For-profit insurance: No value added

In the health care debate, the one question we should be asking is: What is the marginal value of having private health insurance?
Advertisement

After all, if the purpose of health insurance is to mitigate the financial consequences of catastrophic illness or injury, the current level of medical bankruptcy shows that having such “insurance” is, for many Americans, anything but. Recent research from Harvard University and Ohio University showed that 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the illness that pushed them or their families into bankruptcy court.

Yet we continue to trust private insurers. Policymakers and federal legislators seem to have blind faith in their ability to solve the problems of American health care.

Read it all at the Detroit Free Press

On the Hill, Elizabeth Edwards Calls Attention to Medical Bankruptcies

By Ed O'Keefe

Elizabeth Edwards today lent her political star power to a underlooked element of the ongoing health care debate: the rise in bankruptcies related to health care costs.

A recent Harvard study concluded that at least 62 percent of bankruptcy debtors can trace at least part of their financial hardship to medical debt. Data from 2007 also indicate a 49 percent increase in medical bankruptcies as a proportion of all bankruptcy filings between 2001 and 2007. The total number of medical-related bankruptcies is likely higher; study data was compiled before the recession began last year.

Lawmakers met to review the medical bankruptcy study as their colleagues continue crafting legislation to overhaul the nation’s health care system.

“Successful health reform must not just make health insurance affordable, affordable health insurance has to make health care affordable,” Edwards told lawmakers at a morning hearing called by the House Judiciary subcommittee on commercial and administrative law.

Read it all at the Washington Post

Insured but Unprotected, and Driven Bankrupt by Health Crises - Series

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage, if people like Mr. Yurdin are to be protected from financial ruin. They also call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Read it all at the NYTimes.com

Unhealthy numbers: Bankruptcies, uncontrolled costs argue convincingly for health-care reform

At a glance, the plight of these 47 million appears to be much if not most of what needs fixing. But, as Chronicle business columnist Loren Steffy observes in his column this past Sunday (“Insured but not covered”), things are far from copacetic for those millions of Americans supposedly adequately covered by health plans through their employers.

They are not. As Steffy puts it, this umbrella leaks, and thousands of families are going under financially because their health insurance does not perform as advertised. Steffy cites a study in the American Journal of Medicine showing that two-thirds of all bankruptcies over the past six years were related to medical expenses, and that a surprising three-fourths of those filing for bankruptcy for medical-related reasons had medical insurance when they did so.

Or perhaps this is not so surprising. Certainly it will not astonish anyone who has attempted to navigate the maze of co-pays, deductibles, explanations of benefits and frequently inscrutable bills from hospitals, laboratories and other care providers. For the unwary and uninformed health-care consumer, these can all be a source of emotional and financial stress on top of whatever medical condition may afflict them or a family member.

Harvard Professor David Himmelstein , author of the study mentioned above, doesn’t mince words. “Private health insurance is a defective product, he says, “akin to an umbrella that melts in the rain .”

The notion of competition in the health-care insurance industry is mostly myth, Himmelstein contends. For most consumers, the choices are limited by what their employers offer and at what cost they choose to offer it. For some lucky ones the choices may be made broader by the option of insuring through a spouse.

Read more at the Houston Chronicle

U.S. needs health care vs. sick care

By Dr. M. Joycelyn Elders*

The United States has the best “sick care” system in the world, but our “health care” delivery system is lacking. We have the best doctors, the best hospitals, best academic health centers, best nurses, the best drugs, and we are leaders in research.

Our problem is that the system is not available to all of our citizens. In addition, our health care is not equitable, coherent, comprehensive and cost-effective, nor do we have choice. The United States has 5 percent of the people of the world and 25 percent of the world's wealth. We are the richest country in the world and the only industrialized country that does not provide health care for its entire people.

Health care, which now consumes 17 percent of the U.S. Gross Domestic Product, or $2.4 trillion in 2007, continues to grow in its appetite for our economic resources, while the United States continues to fall in overall health care for its citizens in comparison with the remainder of the industrialized world.

We do not have the best health, ranking 46th in life expectancy, 42nd in infant mortality and 57th in overall goodness and fairness as compared to 192 other members of the Organization for Economic Development and Cooperation.

If the rest of the industrialized world can manage to serve all its citizens on less, why can we not?

Lives at risk
The lack of access to health care for so many is literally bankrupting our people and endangering all our lives.

