What Health Reform Could Look Like

| Thu Aug. 20, 2009 11:00 AM EDT

As I have written previously, the most likely upshot of the health care debate is for Congress to adopt some version of health care "exchanges" based on the FEHBP, the Federal Employees Health Benefits program. Some people are calling the FEHBP a "public option," but that's not what it is. In fact, it doesn't even contain a public option. The whole reason it might be acceptable to conservatives is that it keeps the private insurance system intact. As described by Physicians for a National Health Program, FEHBP "is actually a mix of private health insurance plans that carry the same problems of private plans generally: administrative waste, restrictions on health care providers, inequities and inadequate cost controls."

In fact, the FEHBP was proposed back in the 1980s as an alternative to Teddy Kennedy’s universal health insurance campaign. That proposal, as Stephanie Mencimer wrote here last week, came from none other than the Heritage Foundation. So its credentials are spotless, or ought to be spotless in the eyes of mainstream and rightwing Republicans. Not even Dick Armey’s gang of patriots, agitating at town hall meetings, could call Heritage a socialist institution.

The FEHBP does require private insurance plans to meet certain standards, which could represent some small improvement over the present system, provided it survives as part of the final health reform plan. But the best plans offered under FEHBP aren't cheap, requiring steep contributions from the employee--so it also preserves the present system of unequal care depending on income.

You can get a glimpse of the best-case scenario that might result from a reform based on the FEHBP, in this exchange between Washington Post business writer Steven Pearlstein and a government employee living in Maryland who belongs to the Federal Health Plan:

Federal employee: I have a choice among many possible insurance plans. I have chosen one of the more expensive ones (I pay a little over 30% of the premiums) and have been very pleased thus far with the range of doctors that I can access and especially the speed with which my claims are processed. I recently called to ask if a procedure had been pre-approved and was informed within just a few seconds that my plan did not require pre-approval for that procedure. It is clear that the computers at the other end are online and the people answering questions are well-trained. Last year a scheduler at a testing center nearly cried with relief when she heard what my insurance plan was.

I presume that I get this excellent service in part because if I had a bad experience, I could switch to another provider during the open plan period. Unlike a person working for a private employer with a choice of perhaps two or three plans both from the same provider, who would have to appeal to the deaf ears of the employer's HR department, my choice is meaningful. I might have to wait out 13 months in a plan I didn't like, but that is it. No worries about pre-existing conditions, or qualifying for coverage or anything.

So, could this model actually work for the uninsured pool of people? Could the government demand that the insurance companies offer the same plans available to federal employees to the pool of uninsured or not let them participate in the program? Could it just be negotiated that way since the potential pool is so large and the premiums will be subsidized for some? Could non-profit cooperatives have the clout to get this?

Or do I only get service this good because the Senators and the Representatives are in the same plan that I am (or at least their staff are) and the insurance companies treat us better so they don't make the powerful people who share our plans angry?

Steven Pearlstein: The Federal Health Plan provides the model for the so-called exchanges that are at the center of the Democrats' health reform proposal. Everyone who buys insurance through the exchange would basically have the kind of choices you do, and be able to move around from plan to plan in a way creates an ongoing competition among the plans, not only on the issue of price but quality of service and depth of network, etc. That is the kind of competition that will improve the whole system and, to a degree, help to bring down cost growth.

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