What Would A Public Healthcare Company Give Us?

I’ll admit upfront that I’m well behind in all my policy reading, but as a citizen and someone who works in healthcare, I have to wonder why this makes sense.

  1. Is it to lower administrative costs as Kathleen Sebelius said on TV this morning?  Since they only represent ~10% of the total healthcare costs, that’s not going to make a big difference.
  2. Is it to provide coverage for the uninsured?  This seems like a fundamentally good cause but how is that population defined.  Why can’t that happen in the existing system with the right incentives / mandates?
  3. Is it to provide competition for the current insurers?  This seems like a bad path.  Government competing with industry…will the playing field be even?
  4. Is it to provide a government subsidy to those that can’t be profitably insured?  Again…this is probably in the social interest of the country.  Can it be done w/o simply overspending?
  5. Is it to drive a long term investment in preventative care?  Now, this seems like an interesting perspective.  We know one of the issues with long-term investments in patient care is that members churn.  If I invest today in a member that I won’t have, I don’t get my money back.

I think my point here is that a public system (IMHO – In My Humble Opinion) isn’t the right question.  We have systemic challenges around incentives, payment structure, long-term care, supply and demand, health literacy, etc. that have to be addressed.

From what I’ve seen in Medicare Part D (PDP), I have no faith that a public system would manage trend.  They won’t even push people to chemically equivalent generics.  They blindly pursue re-importation.  They don’t have a very limited formulary.  They don’t have aggressive utilization management programs (e.g., step therapy).

Someone needs to set an aggressive goal of keeping trend to 0% for the next decade and then work toward that.

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