Tennessee Governor Phil Bredesen, a Democrat, probably understands the challenges of maintaining and financing a universal health insurance system better than any Democrat in Congress. So why aren't the Obama administration and the congressional leadership listening to him?
Health care reformers received the first major setback in their reform efforts when the Congressional Budget Office (CBO) "scored" (i.e., estimated the financial cost) of Senator Max Baucus's D-Mont., health care reform proposal at $1.6 trillion over 10 years and Senator Edward Kennedy's D-Mass., bill at $1 trillion -- and neither senator had handed CBO the complete legislation.
While most people agree that we need ways to make health insurance more affordable and reduce the number of 46 million uninsured, the public is also concerned that the country can't keep piling on more debt. That's where Mr. Bredesen comes in.
In 1993, the state of Tennessee was able to hastily implement sweeping health care reform legislation by discouraging close evaluation of the proposal and its costs. Sound familiar? Tennesseans have paid a high price for that little-scrutinized legislation.
The public was told at the time that anyone who needed insurance, regardless of health condition, would be accepted. And proponents claimed the state would save so much money by closely managing the care patients received that costs, even for comprehensive coverage, would actually go down. Again, sound familiar?
Yet year after year subsequent governors and the legislature struggled to pay for a program. Mr. Bredesen was recently quoted by the Associated Press as lamenting the program "got totally out of control. It was growing at 15 percent a year. Tennessee had the most expensive Medicaid program in the country... Our experience with trying to do universal coverage ended up being a disaster."
That's because the savings never emerged. By the time Mr. Bredesen took office in 2003 -- only 10 years later -- TennCare was a third of the state budget, forcing regular discussions of how to raise taxes to cover the program. And it never reached the ultimate goal of universal coverage. So the governor decided it was time for a change; he took a lot of political heat for downsizing TennCare by some 170,000 adults in 2005, and reduced benefits for many more.
Eventually, the governor worked with health insurers to create a minimum-coverage plan called Cover TN in 2006. The plan has a maximum payout cap of $25,000 a year. Premiums are split three ways between employer, employee and the state (self-employed people pay two-thirds and the state one-third). Current rates range from $38 a month (that's the individual's one-third) for a non-obese, non-smoker under age 30 to $79 a month for someone age 60 to 64.
Such plans can be structured to provide several physician visits a year (12 under CoverTN), ample preventive care with physicals and mammograms, low co-pays on generic drugs, and still have funds left over to cover some hospital care if needed.
To be sure, $25,000 isn't much if you need a major operation. But only eight people have exceeded that maximum in-patient cost.