July 7, 2007

Bad medicine from City Council

Last month, the Fresno City Council passed a resolution "in support of health insurance for all Californians" on a 5-2 vote.

With the goal of calling on Sacramento to "pass legislation that would ensure good, affordable health care for Californians," the resolution aims for state residents to "have access to quality health care, which is affordable to buy, affordable to use ... requires drug companies to negotiate prices, and requires employers, governments and individuals to all share in the responsibility to assure health care for Californians."

The resolution commits the council to work with an Oakland-based health-care consumer group with the following platform:

Giving health-care responsibility and decision-making to individuals is the wrong approach.

Plans that expand individual choice are "cheap but inadequate" leading to "financial catastrophe."

The problem of the uninsured is that employers aren't forced to supply health insurance.

I'm disappointed in the City Council for choosing a mistaken approach that will hurt the rural Fresno County patients that I care for -- predominantly uninsured or underinsured women with breast cancer.

Patients with few resources face two options:

Health insurance with high monthly premiums, a deductible, co-pays and co-insurance.

Medi-Cal.

Choosing the economically lesser of two evils, a woman with breast cancer applies for Medi-Cal and quickly learns the consequences of losing personal choice in health care.

Fifty-nine percent of California's Medi-Cal recipients report significant difficulty in finding doctors. California ranks 49th in the percentage of doctors who accept a program that pays $24 for the office visit in which a woman is given the news that she has breast cancer, reviews the options for treatment and prepares for a surgical procedure in which she may lose her breast.

Regarding affordability and oversight, the Fresno City Council disturbingly advocates that state and federal governments become more involved in providing health care.

Medicare and Medicaid (in California, "Medi-Cal") are the two largest health-care programs in America. Medicaid expenditures per enrollee is $6,791.84 per year, and Medicare accounts for another $16,018.41. Between the two programs, we cover 27% of the population but spend 45% of our national health-care dollars. In contrast, private insurance averages $3,444.44.

Medicare's administrative overhead was reported at 11.41% in 2003, a figure that omits the cost of collecting taxes that fund the system. More concerning are the 2005 administrative costs associated with the Medicaid program, an astonishing 31%. Private insurance, overhead is 9.03%.

The council proposes that affordable, accessible coverage is best achieved by linking it more tightly to employment under the guise of shared responsibility. While this made sense for a 65-year-old retiring from the same company that hired him at age 18, it guarantees gaps in coverage for Fresno County's work force.

An alternative that better serves Californians in terms of access, affordability, accountability and portability is the California Common Sense Healthcare Revolution. Details are at www.lindahalderman.com and essentially:

Government interference drives up the cost of health insurance. Let Californians buy low-cost, basic Toyota plans instead of expensive, regulation-saddled Cadillac plans required by law.

At tax time, reward Californians who buy their own plans instead of punishing them.

Improve access by allowing nurse practitioners and physician assistants to do what they were trained to do.

Uncouple health insurance from employment instead of guaranteeing gaps and expensive COBRA coverage.

Let Californians decide which coverage they prefer, and give all Californians choices based on their family's needs. Instead of $7,000 currently spent for each recipient in government programs, a private plan would save taxes and improve access.

If a traditional plan with a $1,000-deductible costs $350 monthly and a $3,200-deductible plan costs $125 a month, let Californians choose.

A traditional plan would cost $4,200 a year, and a $1,000 deductible, and $15-$25 copays and up to 20% of all charges for doctors' visits, procedures and prescriptions. The minimum cost during a typical year is more than $5,000.

A high-deductible health plan (HDHP) would cost $1,200 a year, plus typical expenses of less than $2,000 for doctors' visits, prescriptions and tests. Minimum cost is then $3,200.

High-deductible plans are still less expensive during a year with major expenses. Unlike traditional 80/20 plans, HDHPs cover 100% of expenses after the deductible is met. Traditional plans allow a maximum out-of-pocket that often exceeds the deductibles of HDHPs.

Expenses go down even more when HDHP deductibles are met by tax-free Health Savings Accounts belonging to the individual and not tied to a job.

Consumer-driven health care gives Californians freedom to choose. Expanding bureaucracy contributes to the problems faced by patients in Fresno County. The City Council would serve us well by rejecting an expansion of government interference.

The above commentary appeared in the Fresno Bee on July 7, 2007 and received the Golden Pen Award from the FlashReport at: http://www.flashreport.org