We have depended upon employers to carry much of the burden of health insurance over the years. However, now we find in this global economy that they are at a disadvantage trying to compete with countries that have a public health care system. Health insurance expenses are the fastest-growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits.

President Obama’s desire for a health care plan is one that improves coverage for the 45 million to 50 million uninsured citizens, contains costs, and offers high quality, cost-effective, equitable, portable and affordable care for everyone.

We must simultaneously address, integrate and solve the three major components of health care reform: Financing, organizing the delivery system, and educating patients and community, in order to facilitate behavioral and lifestyle changes.

Quality of care would improve if every patient had access to a medical home and an accountable care organization with electronic medical records where care was patient-centered, coordinated and cost-effective.

Monitoring of many of our procedures, techniques, new technologies and drugs needs to be evaluated. We need to replace our inefficient, inequitable financing system with one that works. It needs to include everybody with subsidies for the young, poor and sick. It must require all to pay their fair share.

Physicians must have the information (electronic medical records), infrastructure and incentives they need to improve quality and control cost.

Physicians, heal this system
Physicians must become involved in population health. Health is influenced by factors in five domains, which are genetic, social circumstances, environmental exposures, and behavioral patterns and health care. The single greatest opportunity to improve health and reduce premature death lies in personal behavior.

On an individual level, we can do more to improve our own health than all the medical discoveries in the past 100 years.

We must dream big; our vision is for healthy people in healthy communities with a health care system that is right for all of our citizens. It needs to be available, affordable, accessible, patient-centered, prevention-focused, purpose-driven and solution-oriented. It must empower individuals to take care of themselves, foster responsibility and human dignity, improve health and enhance quality of life.

Any new health care system must contain a provision for a public health care policy; this is a single-payer system. People who prefer private insurance can always purchase it instead of purchasing a public health care policy. In this public health care policy, we must provide every person with access to basic health care, including physical and cultural access through transportation and language sensitivity.

We also must provide education to promote health maintenance, preventive measures in order to thwart disease, basic dental health care, mental health care, emergency services and necessary medicines.

A public option
Ask Medicare patients if they would like to give up their insurance and I think few would answer in the affirmative. Public health care is well liked in the United States. People who do not receive Medicare may not know that each person pays almost $100 per month for the insurance, which is deducted from Social Security checks automatically. After a yearly deductible, Medicare pays 80 percent of most medical care but not dental care. There is a prescription Medicare (Part D) that is separate from other Medicare and has a variety of plans.

A public health care policy would likely be similar to purchasing Medicare. With Medicare, about 98 cents of every dollar paid in payroll taxes are spent on actually providing health care. When you look at the private insurance companies, it is more like 80 cents. The rest goes to administrative expenses and profits. There are many additional costs imposed on the doctors and health care providers themselves, who have to deal with a fragmented, complex system in which they have to negotiate, amend, or cajole payment from many different insurers.

Both business and individuals are breaking under the strain of our very expensive health care system. We must overhaul our system now; its condition is beyond tweaking to make it function for our people. We have tried to tweak the way we perform health care for many decades with disastrous results. We have tried HMOs, PPOs, indemnity with an assortment of public health systems to catch some of our people who fall between the cracks. It has failed while costing us precious lives, health and money of our people along the way.

We need an overhaul of the health care system to save lives, money and American business.

*Elders, a United Methodist, served as the U.S. surgeon general under President Bill Clinton from 1993 to 1994. She received degrees from United Methodist-related Philander Smith College in Little Rock, Ark., as well as the University of Arkansas Medical School. She is currently professor of pediatrics at the University of Arkansas Medical Center in Little Rock.

Source: United Methodist News Service

More Medical Bankruptcy-Have Insurance, Go Bankrupt - PNHP Press Release

Press Release:

Medical problems contributed to nearly two-thirds (62.1 percent) of all bankruptcies in 2007, according to a study in the August issue of the American Journal of Medicine that was published today online. The data were collected prior to the current economic downturn and hence likely understate the current burden of financial suffering. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The authors’ previous 2001 findings have been widely cited by policy leaders, including President Obama.

