Rating the House health reform proposal

In testimony before the House Education and Labor Committee yesterday, Consumers Union’s senior policy analyst, Bill Vaughan rated the House Tri-Committee Draft Proposal for Health Care Reform on how well it met our criteria for meaningful reform for consumers. As explained in a seven-page editorial in the August Consumer Reports, we’re looking for health reform that:

• covers everyone,
• makes insurance simple,
• provides information on quality of care,
• helps employers to offer protection for workers,
• rewards good care—not just more procedures,
• frees doctors to practice medicine,
• and gives you the freedom to choose your plan.

So how does the house proposal rate? Here’s some of what Vaughn told the house committee, including suggestions for what can be improved.

The Tri-Committee proposal will bring us to the goal of affordable, quality dependable health care for all. But we also know that even more savings are possible and can be directed toward spurring breakthrough research if we all work together.

Covers everyone: The House proposal would create a national health insurance exchange that consumers can use to find guaranteed health insurance, regardless of pre-existing conditions. Private plans would compete with the option of a public plan to keep insurance affordable. Subsidies for those making less that 400 percent of the poverty level would expand access to health care to millions of Americans who can’t afford it today.

Makes insurance simple: The national exchange would go along way to simplifying health care. The minimum standard benefit package (and at least 2 distinct, more valuable options,) would have no yearly or lifetime limits. The out-of-pocket catastrophic protection would cover all expenses over $5,000 for individuals, and $10,000 for couples. Those with low-income get even more protection. That would bring financial security and piece of mind, and eliminate the hassle of trying to figure out what is and isn’t covered. The bill also creates a Health Choices Administration and an Insurance Ombudsman as tools to help keep the system uncomplicated.

Provides information on quality: Comparative effectiveness research would inform physicians and patients about which treatments objective science says are the best—and those would be given preference. But if a drug, device, or service does not work for an individual, then that person should be able to try another drug, device, or service without hassle or delay.

The bill has provisions that would pay hospitals less for readmissions due to poor quality of care. It would also establish a new center to set priorities for quality improvement. And it has provisions to make infection rates of hospitals and other facilities public.

Helps employers offer protection for workers: The Health Insurance Exchange would make policies more affordable, and subsidies to small businesses and lower wage firms would make it affordable. Rewards good care—not just more procedures: The bill would increase comprehensive preventive services, and improves Medicare to make such care more affordable. A new Wellness and Prevention Trust Fund would help spur community wellness. Efforts to develop accountable care organizations and medical homes would also help ensure better care coordination.

Frees doctors to practice medicine: The bill has a number of provisions dealing with the medical workforce, graduate medical education, and increasing payments to primary care doctors, all of which should help.

The freedom to choose: Those with good plans can keep what they have. Everyone else can choose between the public and private plans in the exchange.

What can be improved:

 The policies sold through the exchange in each of the three broad categories the bill creates should be made identical so that consumers can shop on the basis of price and quality, not on tiny and confusing differences.

 Reform should require standardization of insurance definitions so consumers can easily compare policies on an apples-to-apples basis.

 It should require insurers to clearly state, in standardized formats, what’s covered and what’s not in every plan offering, and to estimate out-of-pocket costs under typical treatment scenarios.

 The plan should create an insurance information and complaint hotline; compile federal and state data on insurance complaints; and report this data publicly on a Website.

 Consumers should be made fully aware of their rights to register complaints about health plan service, coverage denials, balance-billing and co-pay problems, and be able to appeal coverage denials.

 More should be done to ensure that infection rate and other reported information is made public on a facility-specific basis.

 Better efforts are needed to report medical errors.

 Periodic quality recertification should be required for health care providers, as recommended by the Institutes of Medicine.

 Programs to rate the quality of insurance products and services should be implemented.

Finally, consumers are desperately worried about the high cost of health care. There are some worthy cost-cutting measures in the tri-committee bill, including a public plan option, comparative effectiveness research, form simplification, stepped up fraud prevention efforts, and implementation of MedPAC recommendations, among others. But more are needed to make the health care plan budget neutral.

—Bill Vaughan, Senior policy Analyst, Consumers Union

Read Vaughan’s full testimony* before the House Education and Labor Committee.

