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Category > Philosophy Posted 11 Sep 2017 My Price 10.00

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59627796.pdf

Explain to the class where you believe the following terms are found in the essay if applicable: claim, support, warrant, backing, rebuttal, and qualifier. Give citations to back up your points, and create a final works cited citation for this essay.

It must include MLA citations – both in-text and an end citation. 200-300 Words

Here is the cite to use

Flint, Samuel S. "Public Goods, Public Utilities, and the Public's Health." Health & Social Work 36.1 (2011): 75-77. Education Research Complete. Web. 8 Dec. 2011

VIEWPOINT

Public Coods, Public Utilities,

and the Public's Health

Samuels. Flint

he battle over dismantling health reform

dominates today's health policy agenda.

Some opposition to the Patient Protec-

tion and Affordable Care Act (PL. 111-148)—now

typically referred to as the Affordable Care Act

(ACA)—comes from those on the political left

who see health care as a public good similar to the

military, the fire department, and the court system

(Physicians for a National Health Program, 2010).

Only government can fund and deliver public goods,

because the private market cannot be relied on to

do so with the equity and efficiency required for

critical services needed by everyone. Many on the

political right fear "a government takeover" of the

health care system that will lead to the loss of the

very market-driven, creative solutions that are so

desperately needed to reign in the cost escalations

that threaten to make health care unaffordable.

I see

the ACA as a

politically shrewd compromise

that captures the principal benefits of both camps

and creates the least disruptive path to a workable

framework that can ultimately lead to universal

health insurance coverage at sustainable prices.

This middle ground is achieved through the ACA's

requirements shifting the health care system from

a lightly regulated market commodity to a heavily

regulated public utility.

Public utilities are privately owned firms that

provide necessities in monopoly or near-monop-

oly situations. Because unfettered monopolies can

price gouge, they are required to accept extensive

government regulation to ensure that they do not

abuse their market power. Some public utilities are

complete monopohes (for

example,

regional electric,

water, and gas companies),and others (for example,

cable television, telecommunications) have some

modest competition. However, all public utilities

are profit-driven, privately owned businesses, which

distinguishes them from public goods that

are

funded

and operated by the public sector.

Public utility regulation has two fundamental

characteristics. First,

all

utilities are legally obligated

to serve virtually everyone, despite the known

unprofitability of certain customers and customer

groups. All customers are allowed to use as much of

a utility's services as they like, with occasional ex-

ceptions such as temporary limits on lawn watering

during droughts.

Second,

the

prices that

are

charged

to consumers are determined by public commis-

sions rather than private corporations. Public utility

commissions have essentially unrestricted access to

a firm's books.This provides them with far greater

insight into

company's financing than

required of

publicly held companies, let alone privately owned

businesses and other proprietorships.

Contrast that environment with how health

insurers operated up tiO now. Insurers could select

their customers and set their own prices, like any

other seller of

goods

and services in a private mar-

ket. Insurers do contend with some government

regulation handled primarily at the state level, but

these regulations are limited to issues such as fiscal

solvency requirements, state-mandated benefits,

"patient protection

laws"

for managed care

plans,

and

truth-in-advertising and other marketing practices.

However, state regulation does not address consumer

accessibility or pricing.

1996,

enactment of the Health Insurance Por-

tabUity and Accountability Act (HIPAA) (PL. 104-

191) created federal-level regulation for insurers in

the large-group and self-insured employer markets.

HIPAA requires insurers to cover

all

group members,

regardless of preexisting conditions, and to renew

all insurance plans, regardless of

claims

experience.

However, HIPAA's impact is limited in that it does

not address pricing.This makes guaranteed issue and

guaranteed renewability a hollow promise, because

annual premiums can be hiked at the whim of the

insurance company. Undesirable clients can simply

be priced out of the

market.

And HIPAA does not

CCC

Code: 0360-7283/11 $3,00 O2011 National Association of Social Workers

apply to the individual and small-group

markets,

the

areas where consumer rights are most constrained.

The ACA introduces

new level of insurer regu-

lation so strict that it moves the health insurance

industry out of the free market industry and into the

heavily regulated public utility world.

condition

for participation in the forthcoming health insur-

ance exchanges, the ACA requires insurers to serve

everyone at standard community rates, with some

price variation permissible. Covered beneficiaries

will be insured for as much medically necessary

care as they require because lifetime benefit caps

are outlawed.

