The Right Prescription

Patriotism and the Public Plan

As a sign of good faith, those politicians in favor of a public option should enroll themselves and their families in one now.

By 7.7.09

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On this Fourth of July weekend I was moved to tears by the blog I read written by Karen Davis, President of the Commonwealth Fund, the multi-billion left-wing health care foundation. Ms. Davis invoked the words of Abraham Lincoln in discussing health care reform:

As President Lincoln emphasized in his Gettysburg Address, the U.S. is guided by the philosophy of "government of the people, by the people, and for the people." What is needed in health care is a similar philosophy: a health system that is truly for the people. Redesigning health care so that it puts people front and center and ensures that care is patient-centered, accessible, and coordinated should be the fundamental goals of health reform.

Yes indeed. Except that in the previous paragraph, Davis who fancies herself dedicated to the "unfinished work" of "great task" had this in mind when discussing a "health system that is truly for the people":

A national organization, such as a Health Value Authority…could be given the authority to negotiate provider payment rates and methods on behalf of all insurers -- public and private -- and eliminate the administrative waste now generated by thousands of individual-provider price negotiations. In addition, it could institute new methods of payment, changing the marketplace from one that competes on providing greater volume of services to one that rewards better outcomes for patients and more prudent use of resources.

Not exactly a new birth of freedom but hey, the enemy today is not whether that nation, or any nation so conceived, and so dedicated, can long endure. It's the failure of private insurance plans to offer premiums "15 to 25 percent lower than premiums now offered in the individual and small business market, depending upon whether providers are paid at Medicare levels or at some midpoint between commercial and Medicare levels." Not exactly Lincolnesque but you get the idea.

The signers of the Declaration of Independence came together "with a firm reliance on the protection of Divine Providence, [to] mutually pledge to each other our Lives, our Fortunes and our Sacred Honor." Lincoln urged the assembled at Gettysburg to take increased devotion to that cause for which they here gave the last full measure of devotion.

Can't we at least -- those of us stirred to action by Dr. Davis and the billions lavished by Commonwealth in the pursuit of a public option -- to resolve to join a public plan now, to enlist and abide by those stirring principles even when the law does not require it.

I would submit that we cannot wait for Congress to act to establish a people centered value-enhancing system. Rather, given the resources of organizations such as Commonwealth and the American spirit it embodies, people who support a public plan should enroll themselves and their families in one now. Further, any legislation that includes a public option such require members of Congress to give up their current health care and participate in one form of public health care.

Patriotism demands no less.

Specifically, Commonwealth Fund employees and executives, along with members of Congress, their families, staff should enroll in Medicaid or a public option that includes the following elements:

1. A Health Value Authority that would set prices for drugs and medical treatments, reduce "rates for overpriced services" and limit use of services identified by the authority as being "overused."

2. Cut what doctors and hospitals are paid to payment to Medicare levels and limit future increases to the rate of inflation.

3. Limiting the choice and use of doctors and hospitals to those participating in plans that are part of the "public option."

4. Forgoing any out of pocket expenditures for services or care not covered by the public plan to insure as a nation we achieve the true goal of health care reform: "$3 trillion in health system savings between 2010 and 2020."

Indeed, enrolling in Medicaid or some variant now would give a public option the leadership and head start it needs to give the private plans a run for their money. If healthcare under a public option is so "patient-centered, accessible, and coordinated" and delivers high-quality, high-value care, why shouldn't Karen Davis, Henry Waxman, President Obama and others enroll or at least take the pledge to "go public?"

To paraphrase Lincoln, those who support a public plan should dedicate their health insurance portion as the starting point place for those who here gave their lobbying efforts that that public plan might live. It is altogether fitting and proper that they should do this. Unlikely, but in America anything is possible.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.