Your Health Care Questions

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BOSTON — President Obama continued to answer questions about his health care plan at town hall meetings this weekend. As we have seen over the last two weeks, there are a lot of questions — some fueled by rumors, but many by the complicated and still incomplete plan, which spans about 1,000 pages.

As listener Josef Slikowski writes us, why can't they write the bill in English first and then in legalese?

Below are answers to some of your questions about health care from Los Angeles Times reporter Noam Levey.

If President Obama succeeds in covering the uninsured, how will we find enough health care professionals and how will that impact the insured?

There are some new incentives in the legislation to try to encourage doctors ... or encourage students to go into primary care, and there will be something of a race against time to get enough of those people ... into the field by the time all of these millions of people come out into the system.

What is the difference between universal health care and a single-payer system?

Universal health care suggests that everybody has health insurance. It doesn't necessarily mean that it has to come from one place. So, some people might get their insurance from the government, some people might get their insurance from private insurance companies. ...Single-payer is where one entity, usually the government, pays all of the medical bills.

And the president has said that he is not looking for that. But in the past he has made statements in favor of single-payer?

He has in the past and there are certainly no shortage of people on Capitol Hill, as well, who believe single-payer is the best way to reform the health care system. But the president as well as many folks on Capitol Hill who ... would, in an ideal world, want a single-payer system, I think,  recognize that it's unrealistic to do that. It would be incredibly disruptive to the system currently, putting aside for a second even the debate about whether or not it would be preferable.

Listener Marilyn Bentov of Boston pays an extra $72 a month extra for her Medicare Advantage plan.  She wants to know whether her costs could go up,  because she said if her plan becomes more expensive she won't be able to afford it.

The president does constantly say if you like what you have, you can keep it. (But) there is no guarantee. ... There just simply is no way of guaranteeing that when you're changing a system around.

And those folks who are on Medicare Advantage, particularly, may see some changes in the system. The president has said ... that Medicare Advantage, which is a program where private insurers contract to provide insurance to senior citizens on Medicare, that the amount of money the federal government is paying those private insurers is too much.

An analysis that's been backed up by independent analyses as well comparing how much the federal government is paying for that insurance compared to traditional Medicare, and the results are not that much better across the board.

So the president said that we should cut back on the amount of money that the federal government is subsidizing these private insurance companies to insure senior citizens.

If that happens, it's not inconceivable that some of those private insurers would exit the marketplace and stop providing those insurance products to senior citizens or would change them in some way or another. And if that happened, it is entirely possible that some senior citizens who have those and like them might have to change.

Is there a risk that private insurers will decide not to insure because they won't want to compete with the government?

Proponents believe that if you create a new government insurance plan that competes alongside private insurers, that the public plan can exert pressure on the private insurance companies to reduce their rates and to essentially behave better in the marketplace.

Now, critics contend that if a government insurance plan does that so effectively that private insurers decide that they can't compete and they exit the marketplace, then will you be left at the end of a certain amount of time — five, 10, 15 years — with a situation in which the only insurer left standing is the government? And in that case are you ending up with less choice, not more choice?

You're at single-payer. Now there have been a number of different analyses of this, I think the one that is the most reliable ... is from the Congressional Budget Office. ... The CBO, as it's called, looked at the designs for a new public program, in both the legislation developed in the House of Representatives and the legislation under development in the Senate. And they concluded that in fact relatively few people would actually go to this new government insurance plan — about 10 or 11 million people.

Now how are they so sure that everybody won't end up in the government plan and we'll end up with the situation I was describing before? Well, there are provisions in both the House and Senate bills that limit who can actually sign up for this new government plan. If you are working for a ... large company that offers health insurance for instance, you can't go into these new insurance exchanges where the government plan is available.

There also is, the CBO estimates, even those people who do go into these exchanges ... that two-thirds of them would, in the end, choose a private plan, even if it's a little more expensive.

Some have made a comparison to the post office, the public plan for mailing things. There is private competition from, for example, FedEx. And if a business really had to get something somewhere fast, they're more likely to use FedEx than go stand in line at the post office. Is that a good comparison?

It's a good comparison in this sense. I mean there are many different places in our society where the government provides a service that the private sector also provides. Post office is one. ... Education is another one.

In some cases the public option is cheaper. Public education is free, or public universities are generally less expensive than private universities.

In some places public schools are dramatically worse than private schools. Although there are some states where people might argue ... some of the best universities ... are public universities.

Post office, the same thing. The post office right now isn't doing so hot, so people would say, well, that's not such a good advertisement for having the government provide health insurance.

But there have been other times where the post office has done better. So there are precedents.

And for the limited purpose of trying to determine will a government-provided service necessarily mean that the private sector cannot compete alongside it. For that purpose, I think the post office may be a good example.

Dianne Holmes of Anchorage, Alaska, says she has heard the public-option premiums are going to be tied to the private insurance companies' premiums. Is this true?

The House bill has the federal government setting the premiums at a rate that is sufficient to cover the cost of the insurance that are not linked in any way to the premiums charged by private insurers.

The president has said no one will be denied if they have a pre-existing condition under his plan.  Don Monroe, of Sun City West, Ariz., wants to know, is that just the public plan, or is that going to be made law for private insurers as well?

That would be the law of the land whether it's private insurance plan or a public plan.

This program aired on August 17, 2009. The audio for this program is not available.

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