For a public health insurance plan

All this hoopla about a government health plan as if it were something new, go figure. No, it’s not new. We have several public health plans already, and they cover millions of people, so why is there so much opposition to Obama’s proposed public health plan? We have public health plans that do not have annual deductible limits, office and prescription drug co payments, life time caps AND NO HEALTH INSURANCE PREMIUMS. So which Americans are covered by these plans? 1. Let’s start with the Concierge health plan, the one reserved for legislative, executive, and judicial branches of government. Yes, Congressmen pay for their health plan, but it is extremely affordable when compared to the general public and we don't know much about their co payments and deductible amounts, life time caps, or maximum out of pocket plans. Plus, they can go to Bethesda Naval Hospital and Walter Reed Army Medical Center and have appointments at their convenience. All this at the expense of the taxpayer. How can they gauge the status of health care and health insurance plans? 2. We also have the public health plan exclusive for our armed forces. When health care is not available through the military system, they can purchase services from civilian providers. We don’t begrudge them this health plan, they deserve the best, especially when injured in the line of duty. 3. Then we have the public health plan for military dependents and retirees. They can access military facilities when available, and when not available they get health care from civilian providers via TriCare, the health plan for retirees and military dependents. There are minimal costs for premiums or co pays, really minimal. Even military reserve forces personnel can buy into this plan and it is quite affordable for both medical and dental services. 4. Our veterans deserve the best so we set up a separate public health plan for them. I am a veteran, I am also retired from the Army Reserve and at age 60 I will be covered by TriCare. Ahhh, free drugs for life. Veterans can access the VA system, which is known for incompetence, or the VA can purchase services from civilian providers. The VA is for service connected health complications, but there are millions covered by this plan. The aforementioned plans are for government connected persons and their families. They cover millions upon millions of Americans at staggering costs. But they are deserving of the best care money can buy. 5. Most conservatives complain about Medicaid for low income Americans and those with disabilities, I guess because they are less deserving of good health and life saving treatment. Again, millions are covered by Medicaid, mostly low income children and people with disabilities. Medicaid's stepchild is SCHIP, children whose parents are sometimes referred to as the working poor. Medicaid's cousin is Medicare, for retired Americans. 6. Probably the costliest of the public health plans is Medicare, especially with the “graying of America” that means more Americans are reaching retirement age and living longer, often needing more health care than the average person. There are different parts to Medicare and there are some out of pocket expenses for most seniors. 6. Most recently we added SCHIP, the children’s health insurance plan that was to be funded mostly with money from the tobacco law suit settlements. There are variety of minimal out pocket expenses for SCHIP because it was designed to be affordable for the working poor. We also have millions of public employees of all stripes covered by a variety of health plans. States, cities, counties, school districts and a hodge podge of other public entities offer a broad spectrum of health plans to their employees. Costs are mostly paid with public monies, also known as taxes, just like all the other public health plans previously mentioned. But no one really considers these public health insurance plans. I have no clue how many Americans are covered by all of the health plans available to government workers and their families, but the number is staggering. Some of these plans are straight government plans, some are private companies hired by government entities. When I was a state worker, I had Blue Cross, paid for with state funds (taxes) and I most, but not all, of my family's insurance premium via payroll deduction. Either way, the tax payer is footing the bill. You see, I told you so, we already have several public health plans. Yes, of course, I have a proposal of my own. Combine Medicare and Medicaid into one plan and let Americans buy into it, this would be the public health plan proposed by Obama. Let’s call if G-Care for now (you know - government care). Allow small businesses and non profit employers, public entities included, to purchase coverage from G-Care. Competition for high valued workers will force employers to offer better coverage, but it is driven by competition, not by the government. Expand the public health system of providers, like public hospitals and clinics, and the non profit system of health centers. Public health plans must give priority to non profit and public health providers. This becomes the default health plan and network of providers for those covered in the aforementioned public plans. In most cases, it does not make sense to operate a government health system, like the VA, in direct competition with the civilian health care system. Veterans, military retirees and dependents can be issued an insurance card, just like the one I have from Blue Cross/Blue Shield. When non profit or public providers are available, they will be the provider of first choice. Public providers include public health clinics, federally qualified health centers, public hospitals, and public university medical centers, etc. These providers must conduct verifiable cost analysis and they will be reimbursed by the public health plan on a cost reimbursement basis, no profit margins allowed. Americans may elect private providers with the requirement that they will incur any added costs. A public health plan makes sense in that it can keep costs manageable. There is nothing wrong with reimbursing doctors fair pay for their talents, these are some of the hardest working Americans who have undergone grueling training to save lives. Hospitals and other providers should be reimbursed for all of the wonderful work they do for us; however, there is certainly something morally repugnant about including high profit margins to provide returns to shareholders just because someone had stroke. However, there must be built in regulations on billing standards. Recently, I had an outpatient procedure. I received bills a few weeks after the surgery and paid my bills promptly. But I was billed the same amounts a month later. Was it oversight or were they simply hoping that I wouldn't notice and pay the bills again? My daughter used an ambulance in 2001, when she was minor covered under my health plan; seven years later the ambulance company sent her a bill. My wife went for an office visit, they used an instrument to scrape a sample for testing, a simple thing covered in the cost of the office visit. They billed her for a surgical tray. These "little things" need some policing. Most Americans are covered by their private employers who purchase commercial insurance policies for their workforce. That can continue as it is, much to my chagrin. I don't know who made the employer responsible for America's health insurance, but I am not sure its the right thing to do. I am an employer, I would rather give my employees a raise equal to the cost of their insurance premium and let them buy their own insurance. I can't do that because the insurance companies would take them to the cleaners. Each year I go through a grueling process to select a one-size-fits-all plan to cover my work force and inevitably, some complain and all want more and better. This is doable, alas I fear that the profit interests will prevail and I will continue to pay high taxes, high insurance premiums, outrageous co payments and deductible expenses. Last year, I paid more than 13% of my total income to health care costs, plus 14% in federal tax payments that fund the public health plans described previously, another 3% in Medicare tax, plus state, city, county, hospital district, school district, and community college district taxes that fund health plans for public employees. That’s just too much. Barceleau 4 President