"Health Reform Dialogue" is a disparate group of insurance companies, doctors, hospitals, consumers, employers, and other groups. They all have stakes in the U.S. healthcare system. They've been meeting for six months or more, brought together by private facilitators, away from day-to-day public scrutiny, to discuss possible changes to the system, and have now issued a report on their discussions.
The actual report seems to have been released only to the press. By all accounts, it could be a positive step in achieving meaningful change to U.S. health insurance and care. As one article put it, it's the first time that all major players have "coalesced around significant changes." That's certainly good news; just getting the parties talking would be good news. But from what I've seen so far, there is less here than meets the eye.
There are little red flags that I think ought to make us all very cautious about premature elation. For starters, I note that there's no indication anyone from government took part in these discussions; that professional facilitators (with a built-in interest in making the results of their work look positive) presumably crafted the report; and that the few bits of wording that appear in quotes are very carefully phrased.
One key quote is this one: "We should seek to ensure coverage for all." Really? Duh! And this revelation was reached after only six months? I suppose there are participants in the Health Reform Dialogue for whom that statement is a radical change of view, but it's a long way from where we need to go. The more contentious issues, however, aren't dealt with.
The hang points are where they have always been, on the money and the mechanism. Of course there will be a lot of debate about how to pay for universal or expanded coverage and we will need agreement on that, but in a society as rich as ours, in the long run it's not a financial problem but a political one. More disappointing is the failure even to agree that coverage should be universal. We don't need to "cut in half" the number of uninsured Americans (as one media source reports), we need to devise a system that leaves NO uninsured Americans. Step by step change is one way to get there, but it's extremely disappointing to think that the HRD group couldn't even agree that should be our goal.
The question of how to deliver expanded (or preferably universal) health insurance has also been complicated by the "refusal" of insurance companies to accept any government-operated plan that would provide insurance for those left out of the private system. We should utterly reject the notion that insurance companies can "refuse" anything. Who elected them? Of course they are major players, and of course their views will be taken into account. But the provision of a social safety net (in health insurance as in social security or food stamps) is a government function, if anything ever were. By definition, private business interests do not put the public interest first.
Insurance companies say they are concerned about a government program that would be so generous that people would start migrating out of private plans. Nonsense. There are many ways to craft a government plan to deal with that. The usual model for a "government plan" is the plan that federal civil servants (and Senators) have. The key elements of that are transferability and a choice among different plans, but all insurance coverage is still provided by private insurers. A safety-net plan would not have to offer all the bells and whistles of coverage that the government employees plan has, however; a more basic level of services would easily encourage people to move up to private insurance when/if they could.
The proposed alternative to a government-based plan is the Baucus suggestion for a "mandate" - requiring that people obtain health insurance (as drivers now must have liability insurance). For those least able to pay for insurance, the government would then have to pay insurers to offset costs in those cases, or offer tax breaks to the insured. I guess that might work, but why complicate things? Elsewhere in business, it used to be conventional wisdom to "eliminate the middleman." I guess it makes a difference if, as in the case of the health insurers, you ARE the middleman.
None of this is to suggest that the HRD isn't a step forward. Positive developments include a consensus that change is needed, that more people need to be insured, and that insurance companies could get by without charging more for people who have existing health problems. The HRD discussions will undoubtedly help advance the process of change.