Surprisingly, most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness, including 60.3 percent who had private coverage. Most of the medically bankrupt were solidly middle class before financial disaster hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

Even apparently well-insured families often faced high out-of-pocket medical costs for co-payments, deductibles and uncovered services. Medically bankrupt families with private insurance reported medical bills that averaged $17,749 vs. $26,971 for the uninsured. High costs – averaging $22,568 – were incurred by those who initially had private coverage but lost it in the course of their illness.

Individuals with diabetes and those with neurological disorders such as multiple sclerosis had the highest costs, an average of $26,971 and $34,167 respectively. Hospital bills were the largest single expense for about half of all medically bankrupt families; prescription drugs were the largest expense for 18.6 percent.

The research, carried out jointly by researchers at Harvard Law School, Harvard Medical School and Ohio University, is the first nationwide study on medical causes of bankruptcy. The researchers surveyed a random sample of 2,314 bankruptcy filers during early 2007 and examined their bankruptcy court records. In addition, they conducted extensive telephone interviews with 1,032 of these bankruptcy filers.

Their 2001 study, which was published in 2005, surveyed debtors in only five states. In the current study, findings for those five states closely mirrored the national trends.

Subsequent to the 2001 study, Congress made it harder to file for bankruptcy, causing a sharp drop in filings. However, personal bankruptcy filings have soared as the economy has soured and are now back to the 2001 level of about 1.5 million annually.

Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard, commented: "Our findings are frightening. Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss – precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain."

"For many families, bankruptcy is a deeply shameful experience." noted Elizabeth Warren, Leo Gottlieb Professor of Law at Harvard and a study co-author. Professor Warren, a leading expert on personal bankruptcy, went on: "People arrive at the bankruptcy courts exhausted—financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances."

According to study co-author Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and primary care physician in Cambridge, MA: "We need to rethink health reform. Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance - stripped-down plans riddled with co-payments, deductibles and exclusions – won’t stem the rising tide of medical bankruptcy."

Dr. Deborah Thorne, associate professor of sociology at Ohio University and study co-author stated: "American families are confronting a panoply of social forces that make it terribly difficult to maintain financial stability—job losses and wages that have not kept pace with the cost of living, exploitation from the various lending industries, and, probably most consequential and disgraceful, a health care system that is so dysfunctional that even the most mundane illness or injury can result in bankruptcy. Families who file medical bankruptcies are overwhelmingly hard-working, middle class families who have played by the rules of our economic system, and they deserve nothing less than affordable health care."

"Medical bankruptcy in the United States, 2007: Results of a national study," David U. Himmelstein, M.D; Deborah Thorne, Ph.D.; Elizabeth Warren, J.D.; Steffie Woolhandler, M.D., M.P.H. American Journal of Medicine, June 4, 2009

-----------------------------------------------------------------------------------------

Medical Bankruptcy – Q&A

1 - What is a "medical bankruptcy"?

A number of medical factors can contribute to a family’s financial collapse, including high medical bills or lost time from work. Because different researchers use different definitions, we supplied a detailed analysis of debtors who:

• Specifically identified medical problem of the debtor or spouse (32.1%) or another family member (10.8%) as a reason for filing bankruptcy.
• Specifically said medical bills were a reason for bankruptcy. (29.0%)
• Lost two or more weeks of wages because of lost time from work to deal with a medical problem for themselves or a family member. (40.3%)
• Mortgaged their homes to pay medical bills. (5.7%)
• Spent more than $5,000 or 10% of annual household income in out-of-pocket medical bills (34.7%)

• Total, one or more of the above criteria: 62.1%

The vast majority (92%) of bankruptcies that we classified as medical had medical bill problems as indicated by: listing medical bills as a specific reason for their bankruptcy; or having medical bills of bills $5,000 or 10% of household income or that forced them to mortgage their home. The remaining 8% whose bankruptcy was classified as "medical" indicated that a medical problem or income loss due to illness was a cause of bankruptcy.

2 - Why do only 29% of bankrupt people identify medical bills as a reason for filing bankruptcy, but you say the total percentage of medical bankruptcies is 62.1%?

Families characterize their problems differently. Someone may mortgage a home to pay for surgery, then be unable to pay off the mortgage, describing the reason for filing bankruptcy as "unable to pay the mortgage." Similarly, some people explain that they have lost too much time from work when they have taken off to care for a child who has been hospitalized. We believe that multiple ways of asking about medical bankruptcies give the most complete picture, but we publish the breakdown in responses so that any other research or commentator can draw his or her own conclusions.

