As an introduction, the big news story for the year for health care professionals and the health care industry will be health system reform. The history of this movement is readily traced to the Truman Administration, and some say it was first proposed by the first President Roosevelt. The momentum behind the call for action on health system reform leading to the election of President Obama saw virtually every candidate for the Republican and Democratic presidential nomination advancing a reform proposal based on the accepted need to address coverage and related access issues faced by over 44 million U.S. citizens who do not have health care insurance.
With the Obama Administration established in Washington, the focus has turned to the development of legislation by the Congressional committees with jurisdiction over the multiple issues that need to be addressed in reformatting a health system that constitutes almost a fifth of the country's economy. At this point, legislative language is in the percolating stage and the expectations are that the House and Senate will approve legislation by the end of the summer for consideration by a Conference Committee.
One contentious issue is whether there should be a public health insurance option and how such an option would disrupt the current private insurance market. Senator Schumer added a possible caveat where any public health insurance option developed as part of comprehensive health care reform legislation would be subject to the same rules and standards as private insurance, as reported by the New York Times. Under the Schumer proposal:
- The public plan should be self-sustaining by paying claims with money accrued from premiums and copayments, rather than tax revenue or government funding;
- A public plan should pay physicians and hospitals more than Medicare; . Physicians and hospitals should not be required to participate in the public plan;
- Officials who regulate the insurance market should be different from those who manage the public plan;
- A public plan should be required to establish a reserve fund, as private insurers do, for anticipated claims; and
- A public plan should offer the same minimum benefits as private plans.