Universal Health Care and Pennsylvania
Chairman Micozzie and members of the Insurance Committee: Thank you for allowing the Pennsylvania Medical Society to be with you today to discuss health care coverage for all Pennsylvanians.
I’m Mark A. Piasio, MD, MBA, president of the Pennsylvania Medical Society and a practicing orthopedic surgeon in DuBois.
Let me begin by stating that the Pennsylvania Medical Society supports universal access to health care for all citizens of our commonwealth. In the current environment, those without health insurance often don’t seek preventive care or timely medical care when they need it.
With that said, I want to commend the Chairman and this committee for initiating this important discussion. The exchange today on universal health insurance and medical coverage, from the viewpoints of both financing and delivery, is long overdue. For too many years our state and country have been hampered by lack of meaningful discussion—much less corrective action—on this matter.
However, this issue is much larger than a simple question for health care professionals, politicians, and insurance entities. We will need to ask all of society to participate with us in our deliberations on a health care system redesign.
As discussed at the June health care summit hosted by the Pennsylvania Medical Society and in the Society’s The State of Medicine in Pennsylvania—2005 report, our population is aging and health care demand is increasing. At the same time, the supply of health care professionals, particularly physicians and nurses, appears to be lagging demand. Health care costs are increasing at an unsustainable rate, as new technologies and medical treatments are developed and researched.
At the June health care summit, we did have some consensus on health care trends and the future of health care delivery and financing.
Specifically, almost universally, stakeholders highlighted the lack of integration and cohesive “systemness” within the health care experience as needing immediate attention. Attendees also mentioned that quality and safety incentives need to be aligned among all key stakeholders—including payers, facilities, health care professionals, and patients—and the future costs of health care must be shared responsibly. Stakeholders felt that shaping the future of our health care system should be determined by evidence-based medicine and a market-based approach. They also stated that health care should be portable. The future health care system must be tested, valued, and equitable for all.
So, what about universal health care in light of input from health care stakeholders at the State of Medicine summit in June regarding our health care system?
The issue of universal health care coverage in the United States has gained great momentum since the Massachusetts legislature passed a bill in April of this year that required every resident to have health insurance or pay a penalty.
However, I want to point out that the Massachusetts model is much different than the typical universal health care model that we often think about, for example, the coverage offered in Canada. Some people will tell you that the Massachusetts model is not really universal health care coverage. There are differences.
In Canada, the government covers all citizens through taxes. In Massachusetts, the mandate is primarily paid through employers who provide health insurance for their employees. Also, there are penalties for those employees who opt out of insurance and for those businesses that do not offer health insurance. Those who do not have insurance but want it can purchase health insurance benefits through the state connector. The law attempts to create state insurance markets, establish personal ownership and portability of coverage, and provide the opportunity to purchase coverage through a state insurance exchange for small business, individuals and the indigent. There is also an attempt to reduce regulation of insurers.
While the Massachusetts model is indeed intriguing and many are impressed by it, we should remember that the Bay State hasn’t yet come up with total funding for the program. Plus, the model does not include quality measures or address cost drivers and cost containment. Any plan will require some tough decisions on the part of all stakeholders. And, that’s why the Pennsylvania Medical Society is willing and ready to participate in this process.
Again, we applaud Chairman Micozzie and this committee for taking a bold step in starting the public conversation on this issue in Pennsylvania.
In preparing for today’s hearing, your committee asked the Pennsylvania Medical Society three questions that you would like to investigate.
- Should Pennsylvania require all adults to maintain health insurance coverage? If so, what coverage should be contained in the benefit package? Eventually.
- Should Pennsylvania develop a system to subsidize low-income residents? If so, how would such subsidy be financed? We support a move toward defined contribution.
- Should employers bear some responsibility in providing such insurance coverage or bear some responsibility in the financing of coverage? Initially yes.
The Pennsylvania Medical Society admits that we don’t have all the answers, but we are currently working to research the pros and cons of universal health care coverage in Pennsylvania. When that research is completed, we’ll share it with this committee, and others interested.
I mentioned the summit held on the State of Medicine in Pennsylvania, and that universal health care coverage was discussed. A full report on that summit is due soon from the independent company that facilitated the summit.
Currently, the Pennsylvania Medical Society does have official policy supporting a free and competitive health care market which allows the development of alternative delivery and financing systems and increased price consciousness among consumers and physicians, but which maintains safeguards that ensure that quality of care and access to care are optimal under conditions of their choice.
As a result of our current policy, should universal health care coverage develop in Pennsylvania, I will tell you that the Medical Society believes that individuals should have some level of responsibility both financially and through healthy living.
Regarding financial responsibility, one of the criticisms of the current system for health care financing is that consumers do not realize the actual cost of care. Thus, without any level of financial responsibility, some individuals will not understand the expense involved in providing care. Thus, the potential for wasteful or preventable spending is high.
Regarding lifestyle choices, it’s very clear that certain individual choices such as being a smoker or being obese can lead to expensive health care bills.
For example, cigarette smoking can lead to pneumonia, cataracts, and cancer.
And, when any of these or other tobacco-related problems strike, they will cost money to cure…if they can be cured. According to the American Lung Association, smoking costs the United States over $167 billion each year in health care costs, including $92 billion in mortality-related productivity losses and $75.5 billion in excess medical expenditures.
Obesity too can lead to many less-than-desired health care situations including diabetes, high cholesterol, mental disorders, upper gastrointestinal disorders, and orthopedic problems. Furthermore, obesity complicates surgeries, thus increasing the odds of a poor medical outcome. A 2005 article in the USA Today titled “Health spending soars for obesity” suggests that the cost to treat obesity-related illnesses has increased tenfold since 1987. In 2002, employers and privately insured families spent $36.5 billion on illnesses linked to obesity. During that same year, treating an obese person cost $1,244 more than a person of healthy weight.
If a universal health care program were to be developed in Pennsylvania, it would be reasonable and fair to include a healthy living factor when determining how to finance the program.
Furthermore, the Medical Society believes any reform proposals should balance fairly the market power between payers and physicians, facilities, and patients.
Currently, there are a number of bills sitting in committees addressing aspects of these issues, including House Bill 503, all without resolution. I mention that bill to make the point that we can’t afford to let the discussion of universal access to health care go the same route. Further, we must address all aspects in the delivery and financing of care including professional liability reform such as mediation and health courts.
In conclusion, let me again congratulate Chairman Micozzie and the members of this committee for starting a long-awaited discussion in Pennsylvania about universal health care coverage. The Pennsylvania Medical Society looks forward to working with you, other members of the legislature, and all other stakeholders on this issue. Collectively, we can’t afford not to try, and we certainly can’t afford not to succeed. The future of health care is too important for all of us.
Thank you.
Last Updated: 10/11/2007