Finally, it should be noted that many people who are financially ruined by illness are undoubtedly too ill, too poor or demoralized to pursue formal bankruptcy, and are not counted in our study.

3 - What is the impact of health insurance?

More than three-quarters (78%) of the families that met the criteria for medical bankruptcy had health insurance at the onset of their illness or accident. By comparison, 80% of the non-elderly adult population and 85% of the entire U.S. population had health insurance in 2007. Hence, it appears that health insurance offers only modest protection against medical bankruptcy.

4 - Is the problem of medical bankruptcies just because of the recession?

No. The families in this study filed for bankruptcy between January-April of 2007, before the recession began. Since then, the financial stress on families has grown.

5 - Is this a national sample of all families filing for bankruptcy?

Yes. The sample was drawn from bankruptcy filings across the country.

6 - How did you get your information?

We contacted a random sample of all personal bankruptcy filers in the U.S. during the winter of 2007. Written questionnaires were returned by 2,314 debtors, and we also analyzed their bankruptcy court records. We also carried out extensive telephone interviews with 1,032 of these debtors.

Finally, to be sure that the debtors who returned our survey were similar to those who did not, we also analyzed the court records of 99 of the non-respondents. They were almost identical to those who returned the survey in terms of debts, income, assets and other characteristics.

7 - What’s the basis for saying that the proportion of bankruptcies that are medical rose by 50% between 2001 and 2007?

In order to compare the medical bankruptcy rates in 2007 and in our 2001 study we had to use the same definitions in both years. Our 2001 study had used a less stringent ("legacy") definition of medical bankruptcy that included families with more than $1000 in unpaid medical bills. Using this "legacy" definition, the medical bankruptcy rate rose from 46.2% in 2001 to 69.1% in 2007 – a 49.6% increase. The 2001 estimate relied on data collected from bankruptcy filers in five states. Analysis of the 2007 data confirmed that the five states included in the 2001 survey also saw a 50% increase in medical bankruptcies.

8 - Would health reform eliminate the problem of medical bankruptcy?

Many debtors described a complex web of problems involving illness, work, and family. Separating medical from other causes of bankruptcy is difficult. Hence, we cannot presume that eliminating the medical antecedents of bankruptcy would have prevented all of the filings we classified as "medical bankruptcies." The high rate of insurance among the medical bankrupts suggests that any health reform that fails to improve existing private coverage is unlikely to make a major impact on medical bankruptcy. Moreover, our data also highlight the need for improved disability coverage.

9 - Why do some others claim that medical bankruptcy rates are much lower?

Ours is the only study based on direct surveys and interviews with a large sample of families filing for bankruptcy. Others have based their findings on bankruptcy court records alone (with no direct surveys or interviews) or on surveys of the general public that inquire about bankruptcy filings. Court records fail to identify medical bankruptcies because many medical bills are charged to credit cards and hence cannot be identified as "medical" in court records. Similarly, when medical providers turn debts over to collection agencies they would not appear as "medical." Because bankruptcy carries a substantial stigma, about half of all respondents who are bankrupt deny that fact. As a result, surveys of the general public are an unreliable source of information on medical bankruptcy. For these reasons, the only way to accurately assess medical bankruptcy is to directly survey families who file for bankruptcy.

-------------------------------------------------------------------------------------------------

Medical Bankruptcy – Fact Sheet

• In May 2009, more than 5,000 families filed for bankruptcy every business day. For all of 2009, the total is expected to reach about 1.4 million. The average personal bankruptcy involves 2.71 debtors and dependents. In total, an estimated 3.8 million Americans will be involved in personal bankruptcy filings this year.

• Illness and medical bills were a cause of at least 62.1% of all personal bankruptcies in 2007. Based on the current bankruptcy filing rate, medical bankruptcies will total 866,000 and involve 2.346 million Americans this year – about one person every 15 seconds.

• Using identical definitions in both years, the proportion of bankruptcies attributable to medical problems rose by 49.6% between 2001 and 2007.

• Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of them had attended college and 66.4% had owned a home; 20% of families included a military veteran or active-duty soldier.

• Most medical debtors had some health insurance, but many suffered gaps in coverage:

77.9% of the individuals whose illness led to bankruptcy had health insurance at the onset of the bankrupting illness; 60.3% had private insurance.
69% of debtor families had coverage at the time of their bankruptcy filing
60% of families had continuous coverage
Only 0.3% of the uninsured went without coverage voluntarily, i.e. because they though they didn’t need it – most others couldn’t afford it.

