A number of healthcare reformers have championed the concept of improving Medicare and then moving it into the private sector to be run as a private not-for-profit enterprise. This "Public Medicare" would collect premiums (though income adjusted) as do other corporations, but could also assimilate other government based programs, such as Medicaid and TennCare, and collect the monies currently used for programs as well. These government based programs, as well as others, could be more effectively managed by a single entity, from both a financial and healthcare outcomes perspective. We have searched for a way to set this up as an effective public option and to also rid ourselves of persistent complaints of the non-reformists.
The solution for this now seems very simple. The public option needs to be run as a non-profit, but it really does not matter who runs it. If some people are afraid of a "government takeover of healthcare" then we could remove that concern by allowing the existing private insurance companies to administer this Public Medicare option, though with a standard set of benefits for patients and compensation for providers. We could further establish overlapping geographic regions of control that could pit these privately run non-profit plans against each other so that they could compete for patients and for provider participation. With a level playing field, an established minimum level of healthcare coverage, and with fair treatment of providers, we could have healthcare for all and still have a privately run system. In fact, with the assimilation of the other government type plans, we could get the government completely out of healthcare delivery, except for their help in insuring that the total system is run fairly, honestly, and competitively.
Now, what about that last issue mentioned above. All objections to a public option for healthcare reform could be sidestepped with the above plan except for the loss of the current profit margins of the existing private for-profit insurers. This, also, could be addressed in two ways as follows. First and foremost, allow these regional non-profit public Medicare plans to compete against each other in healthcare outcomes. As their book of patients become healthier and as their providers become more efficient, most of the money that they save could be viewed as "profit" that could be used to reward patients and providers, and for corporate income that could be divided as the corporation sees fit. Utilizing a single information system, the relative population risk profile could be determined so as to allow a fair comparison of outcomes between the various privately administered plans. Now, for the first time we would really have competition in healthcare. Secondly, with an established minimal standard of coverage, these plans could be allowed to sell insurance options with more "bells and whistles" for those who want to pay more. However, these optional plans should not be allowed to pay the providers more, or we would wind up with a two tiered system.
This is a work in progress, so please comment and give input. I will send out "letters to the Editor" of Tennessee newspapers and send this concept to my representatives to try to get some feedback. Time is short and we need to dissuade Congress from passing a bill that is no real reform at all, simply for the sake of getting something passed.
Mark E. Green MD