For most of us, trying to understand the intricacies of health care reform is nearly impossible. We can’t help but think that “health care for all” would be a great thing – but we’re scared by the phrase “socialized medicine.” We’re afraid that if we take a chance & agree to the reform, it will fail, and we’ll find ourselves in even more trouble than before. Yet we’re afraid that if we don’t reform the health care system, our growing medical debts will eventually consume us. It’s scary – and quite confusing, to say the least.

That’s why we’re grateful for the guys over at the Health Affairs website, where they try to make everything a little easier to understand. They’ve recently posted a very interesting article on the proposed new Public Health Insurance Plan – and how it should take a few lessons from Medicare. We enjoyed the article so much that we’d like to share some of its finest points with you here.

Top 5 Lessons from Medicare : How Medicare’s Strengths & Limitations Can Help Create  A Public Health Insurance Plan

1. Stability and Security : People can actually count on Medicare coverage. When you’re insured under a private health insurance plan or Medicaid, your coverage isn’t always dependable. Your insurer may drop you from your plan or raise your rates if you develop serious health problems. Medicaid benefits also change with every increase or decrease in state revenues. Yet, with Medicare, no individual is dropped due to health problems. This should definitely be one of the top priorities of a Public Health Insurance plan.

2. Uniform Eligibility and Benefits Nationwide : Medicare provides the exact same benefits and eligibility throughout the nation. Eligibility into Medicare is simply based on age or disability – to guarantee that the sickest people, who need it most, are able to obtain affordable health coverage.

3a. Transparency and Consistency of Benefits : Medicare benefits are explicit. They use consistent criteria for determining “medical necessity” and major policy changes are publicized well in advance so that enrollees and health care providers can prepare for the changes.

3b. However, the current Medicare program is a little slow to adopt changes. For example, adding prescription drug coverage to the Medicare plans took entirely too long. So, while the new public health insurance plan should follow Medicare’s transparency and specificity, a method of periodic review needs to be devised. The new public health insurance plan should include comprehensive benefits that are periodically reviewed for their adequacy and necessity.

4. Keeping administrative costs low : Somehow, Medicare consistently manages to operate with far lower administrative costs than private health insurers. These low costs are attributed to several factors, including pre-determined payment rates for most facility care and professional provider services, low expenditures of marketing, and consistency of benefits – among others. By keeping administrative costs low, the public health insurance plan would be able to keep health insurance costs low for the consumers.

5. Public Accountability : This is, perhaps, one of the most important lessons. Medicare is accountable to the public. The Medicare mission is to serve its enrollees and the public, and it answers to Congress for its actions. However, private health insurance companies are accountable to their board of directors and/or shareholders. Somewhere in the mix of it all, they lose a little bit of their public accountability.

This is really only the tip of the iceberg when it comes to the great health care reform debate. Tomorrow, we’re going to discuss an opposing view – one that discusses why our Public Health Insurance Plan should not be modeled after Medicare. Or, rather, why a Public Health Insurance Plan shouldn’t even be created. We’ll see you here tomorrow…

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