Maya Rockeymoore on Healthcare Reform |
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OurBlook interview with Dr. Maya Rockeymoore
Editor's Note: We've pleased to present the views of Dr. Rockeymoore, who has appeared in many major media outlets and is the author of "The Political Action Handbook: A How-To Guide for the Hip Hop Generation" and co-author of "Strengthening Community: Social Insurance in a Diverse America."
MR: It is not true that a public plan will kill private industry. A public plan provides Americans with more options for affordable, efficient health care. Medicare is a public/private partnership and the industry remains alive, well and very much a part of the system. Also, the Federal Employees Health Benefit program, which is maintained by the U.S. Office of Personnel Management, is in partnership with private insurers. Similarly, the Department of Defense’s TRICARE plan for military personnel and families and the Department of Veterans Affairs CHAMPVA for veterans both enjoy a relationship with private insurers. In each of these cases, private insurers participate in a plan sponsored by the federal government. These partnerships allow beneficiaries to access high quality, affordable care.
Proponents of a public plan insist such a program is necessary to create competition to stop the skyrocketing costs of health. Why is our current market-based system unable to cut costs without government competition? Are there other forms of regulation that fall short of creating a new government program that could rein in costs? ]MR: Our current fee-for-service, market-based system is highly inefficient with redundant administrative costs and abundant opportunities for waste, fraud and abuse. The current system is also focused on “sick care.” We have a system that pays doctors and insurers more for treatment of disease and illness than for prevention and wellness services. A public option that embraces prevention and wellness and focuses on quality, affordable, efficient care would force private insurers to reform their systems accordingly. The establishment of a public option is the best way to rein in costs as well because it allows private insurers to adjust their models of care based on market forces as opposed to massive regulation.
MR: Obesity is a major contributor to many preventable chronic diseases that are driving health care costs. A universal health care system will not be able to rein in costs if there are insufficient efforts to support comprehensive prevention and wellness. The House and Senate HELP versions of the health care reform bill contain important and unprecedented investments in clinical and community-based prevention and wellness. Important provisions include the establishment of a prevention fund to support community-based wellness programs, tax incentives for wellness programs in large corporations, community transformation grants that help to support healthy changes in the built environment, and the expansion of community health centers. Any bill that gets signed into law should retain the existing prevention and wellness provisions that are in the Senate HELP and House versions of the bill.
The last health care debate, a la Hillary Clinton, was met by an immediate backlash from health care providers and insurance companies. This year, the debate began with a ‘strange bedfellows’ meeting on cost cutting measures at the White House. The proposal of a public plan seems to be fracturing this fragile bipartisan atmosphere. Do you think there is any room for compromise now that detailed legislation is about to be debated publicly? Will we see Harry and Louise return? MR: U.S. companies are struggling to remain competitive under our current system of inefficient and broken health care. American families are struggling to pay for ever-rising health care costs, many insured live in fear that they are underinsured or will lose their coverage, and still many more do not have access at all because they have lost their jobs or are in jobs that do not provide coverage. Health insurers realize that the political and policy climate has changed since Clinton’s efforts to enact health care reform. Although they may not like it, insurers and other anti-reform lobbyists do not have as must leverage in the current policy environment due to the multitude of challenges facing the system and the country (e.g., rising costs, rising unemployment, reduced global competitiveness, etc.). Politics is the art of compromise. All parties must now sit at the table and work out a deal for reform that is in the best interest of American corporations and families. If Harry and Louise return, it should be to apologize to the American people for prolonging our national suffering by preventing millions from accessing health care coverage.
Opponents of a public plan have decried a potential government program as “socialism” and “rationing.” Yet, Medicare is one of the most consistently popular programs in our history. From your perspective, do you think that people relate the two? Do you think a public plan gives too much control to the government? MR: Opponents of the public plan are fearful that it would jeopardize coverage for those who already have access to health care. But those who are already covered will not be harmed by the implementation of a public plan. Indeed, they will benefit by the presence of a new option for care that they can consider for themselves and their families. At the same time, they can feel good that other Americans have expanded opportunities for health care coverage. By providing a shining example that private insurers can follow, the public plan represents an opportunity to increase the quality and affordability of the nation’s care while reducing health care costs. Despite frequent criticisms leveled at it, Medicare is an example of how the government can implement a program that significantly expands access to health care coverage without jeopardizing coverage for those who already have it. Despite Medicare’s example, people are not relating it to the public plan as none of the proposals being considered by leaders in Congress are seeking to create a public plan by expanding Medicare. For those tempted to say that a public plan gives too much control to government, they need only to look to Medicare (which was enacted in 1965) to understand that a government-sponsored plan does not translate into government domination. Private insurers, hospitals and doctors remain influential in the face of Medicare’s existence and they even benefit from Medicare through its various components which include hospital coverage, outpatient care, Medicare Advantage/HMOs, and a prescription drug benefit. That being said, it is expected that legislators will look to pay for many health care reforms by eliminating fraud and abuse in the Medicare program. .
David Leonhardt, an economist and New York Times columnist, writes that rationing is already an unfortunate reality in health care, but mostly because of the way scarce resource are allocated, such as the high costs paid for experimental or unproven treatments that could be going to preventative care. Do you think there’s any reform that could increase the number of Americans covered without rationing? MR: I agree with David Leonhardt’s assertion that the choice isn’t between “rationing and not rationing” but between “rationing well and rationing badly.” Our current system rations in ways seen and unseen. And because scarce resources dictate that we have to make choices as a society, tradeoffs will continue to be a part of the health care system. A reformed system needs to ensure that we make the best choices possible. This can be accomplished by investing in studies that examine the effectiveness of medical procedures. Evidence from these studies should be used to guide coverage options. With this information, we can be more efficient and effective in providing the care that people need while covering many more people.
