NPR corralled its health care reporter, Julie Rovner, and came up with a bunch of complicated questions about the various health care proposals, and asked her to research the answers. Here's the segment:
Q: We going to start with the most-asked question from listeners: What kind of plan to the members of Congress have, how much do they pay for it, and what does it cover?
A: Boy! I get this one all the time. Members of Congress have basically choice of the same plans that the other 9 million federal workers have. This year they can choose from 16 different plans. The most popular by far -- I assume among members of Congress, but certainly among federal workers in Washington, DC -- is the Blue Cross Blue Shield standard option plan. This year the premiums are $1120.40 a month per family. Of that the government pays $763.88. The member of Congress would pay $356. 59 a month!
Q: Thank you for that precision in the answer, by the way!
A: They want to know! I should add that members of Congress also have access to the attending physician of Congress -- that's a doctor there in the Capitol. They pay a couple of hundred dollars a year and have access to some preventive care -- they get their flu shots there and if there's an emergency they tend to go to the doctor there in the Capitol there... But their families do have to use their regular private health insurance.
Q: Okay. Here's a question from listener Don Calvert in Fort Lauderdale, Florida. He writes that he's been in the insurance business for thirty years. He wants to know what the government means when it says "affordable health insurance plan." What's the target price for a government plan for singles and families? He says once you get past $150 a month, you start losing participation in a medical plan.
A: This is one of those threshholds that's still evolving. But we do have a bill out of the Senate Health, Education, and Pensions Committee and they say coverage is determined to be unaffordable if the premiums paid by the individual is greater than 12.5% of the individual's adjusted gross income. So I did a little example. Say you earn $40,000 a year. After your deductions, your adjusted gross income is $36,000 which conveniently for me -- I'm math challenged -- is $3,000 a month. And you're paying $375 in premiums. Then your coverage would be unaffordable. That's just for the purpose of existing coverage that you have now. Under the bill, you would get financial help for a family of four all the way up to earning $88,000 in income -- because health insurance is very expensive! So affordability is something that they're trying to figure out now. It certain, I think, would be more than $150/month, though.
Q: Here's another question about cost. It's from Mary Cerone in Pittsburgh who writes: "If one of the selling points of the proposed healthcare legislation is that it will reduce cost, and if the non-partisan Congressional Budget Office -- as well as other studies -- show that the President's plan will not in fact achieve cost reductions and in fact will lead to cost overruns and reduced quality, why on earth are we still considering it?"
A: Okay. This is the hardest thing in the entire debate but I'm going to take a shot at trying to explain it. There are two different things that we're talking about. There are cost reductions in the short run and there are cost reductions in the long run. And then there are costs to the federal government and costs to the system as a whole. So you've got kind of four moving parts here. Over the short term, if you add 47 million Americans to the rolls of the insured, you're going to add costs to the system and you're particularly going to add costs to the federal government. About $100 billion a year, says the Congressional Budget Office. Now, the CBO doesn't look at costs to the system, they really look at costs to the federal government. They say that over ten years, in order to offset those costs, you're going to have to come up with real hard savings. You're going to cut other programs or you're going to have to raise taxes. So those are the short-term costs. The hope is that over the long term -- more than ten years -- which is not what the CBO looks at, there will be ways to change the system -- to change the incentives, to change how the system is structured, how doctors provide care, how insurers do things -- that will perhaps save money both for the federal government and for the system as a whole. That is the goal of this entire exercise. That is why everyone is still at the table trying to do this -- to save the government money and save the system money.
Q: This listener question is on tape. "My name is Beverly [?] from Tahlequah, Oklahoma, and here's my question. Extension of health coverage by whatever plan to all Americans will reduce unwarranted costs tremendously by eliminating the delays in diagnosis and the lack of preventive care that exists now, and by reducing congestion in emergency rooms. How great a cost offset will these saving produce?"
A: That is certainly the hope. A lot of lawmakers are very frustrated with the Congressional Budget Office because they're saying that a lot of preventive care really won't have much of a pay-off in terms of cost-saving. There's a lot of things that can be done in the healthcare system that will certainly make people's lives better and make people's health better but won't necessarily save money. It's not a reason not to do it; but it's a bit of a frustration to these lawmakers because it won't necessarily show up in the bottom line.
Q: Here's a question from listener Eric Pfluger of Jersey City who writes: "As private carriers tend to try to cherrypick their customers, is the public option likely to become a dumping ground for supposedly 'undesirable' patients? If so, what are the cost implications?"
A: This is an easy one! The answer is no, because cherrypicking won't be allowed anymore, either in the public option or in the private option. The deal that the insurers are trying to make is that they say they will no longer be selective in who they insure and don't insure as long as everybody is required to be covered. The idea is that if everybody is in the pool, sick and healthy, then insurers can spread the risk across the sick and healthy. They won't have to try and find healthy people because everybody will be required to be covered and therefore everybody can have at least premiums spread pretty widely.
Q: Here's an interesting question from Randall Davie in Forest, Virginia. "Why are healthcare costs growing so fast? Does it have anything to do with the basic economics of scarce supply and high demand? If so, will any of the current reform ideas address supply and demand?"
A: Well, there are lots of PhD's on this subject, and I'm not one of them! But I think it's mostly because health care is what we call an "inelastic commodity." We are willing to spend whatever it takes to keep us healthy, particularly if we feel like it's somebody else's money! So long as many of us have insurance that we feel like someone else pays for, we can blame malpractice premiums or fraud or waste of a lot of other things, but basically it's a lot of new and very expensive technology with patients demanding the latest and the best and the most expensive. That's a whole lot of what drives healthcare costs in this country and around the world!
Q: You mentioned malpractice costs. Malpractice caps is a subject we've been hearing about. Marcella Hernandez of Galena, Ohio wants to know if monetary limits on lawsuits would be essential to reducing healthcare costs.
A: I get this question every time I take questions from an audience as I have for the last twenty years! A lot of people wish it were so. A lot of doctors wish it were so. But malpractice is about 1% of healthcare spending. Even if you add defensive medicine that doctors do to prevent lawsuits, it's a tiny, tiny fraction. You could solve the entire malpractice problem and you'd still have a big problem with healthcare costs. It's important to some doctors in some specialties. But it's really not what's driving healthcare costs. It's a lot of new technology and a lot of demanding patients.
Q: Obgyn, for example.
A: Obgyns, neurosurgeons -- there are pockets of problems with malpractice but it is not what's driving healthcare costs in general.
All Things Considered, 7/2709
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