The

ACA

establishes price controls through state-

level health insurance rate

review.

States are allowed

greater visibility into insurers' accounting records

than current rules permit, and, most important, the

ACA enacted mandatory medical loss ratios (MLRs)

that give state-level rate setting real teeth.

The MLR is not a new concept. It is simply the

percentage of aggregate premium dollars paid by

insurers for actual medical care used by beneficia-

ries.

Remaining premium revenue is considered an

administrative expense for costs such as marketing,

office equipment,

employee

compensation, and

prof-

its.

Currently, insurers regularly report their MLR

by market segment to state insurance commissions;

and at least two states, California and New Jersey,

have tninimum MLRs of 85 percent and 80 percent,

respectively (Henry J. Kaiser Family Foundation,

2008;

U.S. Senate Committee on Commerce, Sci-

ence,

and Transportation, 2010).

The ACA calls for MLRs of 80 percent for the

individual and small-group markets and 85 percent

for large-group markets—hardly draconian stan-

dards.

In 2009, the mean MLRs for the six largest

commercial health insurers were 85.1 percent in

the large-group market and 81.2 percent in the

small-group

market.

The individual market, which

accounts for

less

than one-tenth of aggregate premi-

ums, had

considerably lower MLR of 73.6 percent

(U.S.Senate Committee on Coinmerce,Science,and

Transportation,

2010).

Nonetheless, ACA standards

are manageable industry targets, because insurer

risks (and, consequently, insurer premiums) for the

individual market will be reduced when health

insurance exchanges are operational and a larger,

more stable group is created for those currently in

the individual market.

Under the ACA, if an insurer is not paying out

the prescribed percentages of premiums for medical

care,

they must provide cash rebates to covered ben-

eficiaries.This mechanism should effectively prevent

excessive compensation and corporate profit, and it

places the health insurance industry squarely in the

public utility sector of

the

economy.

Finally, for those who are frustrated that the

ACA does not provide universal coverage from the

outset, a review of European health care systems

is encouraging. There is a rampant misperception

that "sociahzed medicine" throughout the rest of

the industrialized world means a monolithic single

payer (the government), with publicly owned hos-

pitals and salaried physicians employed by the state.

That is a myth.

The Dutch, Germans, and Swiss enjoy universal

coverage at considerably lower costs than those

in our country, with well-functioning, private,

niultipayer insurance systems that purchase care

from privately owned and operated provider health

systems and individual physicians. As in the ACA

plan, beneficiaries are insured through local health

insurance exchanges, with no"public

option"

used

hold down prices (Schoen,Helm,& Folsom,2009).

There are uniform quality

benchmarks,

and

provider

reimbursement rates are negotiated for all payers,

method of determining provider payment rates that

is growing in popularity here in the United States

(Stremikis, Davis, & Guterman, 2010).

There is no denying that the ACA falls short

on universality, the top reform priority for health

advocates. However, it creates

framework that can

expand decent insurance coverage to all Americans

over

time.

was

pleased that NASW,

staunch single-

payer supporter, swallowed hard and ultimately

endorsed the ACA, even after the public option

had to be jettisoned from the plan due to politi-

cal pressure (Gorin, 2010). If

the

rest of the parties

debating the fate of the ACA could similarly lower

their voices and study the actual elements of the

legislation,

believe there would be more apprecia-

tion of just how effective the public utiHty model

can be in resolving many of the nation's health care

system ills. ITH?!

REFERENCES

Gorin, S. H. (2010).The Patient Protection and Afiordable

Care Act, cost control, and the battle for health care

reform [Editorial

Heahh &

Social

Work,

35,

163-166.

Health Insurance Portability and Accountability Act of

1996,

PL.

104-191,

110 Stat. 1936 (1996).

Henry J. Kaiser Family Foundation. (2008, September 3).

Proposed

medical

loss

ratio

requirement

California

would

not

address

rising

health

care

costs,

insurers

say

(Kaiser

Health

Social Work

VOLUME

36,

NUMBER

FEBRUARY

2011

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