What role do you see small business owners playing in the debate? The major players in the debate so far represent powerful interests such as drug companies and doctors, but small business plays a vital economic role in any discussion of costs to employers. MR: Small businesses have a significant stake in the national health care debate as they suffer from the inefficiencies in the current system that force them to pay higher per capita costs for care compared to larger corporations (if they provide health care coverage at all.) Small businesses owners should share their stories about how the current system jeopardizes their company’s financial viability and the health of themselves and their workers. These stories could help shape the nature of the debate and spur the development of options, such as the proposed national health care exchange, that are “small business friendly.”
Do you feel that a public plan is necessary if reforms include mandated health coverage?
Health care reform has been on the table in Congress before, but the resulting reforms, once they meet the president’s desk, are often more tweaks then overhauls. How do you see the debate on health care reform playing out in Congress this year? MR: The biggest challenge to health care reform is in bridging the divide between progressive and centrist Democrats who disagree on certain aspects of reform, such as the role and structure of a public health care option. Despite this division, the country expects and needs reform to happen and all factions will have to come together to work out an agreement that accomplishes the goal. I am optimistic that a version will be negotiated that contains significant reforms that will be a dramatic improvement over our current system.
Do you think we will see sweeping reform at the end of the day when these proposals are negotiated? MR: There will be significant reforms coming out of this effort at the end of the day. There are provisions, such as the prohibition on discriminating against people with pre-existing conditions and the national health care exchange that allows people to shop for affordable coverage, that everyone agrees needs to be implemented. These provisions will force radical changes in the way that insurers currently do business.
Do you see any Republicans crossing the aisle to support a public plan? Do you see any Democrats crossing the aisle to oppose one? MR: I expect the Republican caucus to place a considerable amount of pressure on their members to remain in complete opposition to the Democratic/Obama Administration agenda. As a result, I do not foresee any Republicans supporting a public plan. There may be some slippage within the Democratic Party. Blue Dog Democrats on the House side and some centrist Democrats on the Senate side have indicated their discomfort with the notion of a public plan (as it’s been conceptualized by the Obama Administration and more progressive Democrats). These Democrats need to be assured that the plan will not affect their constituents who already have health coverage and will fix the broken aspects of the current system (including controlling health care costs). While I see the possibility of them crossing the aisle to oppose such a system, such opposition would not be in the best interests of their constituents or the country.
Are there any other points you would like to make about health care reform? MR: Congress needs to consider how to create a comprehensive wellness insurance plan as a complement to the health care system. Wellness insurance would provide critical support to Americans trying to maintain their health through gym memberships, nutrition education courses, weight loss programs, and tobacco cessation programs ... to name just a few wellness services. While the wellness and prevention provisions in the House and Senate HELP versions of the bill are important, they are not of sufficient scale to provide all Americans with access to wellness services that will help them prevent disease and maintain healthy lifestyles. Wellness insurance could prove to be the catalyst to expedite cost reductions by creating healthier people and communities.
Dr. Rockeymoore is former chief of staff for Rep. Charles Rangel, D-NY, and currently the president of Global Policy Solutions in Washington, D.C., managing grants and initiatives in excess of $11 million. She holds a B.A. in political science and mass communications from Prairie View A&M University and an M.A. and Ph.D. in political science and public policy from Purdue. Trackback(0)
Comments (2)
  written by DrDavidMcNeil, October 10, 2009
It IS certainly true the the Public Option will destroy private insurance companies. It would not have to be this way, and Ms. Rockeymoore's comments speak to an alternative reality that could and should exist. But all you have to do is read the bills under current consideration. They do not respect the limits and bounds and partnership described by Ms. Rockeymoore. They will force private insurers out of business; they will force individuals to join the public option. Please see my blog entries:
BaucusCare Approximates Single Payer, http://doc2dochealthcarereform.com/2009/09/28/“baucuscare”-approximates-single-payer/ If You Like Your Health Care Plan You Can Keep Your Health Care Plan - Umm, Well, Except -, http://doc2dochealthcarereform...an-except/ - and - Pre-Existing Unintended Consequences, http://doc2dochealthcarereform...-existing-“unintended”-consequences/
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President Obama has made it clear he isn’t working to set up a precursor to a single-payer health care system. Meanwhile, the insurance industry says that any version of a public plan will kill private industry. Is there any precedent for a public/private partnership in health insurance? If not, how could this experiment be structured?
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-- But how will the mere existence of the public option force private insurers to reform their systems? Will the public option be less expensive by forcing providers to accept lower reimbursements? The wellness and prevention offerings you mention cost more money - they will not make the public option more efficient; they will make it less efficient. Finally, the public option is not, in an of itself, the seat of "massive regulation". Read the other sections of the bills. They number over 1,000 pages of nothing but massive regulation!!! Not to mention, you ain't seen nothin' yet: Administrators will convert these 1,000 pages into 10,000 pages (I am serious) of interpretive and administrative guidelines. And then the courts will weigh in with judgments on certain sections, requiring thousands more pages of guidelines and billions more in cost!