• Among medical debtors, hospital bills were the largest medical expense for 48% drug costs for 19%, doctors’ bills for 15% and insurance premiums for 4%. In 38% of cases, lost income due to illness was a factor.

• Out-of-pocket medical costs since the onset of illness averaged $17,943.

• For the privately-insured, out-of-pocket costs averaged $17,749.
• For the uninsured, out-of-pocket costs averaged $26,971.
• Patients with neurologic disorders such as multiple sclerosis faced the highest costs, and average of $34,167, followed by diabetics at $26,971.
  

• According to earlier studies, between 7.1% and 14.3% of Canadian bankruptcies are due to "health/misfortune" (a category that includes some non-medical problems).

--------------------------------------------------------------------------------------------------------

Downloadable copies of press release and info above is at the PNHP website here.

And again, downloadable full text of professional peer review journal article is here.

----------------------------------------------------------------------------------------------------------

More:

In addition to whatever else your minimal demand is, mine is for what would seem to be a non-radical, non-shrill, non-extremist minimal demand, and one that some senators and congresscritters claim to have agreed to (but need pressure to help them keep them promise):

"There must be a complete, honest, side-by-side comparison of all proposals, including single payer HR-676 (Conyers) and SB-703 (Sanders), by the Congressional Budget Office.

The side-by-side comparison should include projected costs to state governments, employers and to households of different income levels. For 2010 and beyond."

Because the only way to actually control costs and provide universal and comprehensive coverage is single payer.

It is crticial that whatever it is we are going to be allowed to get, and whatever it is we are not getting, be honestly and transparently compared for all to see:

The best we have for now is the January 2009 report from the Commonwealth Fund done by the Lewin Group comparing congressional proposals, as summarized in their graph and table below:

1. "Stark"=Single Payer (expanded and improved Medicare for All)

2. "Building Blocks" = Obama/Baucus (mandates to buy private for-profit health insurance + real Public Option + expanded Medicaid)
   
   

Total Change in National Health Expenditures, in 2010 (in Billions) Under Different Health Reform Proposals:

and

Change in Health Spending by Stakeholder Group, Billions of Dollars, 2010

That is why Senator Baucus keeps asking the CBO to "fix the numbers."

Call these critical Democratic Senators, and let your voice be heard:

• Senator Max Baucus at (202) 224-2651
• Senator Charles Schumer at 202-224-6542
• Senator Edward Kennedy at (202) 224-4543
• Senator John Rockefeller at (202) 224-6472
• Senator Ron Wyden at (202) 224-5244
• Senator Kent Conrad at (202) 224-2043
• Senator Jeff Bingaman at (202) 224-5521
• Senator John Kerry at (202) 224-2742
• Senator Blanche Lincoln at 202-224-4843
• Senator Debbie Stabenow at (202) 224-4822
• Senator Maria Cantwell at 202-224-3441
• Senator Bill Nelson at 202-224-5274
• Senator Robert Menendez at 202-224-4744
• Senator Thomas Carper at (202) 224-2441

Cross Posted from Daily Kos with a Hat Tip to Dr. Steve

Medical bills underlie 60 percent of U.S. bankruptcies: study

Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

The United States is embarking on an overhaul of its healthcare system, now a patchwork of public programs such as Medicare for the elderly and disabled and employer-sponsored health insurance that leaves 15 percent of the population with no coverage.

The researchers and some consumer advocates said the study showed the proposals under the most serious consideration are unlikely to help many Americans. They are pressing for a so-called single payer plan, in which one agency, usually the government, coordinates health coverage.

"Expanding private insurance and calling it health reform will fail to prevent financial catastrophe for hundreds of thousands of Americans every year," Dr. Sidney Wolfe of the Health Research Group at Public Citizen said in a statement.

"Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year," the report reads.

"Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy."

The researchers studied 2,134 random families who filed for bankruptcy between January and April in 2007, before the current recession began.

Read more at Yahoo! News

The Private Health Insurance Industry is Killing the U.S. Economy

by Richard Kirsch and Rep. Jan Schakowsky

Fifteen years ago the private health insurance industry told Congress and the nation that it could fix the health care mess if government got out of the way. The insurers said that they would control costs for American families and businesses and improve the quality of care. The American people, American business and the Congress aren't about to buy that line again.

