Ann Arbor, Mich.
Dude! Your Band-Aid is inside out! [Cover art, July 13] How’re you going to “cure…the global economic crackup” if you can’t apply the world’s most basic boo-boo device? Kiss it and make it all better? Not to mention that the Band-Aid is “flesh” tone. A cure for/by those of Caucasian persuasion?
The Public Option: Doomed to Fail
Cambridge, Mass.; Washington; Chicago
Regarding your editorial “Public Option Now!” [July 20/27]: a public option won’t fix the mainstream Democrats’ flawed healthcare reform proposals. Only a single-payer reform would make universal, first dollar coverage affordable. It would save about $400 billion annually on bureaucracy and rein in costs over the long term through global budgeting and rational health planning.
Even a public plan option far more robust than anything on the table in Washington would forgo most of these savings, making comprehensive coverage unaffordable. While a public plan might cut into private insurers’ roughly $10 billion in yearly profits (which is why they hate it), that’s only 10 percent of their overhead. They spend much more tracking eligibility, collecting premiums, marketing to healthy (profitable) patients, demarketing to avoid the sick, and shifting costs to patients and providers. A competitive public plan couldn’t match the efficiency of Medicare, whose integration with Social Security allows automatic enrollment, disenrollment and premium collection.
Moreover, a hybrid plan would forgo hundreds of billions in administrative savings because hospitals and doctors would still have to maintain armies of administrators and billing clerks to joust with hundreds of insurers.
A kinder, gentler public plan would quickly fail in the healthcare marketplace. Insurers compete by not paying for care. Competition in health insurance is a race to the bottom, not the top. A public plan that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive premiums to uncompetitive levels. Similarly, eschewing private insurers’ schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To survive, a public plan would have to imitate private plans’ bad behaviors.
A healthcare system dominated by private insurers cannot provide families with the affordable coverage they need. A public clone of private insurers won’t help.
DAVID U. HIMMELSTEIN, MD
STEFFIE WOOLHANDLER, MD, MPH
SIDNEY M. WOLFE, MD
QUENTIN YOUNG, MD
MARCIA ANGELL, MD
2nd Sex, 2nd Wave, 2nd Thoughts