The Massachusetts Health Reform Bill has received much acclaim for being the start of an era of affordable, universal health insurance for all residents. All in the state house and the executive branch worked hard and there are three major provisions to come out of it. Some of these you will recognize are in the US House Dems' platform.

1. Expansion of Medicaid.
2. Subsidies to help pay for private insurance to low-income individuals.
3. Forcing those making more than three times the poverty level to buy insurance or pay a fine.

Yes, if you are an employer and have more than 10 employees and fail to provide health insurance to your employees you will be fined no more than $295 to subsidize care. In addition, hospitals won rate increases.

Drs. Himmelstein and Woodlander of Physicians for a National Health Program recently issued a press release. Follow the link and you will get an understanding of the implications of this plan from experts. An excerpt:

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage, boost copayments, deductibles, uncovered services etc.

Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.
Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts—already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers.

How does Health Security America compare with the Massachusetts Plan?
First, after reading comments from the link above, the handiwork of self-protective special interests in the Massachusetts plan is plainly visible, and hospitals and insurance companies top the list. They have succeeded in rigging the game for their own security, and this is why citizens will have to govern their own plan—a major part of the Health Security America design. Citizen participation effectively neutralizes the powerful corporate interests.

Insurance companies will help distribute the plan, but at a markup determined by citizens themselves. Hospitals will be governed in the end by citizens' approval and will essentially become true non-profit entities. Citizens will determine the premiums and the coverage. Citizens will determine what is ethical by the use of their vote in the governing process. It will be a national plan—the same all over the US. Yes, all insured will get the same care not only those who can afford it.

Congress does have a role; it will set up the non-profit quasi-corporation run by citizens to govern and accomplish these things I listed. And Congress will have to adopt the 8 inviolable rules demanded by Health Security America and see they are in the by-laws. Since Congress will not ultimately have to take this out of its budget (Health Security America will pay its own way), citizens should be able to press Congress to get the ball rolling. I hope so, and I think most people are desperate for change, too, but the fight will be long and the special interest will fight hard. Those drug companies, health care combines and professional associations will operate on the premise that you, the citizen, is not smart enough to effect this positive change, but you are. Just work hard and we can get it done.

It is a single payer plan in that any entity taking Health Security America funds must follow its rules, and it will be an affordable, broad-based plan, with potentially 295 million clients. It will be virtually impossible for a hospital or a clinic to survive without most of the people, so there will be a single payer plan by default.

I expect marked reductions in premiums ( as high as 50% or more) cost by virtue of the governance procedures and the fee schedules set by Health Security America.

How do we call Health Security America a universal plan? Here is how:
Citizens will have to insist that when congress sets up the Health Security America plan that it set the poverty level, and if a person states that he or she can not afford the premium, then he or she goes to the government office that offers health care relief (It is safe to assume that this will be the Medicaid office) and presents the information documenting his inability to pay-- this office will then pay his premium. There now is only one person not included and I'm not worried about him or about to levy a fine. He is the citizen who declines to sign up. It is voluntary to sign up for Health Security America. Yes, you are responsible to do this. If you don't, you're on your own. If you run up medical bills, you will be required to pay just as you would if you didn't pay a mortage, car payment or child support. I don't think this is too much responsibility to ask of citizens.

Fred Bannister, M.D.
Chetek, Wisconsin
April 2006

Health Security America is the remedy.

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