that can be so effectively addressed by a public option, even one that draws about 5% of the insured population, as estimated by the Congressional Budget Office. Those lower costs will address your proper concern for rural hospitals by helping grow an insured customer base for those hospitals, as well as provide an alternative for many who are now part of those programs the price of which you rightly worry about – TriCare and Medicaid. Such a public option, in conjunction with improvements in Medicare, will provide the most important and effective counterbalance to private practices – and their high administrative costs and too often poor results – that are now driving health care costs. Most importantly, I ask that you consider the role of public option insurance – as model and competitor – in pushing private carriers to work in a market that truly serves the best interests of taxpayers and consumers, rather than continuing the laser-like focus on only one segment of stakeholders, the stockholders. Stockholders capitalize industry and should be rewarded for that, but when that reward comes at the expense of all other stakeholder groups, especially in an area like health care, then the market needs reform. A big market needs big reform. Little bites will not to do the job. The plans now put forward would be of great benefit to rural areas where competition among existing plans is nearly nonexistent, as your efforts with HR 1583 have shown you. People in these areas have limited choices and are generally underinsured, when insured at all. Your support of HR 684 must have grown from a knowledge that many in those areas too often choose between electric bills and pills, and that Medicare Plan D does not do enough to help them in that decision and, as structured, is too expensive for the benefits it brings some. Current legislation includes subsidies for low-income and moderate-income workers, people like farmers and other self-employed individuals, and make many of them, now under- or uninsured, able to afford adequate insurance for themselves and their families. The requirement, modest after amendments made in Rep. Waxman’s committee, that employers take up some of the cost for insurance should they not offer it on their own, will lower costs to the Federal government. When combined with reformed Medicare practices, the presence of a public option will help rationalize the market in ways no “bits and pieces” legislation can. Even with the government as a small player in so large a market (per CBO estimates), the government will have to “stay in the game.” Too often legislation passed is seen as the end of Congressional activity rather than a basis for continuing involvement. Congress passes a law, and then moves on to the next matter. Without a public option overseen by Congress, over time, any reform will be a snapshot of a particular time Congress will then leave behind. On the private side we will have very smart people, with a primary loyalty to the company they are paid to make profitable, working all day, every day, to find the sorts of loopholes that will assure profit at whatever expense that pursuit brings to taxpayers and consumers. I want my gatekeeper to affordable, quality health care checked and balanced by someone I can vote for – like you. I have no say in the boardrooms. Those who say I can “vote with my dollars” and move my coverage to another insurer misrepresent the real situation. I can change insurers only if I have insurance other than that I get through an employer, or if I live in an area where there are in fact several possibilities for private insurance (pretending for the moment that I could afford that). This is true for me and for almost everyone I know. The numbers tell me it is true for the majority of Americans. Every private insurer, without a public option to keep them honest, will take up what that industry thinks “best practice,” and we will be left with what we have to settle for now – a “system” that even the insurance industry knows to be unsustainable. I want a public option for medical insurance as one of my choices in considering coverage. I want an insurance option that our sons, in their 20s and working hard, can afford. Congressman Taylor, a public option in the market of health care insurance is in the best interest of the majority of your constituents and for the majority of Americans. I urge you to reconsider your refusal to support such an option.
Sincerely, |