Memo From The Editor

A question of access

Marianne Dekker Mattera

At its Annual Session in Philadelphia last month, the American College of Physicians-American Society of Internal Medicine announced a plan that is supposed to ensure that all Americans have health insurance coverage within seven years. (The time frame roughly corresponds to the goal of having something in place by the end of the decade.)

According to ACP-ASIM incoming president, Sara Walker, the plan is meant to build on the health care system already in place in this country, not replace it with the sort of single-payer systems found elsewhere around the world.

Here are the basics:

• A subsidized health insurance program for all who lack another form of coverage.
• A standard basic benefits package, which includes preventive services, that all insurance plans would be required to offer.
• A set of uniform federal rules on risk rating and renewability that all health plans would be required to adopt.
• Purchasing groups to give individuals collective buying power.

The first bullet point would be accomplished by creating national income eligibility for Medicaid up to 100 percent of the federal poverty level; turning the State Children's Health Insurance Program (SCHIP) into a federal-state entitlement program; and establishing a premium subsidy program for individuals with incomes from 100 ­ 200 percent of the federal poverty level. That would allow them to buy in to Medicaid or SCHIP or to purchase insurance in the private market. Congressional action would be needed to carry out all parts of the plan.

I find it difficult to believe that the ACP-ASIM plan stands much of a chance.

Why? Because the organization hasn't answered the hard questions. When asked who's lined up in Congress to sponsor the plan, they had no answer. (In fact, at press time the plan hadn't even been mentioned on the Hill yet.) When asked how much their plan is likely to cost, they had no answer.

Well, actually that's not quite true. We were told that they deliberately didn't do the calculations because they wanted to focus not so much on what insuring everyone would cost, but on what not insuring everyone would cost. Trouble, is, they didn't have numbers for that either.

Frankly, without numbers no one in Congress is going to back this plan—or any plan. Especially not in an election year. And there are four of those in the seven-year period ACP-ASIM would give us to enact their reform.

I applaud ACP-ASIM for trying to think creatively about revamping the US health care system to assure that all citizens can enjoy the benefits of the most advanced medical care in the world. But if you're going to do that, you have to go all the way.

You can't leave the really hard work—gathering the financing numbers that will make or break any health care reform measure—to someone else. I know I'm never anxious to champion a new proposal that means I have to do a lot of the legwork before I can take it any further. I can't imagine even one member of Congress will be thrilled about doing that either.

I'd urge the ACP-ASIM to go back and do some of that legwork. They might also think about how they're going to twist enough arms to get the measures through Congress once they convince someone to introduce it.

Since the ACP-ASIM doesn't have a political action committee through which to channel funds to office seekers who support their goals, they must line up allies in the medical community who do have PACs.

Without that, I'm afraid, the move to gain medical access for all will simply be stalled by a lack of political access.

 

Marianne Mattera. Memo from the Editor: A question of access. Medical Economics 2002;10:6.