At a time when public health care occupies the national stage in light of the 2008 presidential race, some Pennsylvanians, including a few locally, are backing a new proposal that would fundamentally change how health care is funded in the Keystone state.However, some in the health insurance industry say the plan will be too costly for the state and cannot deliver care as comprehensively or as efficiently as the private sector.
"We want to bypass the profit-first insurance companies," said Ron Stouffer, a local health care activist from Mt. Penn, a supporter of the new plan.
Dubbed the Pennsylvania Family and Business Health Care Security Act, Senate Bill 300 and House Bill 1660 if passed, would institute a universal, single-payer system of health care for Pennsylvania.
The twin bills would also phase out the hundreds of private insurance companies that now cover medical costs, Stouffer said.
The proposed legislation has also drawn support from State Sen. Michael O'Pake (D-11).
"Since the Federal Government has done nothing to solve the lack of affordable and accessible health care for all, Pennsylvania should consider various solutions, and this is one concept that should be discussed," said O'Pake spokesman Neil McAuliffe.
Gathering in cities across the state on June 19, members of the advocacy group Health Care For All PA, along with allied organizations, urged the state government to do away with private insurance, which the group believes is inadequate, inefficient and unethical.
A 501(c)(4) social welfare organization, Health Care For All PA supports single-payer health care for Pennsylvania, arguing that the state can cover health care costs more efficiently than the private sector.
State Sen. Jim Ferlo (D-38) and State Rep. Kathy Manderino (D-194) introduced the two bills to their respective houses more than a year ago.
Since then, the bills have sat in committee.
Gov. Ed Rendell has said that he will sign the bills into law if they reach his desk.
Rendell has backed a health care bill of his own in the Pennsylvania legislature. Called PA Access to Basic Care (ABC), or Senate Bill 1137, the governor's bill does not institute a single-payer system, as does SB300.
Instead, PA ABC expands health care coverage through private insurance companies.
According to Stouffer, who volunteers for Health Care For All PA, SB300 and HB1660 would create a single state fund by taxing three percent of an individual's income and 10 percent of an employer's payroll.
In many cases, this would represent a significant decrease in the percentage of payroll employers currently pay to private insurance companies, said Stouffer.
This fund would then pay for comprehensive medical care, including nursing home expenses, and would eliminate co-pay and deductibles.
Patients would retain choice of doctors and hospitals.
According to Stouffer, a state-wide fund would be more efficient because operating costs would absorb only five percent of the budget, as mandated by the law, whereas insurance companies now take 20-25 percent in profit and overhead.
Stouffer said the bills provide money to retrain people whose jobs in insurance would be lost as a result of the new law.
"Their business is not a jobs program that Pennsylvanians can afford any more," said Stouffer.
Only veterans and Medicare recipients would be exempt from coverage under the proposed law, said Stouffer, because both groups already receive coverage from other sources.
However, it would no longer be necessary to purchase Medicare supplements to cover costs such as mental health care, he said.
Stouffer's support for single-payer health care is far from universal, however. Scott Crane, legislative chair for the Pennsylvania Association of Health Care Underwriters, argued that however appealing single-payer health care sounds in theory, it does not work in practice. "I have yet to see a single-payer system that works," said Crane in a telephone interview. "The private sector can provide goods and services more efficiently than the public," he said.
By paying for all medical expenses, Crane said, the state creates a demand for medical care that it cannot possibly afford. The result, seen in countries such as Canada and Great Britain, is a rationing of medical care-for example, long wait times for anything short of an emergency.
Rather than a single-payer system, Crane suggested different approaches for different groups of uninsured. For example, if an uninsured young adult requires extensive medical care, that cost could be subtracted from his future wages. This would create incentives for young people to purchase health insurance before misfortune strikes.
The response from the local medical community to SB300 and HB1660 has been ambivalent.
"We certainly support any measures that would improve the availability and affordability of health insurance coverage, but not at the expense of individuals and small businesses who are already facing high tax burdens," said Steve MacLauchlan, CEO of the Pottstown Memorial Medical Center.