> Wall Street Journal
> August 19, 2005
> Op-Ed
> Cover Yourself!

> By Jack Lewin, M.D. and Ronald Williams
> (Dr. Lewin is CEO of the California Medical Association. Mr. Williams
is  president of Aetna.)

Dr. Lewin was helpful to CEO in our efforts to pass the Employee Health Security
Act.  He has historically been a strong advocate for bolstering the employer based
system. This recent op ed is a little disturbing.  Below is a response by health care advocates.

> With 45 million Americans uninsured, achieving universal access to
health
> care may seem daunting, but it's not impossible. Encouraging work is
> underway in California to aid employers who don't provide insurance
to
> voluntarily expand primary and preventive care, and the innovative
coverage
> options targeting groups such as students and part-time employees
show
great
> promise.
>
> Employer-based coverage is beneficial and should be preserved. But
the
> environment is changing and costs are crippling the system. Under an
> individual-coverage requirement, many more Americans would benefit
from
the
> private-sector health care that most enjoy currently in our
employer-based
> system. This would foster the adoption of consumer-directed health
plans,
> which typically include high-deductible plan features. These new
plans
> create greater awareness of health-care costs by providing consumers
with
> better information about available treatment options, including the
cost
of
> these services. Consumers then can make the treatment choices that
are
right
> for them without the third-party disconnect that divorces the
consumer
from
> costs.
>
> With an individual-coverage requirement, people who want more
comprehensive
> coverage and can afford the higher premiums could choose to buy it.
>
> As it is, state legislatures are still mandating costly new benefits
for
> insured persons, destabilizing employer coverage and, as a result,
> increasing the number of uninsured.
>
> We urge the state legislatures and Congress to approach this debate
with
an
> open mind as the access to care debate intensifies. At the very
least,
let's
> study and analyze this concept to determine whether its practical
> application can work to unite us in our quest to solve the persistent
> problem of the uninsured.
>
> The status quo is the worst possible strategy. We need a new approach
to
> financing universal access that is more practical and affordable,
while
> still socially responsible and ethical.
>
> http://www.calphys.org/html/editorials01.asp
>
>
> Comment: Dr. Lewin has long been a passionate advocate of health care
> coverage for all. He shares with us the frustrations of observing the
> profound escalation in costs without a commensurate increase in
coverage.
He
> is well informed on the options, but is partnering with the private
> insurance industry the right choice?
>
> This joint op-ed states that "the innovative coverage options
targeting
> groups such as students and part-time employees show great promise."
Great
> promise? Many of these "innovative" products do not provide even
bare-bones
> coverage, and it should be a criminal act to even imply that they are
> insurance products.
>
> The op-ed also states that "people who want more comprehensive
coverage
and
> can afford the higher premiums could choose to buy it." With current
trends,
> this equates to a statement that you can qualify for services such as
joint
> replacement only if you are willing and able to pay for coverage. For
those
> who say that joint replacement would be covered, we should ask then
what
> would be left out?
>
> In addition, the op-ed mentions the "third-party disconnect that
divorces
> the consumer from costs." This is code language for requiring the
patient
to
> pay out-of-pocket as a mechanism of relieving the insurance
intermediary
of
> its responsibility to insure against loss. That impairs access due to
lack of affordability.
>
> The op-ed calls for study and analysis, as long as the solution is a
> consumer-directed, individual mandate that protects insurers while
leaving
> patients exposed to financial disaster. Although more studies will
> continue - indefinitely - enough have been completed to draw
conclusions
> about the perversities of this approach. For those who believe that
they
> need more study, I would suggest reading, as a few sources, Health
Affairs,
> Kaiser Daily Health Policy Report, The Commonwealth Fund, Families
USA,
> National Coalition on Health Care, Physicians for a National Health
Program,
> Consumers Union, and a Google search of the issue. Just be careful to
> separate health policy science from ideology (theirs and ours).
>
> The authors are certainly correct when they state that "we need a new
> approach to financing universal access that is more practical and
> affordable, while still socially responsible and ethical." We are
already
> spending enough to do that, but, sadly, their model is not socially
> responsible.
>
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