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Ex-Governors Spar Over The Role of a Public Plan at AHIP Convention

Cheryl Clark, for HealthLeaders Media, June 5, 2009

Hundreds of health plan representatives heard three former governors—two of them physicians—argue over what role federal money should play in health reform as the America's Health Insurance Plans convention began its annual convention in San Diego on Thursday.

Former governors Howard Dean, MD (Vermont), Jeb Bush (Florida), and John Kitzhaber, MD (Oregon), agreed that the current system is functionally flawed. And they agreed that health plans, employers, and consumers need to take more responsibility for their own healthcare.

But they disagreed on how much of a role the government should play, and whether any level of its regulatory presence would stifle innovation to improve the delivery of medicine.

For many in the room, listening to Dean might have resembled hearing the enemy speak. Health insurance companies are vehemently opposed to a public plan.

But Dean considers public health insurance a necessity. "I think it is absolutely essential. And I don't think health reform is worth doing without a public option."

"What the president is proposing to do is say, if you like what you have, you can keep it. If you're comfortable with the private insurance market, you can keep it. Not only that, but we'll help you buy it. There will be a government subsidy based on your income, particularly helpful to small businesses, that you will receive to buy healthcare in the private market," Dean said. "But you will also have a choice of buying into a public plans such as Medicare or some other public plan. And I'm one of the few defenders of that in this room."

"Now I know people in this room, in this industry, are very, very fearful," he said. "This is the center of opposition."

He looked at the rows of representatives of Aetna, Blue Cross, and dozens of other companies assembled and said, "Your living is at stake here. But I don't think it's going to be as tough as you think it is."

The reason, he said, is that most of the nation's CEOs, despite "incredible inflation," prefer to have employer based health insurance. He emphasized that there is still a role for private health insurance, but one that would be shared by public plans.

Bush, however, argued for government to step back. "Beware of too much intrusion by the federal government in all of this," he said. "I'd be very, very cautious of ever expanding federal government."

Bush said too much of the debate centers on access, and not responsibility, saying patients should be given more incentive to more take responsibility for lifestyle decisions that affect their healthcare.

"In almost every other aspect of our lives we ask people to be responsible for their own decisions. But in healthcare, by and large today, individuals are not responsible for their healthcare decisions," he says.

Bush urged for more emphasis on disease management, which he said "should be allowed to happen more often than it is."

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