*links to PDF

Comments

[E. Nowak]

Wow, I thought this was a very good report. The comments above sound like they work for the Republican party or some facet of the health industry.

As someone with a pre-existing condition that has very little money in the bank because of health care, I dread the possibility my husband might lose his job and we are forced to pay for COBRA, or what if he's unemployed longer than the COBRA subsidies? We wouldn't be able to afford health insurance.

I have had three relatives die because they did not have insurance or had sub-standard insurance. I am appalled at the person whining about his USAF medical care -- which from what I have read, is very GOOD care. Yet he's against health reform (which would NOT BE government run healthcare but subsidized healthcare insurance!) for others!

Frankly, I really think it's the HAVES who cannot see sparing a little to help the HAVE NOTS. I cannot believe that America has sunk this low.

[Greg W]

What a blatant, unquestioning recitation of Democratic talking points. No consideration is given of the legitimate critiques offered by the GOP, just a reflexive dismissal of them as merely being baseless 'fears'. In fact, there's very little critique of any sort, or even acknowledgement that there could be downsides to such a sweeping change in our system of health care. All we get is, essentially 'it can't be worse than what we have now' - a transparent dodge that should be a red flag to everyone...
I subscribed to Consumer Reports to see reviews of cars and appliances, not to be subjected to yet another recitation of Democratic talking points. My subscription is being cancelled.

[gary]

I have just received my Aug. consumers and was looking forward to enjoying an unbiased report on items I purchase, instead I find an article on health care. It is obvious that the individuals that put this article together are very naive to believe the goverment could actualy do any part of it better, but I degress I am writing to let you know I disaprove of your viewpoint format. I purchase this magazine for facts not personal and political opinions. If you continue with this format I will not be renewing my subscription of many years.

[Steve]

If I were in a postion of power at Consumer's Union, I would fire Bill Vaughan. His comments/testimony are/is ambiguous at best, and the voice and authority of Consumer's Union is now in question. Show me even one real life example where even a portion of what has been proposed works. I lived in England for seven years, and I have been under government (USAF--the best of all federal services) health care since 1974. I know what government health care looks like, and there isn't a single congressman that would put up with the health care offered by the military--much less Canada or England. Bill Vaughan should help Michael Moore write his next movie!

[Steve]

I have two comments. First and foremost, I am almost always against a government-sponsored program. This is because there are too many politics involved and the result is a mess. Politicians take opposite sides on issues, not because they are right, but because the 'other guys' took certain stands. I don't want the very politicians that I have no trust in and no respect for running my health care system.

Which leads into my second comment - how can a private plan compete with a taxpayer-subsidized plan? It seems to me like the government plan will have a huge benefit because it can operate at a loss forever because politicians will keep funding it forever. What will happen if we start this thing and don't like it 5 years from now? Will there be any private insurers left, and if so, can we ever get away from the government plan?

I agree that massive changes are needed in our healthcare system, but allowing politicians to run it is like letting the wolf guard the hen house. Once they get control they will never let it go, because they care more about their own power than they do the people they represent.

[Dave R]

Are you serious? What a biased report. Cost cutting measures? Yeah, it's called ever increasing tax dollars, and worse, borrowed money that cannot be paid back. Whenever the gov't tries to compete with private enterprise, they subsidize to the point of driving the private companies out of business and then start the downward spiral of decreasing services while raising the costs( read prices). It is the nature of the beast. Like a law of physics. The only way to really lower costs is to reduce usage. You can gain some savings with technology etc. But no where near enough to pay for this boondoggle. Reducing usgag is more than just trying to get people to live healthier. Again, just a panacea. they will HAVE to reduce usage by making it harder or impossible ot get certain procedures.Is this plan going to work better than all the other gov't controlled or singlepayer systems that have been and are being tried in this world? The obvious answer is no. I am a simple man struggling to make a living. When the gov't takes my money and gives me something like they have in Canada etc. Excuse me for being rabidly against it. I do not want to wait for medical care on a waiting list. Feminists should be especially against this plan. Breast cancer is a major killer of women and do they really want to wait for the proper care? We won't have a country we can go to like the Canadians do to get the quality of care we need. I am not a health professional. Just a working stiff.