[editor’s note: from time to time I invite other staff members to write about issues I think may be of interest to our families. This week’s guest blog is written by Morgan O’Toole, and concerns healthcare reform, specifically the possibility of a “public option” health insurance plan, a topic currently much in the news. He adds his own two cents’ worth here. In the interests of full disclosure I should point out that Morgan is my son, and is responsible for the day-to-day operation of the Clinic’s business office. – JOT]


Despite many false starts and earnest attempts it appears that some form of significant and meaningful healthcare reform is imminent. Talk of a “public option plan” is in the air, a policy proposal that would have been unthinkable only a few years ago. For many consumers and providers of healthcare, this discussion cannot come too soon. At Kartini Clinic we see the woefully inadequate state of medical and mental health coverage every day. Despite incremental improvements in coverage, secured under so-called mental health parity laws (now passed in more than 18 states, with a federal law due to come into effect January 1, 2010) the stark reality is most people are underinsured, especially when it comes to mental health treatment, with little or no option but to pay for services out of personal savings, or take on crippling debt. Healthcare costs have become the leading cause of personal bankruptcies. And most tellingly, more than half of those who declare bankruptcy in fact had insurance. And this says nothing about the tens of millions of Americans with no health insurance at all.

Our current system of employer-sponsored group health insurance is increasingly failing to protect policy holders from catastrophic treatment costs. For example, after diligently paying (often very expensive) premiums, families and employers alike are often shocked and angered to find their benefits do not extend to meaningful treatment of anorexia nervosa, the deadliest of the so-called “mental disorders” (as many readers will know, at Kartini Clinic we believe this distinction between ?mental disorders’ and ?physical disorders’ is nonsense; AN is a medical condition that affects the brain, with mortality rates comparable to childhood leukemia; treatment should not be excluded because some insurance companies want to use outdated, and inaccurate, definitions).

Part of the reason for this inadequate coverage is that people do not have any meaningful choice when it comes to purchasing health insurance. Most of us are forced to accept what our employers offer. If you are lucky, you get to choose between several options (too often, however, this is between bad, worse and worst). Given a real choice, most of us would choose plans more appropriate to our own needs, and, crucially, would value the ability to change insurance plans if our coverage needs changed. I am always mystified by pundits, economists and politicians who seem to think health insurance purchasing decisions should be like shopping for a wide-screen TV. You decide what you need and what you can afford, shop around for the best price, and make the purchase. How on earth are people supposed to understand all the things that might go wrong with their health? How is it possible to know whether you or one of your family members will wind up needing extensive mental health treatment or, say, organ transplant benefits? And who can really understand these policies anyway? Certainly not the insurance companies themselves. Our staff at Kartini Clinic call on patients’ benefits every day, and are routinely given inaccurate, misleading or confusing information by insurance company employees.

But what can be done to fix this problem? True choice in health plans will require an ability to buy group insurance on the open market. Individual health insurance policies — currently the only alternative to employer-sponsored group policies for those who cannot qualify for Medicare or Medicaid — are allowed to exclude people with “pre-existing” health problems (imagine: health insurance for those who might actually need it!). Because of this, virtually everyone is forced to go through an employer to get reasonable coverage, assuming, of course, that your employer even offers a plan or you are not one of millions of Americans who recently lost their job. How exactly this insurance system came to be billed as “market-oriented,” is a mystery to me.

Little about our healthcare market looks anything like other markets we are used to. Imagine having to go through your employer to get car insurance or life insurance or mortgage insurance? Most of us would consider that absurd, but we seem all too willing to accept it in the case of health insurance because we have been told the alternative is “socialized medicine” or “government-run healthcare.” Don’t believe it. Fundamentally, the current debate about a public option plan is an attempt to break the link between employment and health insurance, and I, for one, believe it is absolutely essential that Americans get a balanced view of what is at stake for them.

So how could such a public option help?

On one hand, a public option would guarantee access to group insurance, probably at more affordable rates because of its potential size than private insurers currently charge. On the other hand (as many readers may have already experienced) simply having an insurance policy does not guarantee benefits for every treatment, or access to every kind of specialist you might need. In order to truly serve all of us when we need it, a public option plan would need to address the issue of those providers who might choose to “opt out” of the plan because they are not reimbursed by the public plan at levels sufficient to cover the cost of delivering treatment.

At Kartini Clinic we know this problem very well. We would like nothing more than to be able to accept Medicaid or Medicare patients, not to mention certain other large private insurers, some of whom want to pay even less than Medicaid, but the plain fact of the matter is we would wind up paying to see these patients, as much of our costs would go uncovered. Our only alternative then would be to lower the quality of the treatment program by raising the ratio of patients to providers, cutting the number of our employees, their benefits and their wages. Simply creating a public plan would not be meaningful reform to many unless it is properly funded and wisely administered.

Nor is a public plan the only way to solve the issue of affordable, universal access to group insurance. A plan currently being co-sponsored by Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT) envisions a national insurance pool, run by private insurers, but mandated and regulated through federal law. It would replace the current, incomprehensible patchwork of public (e.g. Medicaid) and private plans and state regulations with a single, national group plan, available to all. Individuals would be able to purchase group insurance on their own, from competing options and, if you didn’t like your insurance plan or found it inadequate, you could purchase another plan, better suited to your needs (with a government subsidy for the neediest). Even with this plan, though, problems with access to specialists like the Kartini Clinic would still need to be addressed.

You can read more about this plan on Sen. Wyden’s website. For another, somewhat more skeptical, perspective on this proposal see the Heritage Foundation’s analysis.

Lastly, with an issue this complex, reasonable people should and will disagree, and there is almost certainly more than one way to tackle these problems. But in my opinion, the bottom line is this: the need for fundamental reform is now essential to us all. More of the same is simply not an option. It is not an exaggeration to say that our nation’s very health and economic well-being depends on it.

I urge everyone who reads this blog to get educated on the topic of health care reform, then talk to your co-workers, neighbors and friends. Contact your congressional and state representatives and become active in what may be the most important and far-reaching public policy debate in your lifetime.