The result of leaving health care reform to the insurance industry is that health insurance premiums have gone up six times faster than wages in the past nine years. Those dollars are buying skimpier health coverage with high deductibles and caps on benefits, resulting in more and more insured people being forced into medical bankruptcy. Businesses that are struggling to meet health care costs in a global economy and dropping coverage, so much so that now 1 out of 3Americans under the age of 65 has been uninsured at some time in the past two years. Health care eats up 16% of our economy, up from 11% when the nation decided to leave the private insurance in charge.

The insurance industry and their defenders on the ideological right are resorting to the same name tired name calling that worked for them the past, "government-run" health care. It's a desperate attempt to fend off a sensible government role in making health care affordable to our families, businesses and nation. This time it won't work. The President and leadership in Congress -- and the American -- people support a two-pronged role for government. One, set rules so that the private insurance industry can't continue to put profits before our health. Two, offer a choice of private insurance or a public health insurance plan, so people aren't stuck only with private insurance.

The fact is that if private insurers controlled health care inflation as well as Medicare has over the past decade, businesses and families would see much lower premiums than they do today. Between 1997 and 2006, per enrollee spending in private insurance grew 59% faster than spending in Medicare. And Medicare has the tougher job, because it cares for the most expensive population: the elderly and those with serious disabilities.

One reason that private insurers have gotten away with skyrocketing premium increases is that they have a near monopoly across the nation. According to data from the American Medical Association, in virtually every metropolitan area in the country (96%) the insurance market is dominated by so few insurers so as to be considered "highly-concentrated." A public health insurance option coupled with a regulated private insurance market will break the stranglehold a handful of companies have on the insurance market. Most importantly, under these reforms consumers will be able to vote with their feet when their health care plan -- public or private -- doesn't work for them.

In fact, the main argument that the industry and the right has with offering the choice of a public health insurance option is that too many Americans will choose it. If private insurers are really more efficient than government, they shouldn't have any trouble competing with a public health insurance plan. It's the height of irony that the defenders of free markets are opposed to competition. But when it comes to health care, which is a public good, public insurers really are more efficient.

There is broad agreement that America's health care system does not deliver the value we need. Today, private insurers have little incentive to develop sophisticated disease management programs, since such programs may attract sicker patients into their plan. And when care improvements are achieved, private plans have no incentive to share best practices with industry competitors. A new public health insurance plan would create a mechanism for the development of innovative and transparent payment mechanisms, the expansion of quality incentives, and the adoption of evidence-based protocols. As the Veterans Health Administration and Medicare have proven capable of doing, a new public health insurance program could lead the way in advancing electronic medical records, creating incentives for greater integration of delivery systems, and establishing improved measures of quality.

The American public gets it. In a national survey of voters taken last year, four-out-of-five voters (79%) said that the insurance industry puts profits before people. A Kaiser Family Foundation poll released this week found that two-thirds (67%) of U.S. residents "strongly" or "somewhat" favor establishing a public health insurance option "similar to Medicare."

Polling by Lake Research Partners this January found that the public believes that the choice of a public health insurance option will lower costs, improve quality, and increase competition. The poll paired the strongest conservative attacks -- "rationing", "government bureaucracy", losing private health insurance and being dumped into a public plan -- against the arguments for the choice of a public health insurance plan. In every case the public favors the pro-public health insurance option, in most cases by margins of better than two-to-one. For example, 61% agree that a public health insurance plan will be better able to control costs by using its purchasing power to drive competition. Voters reject by wide margins claims that a public health insurance plan will limit access, with 66% of voters agreeing that a public health insurance plan will provide an affordable option with a wide choice of doctors.

The question before Congress is whether it will follow the will of the American people. Or, instead, bow to the private insurance industry and other interests that stand to lose if reforms are passed to really make health care more affordable. The President and Congressional leadership share a strong commitment to reforms that will guarantee good, affordable coverage for all, with a choice of private or public health insurance. We know opponents will use scare tactics across the country and a huge corporate lobbying presence inside the Beltway to block reform. Progressive leaders in Congress and Health Care for America Now will be working hard to keep the American public engaged in this fight over the next months. Our success will be the hallmark of a new era in American politics in which the public good is put ahead of corporate excess and greed.