In the raging debate over national ecumenical care, individual states have attempted to promote further systemic efficacy by instituting specific programs in order to address the problems of the uninsured, which, in 2006, had bloomed to over 800,000 in Tennessee alone, and so, under the auspices of Cover Tennessee, Governor Phil Bredesen set into motion four key programs that dared to meet the needs of those residents. They are divided as such: Cover Kids, which helps provide care to children 18 and younger, Cover RX, which is designed to assist those without pharmacy coverage, AccessTN, and CoverTN.
AccessTN, though limited in scope to under 10,000 individuals, covers those who are uninsurable due to pre-existing conditions, but premiums are 150 to 200 percent above standard commercial insurance. CoverTN is a partnership between the state, employer, and individual for the state’s working uninsured making less than 250 percent of the federal poverty line but is a barebones approach of limited benefits that can hardly be said to reflect traditional insurance coverage: services are limited, pricey bills are often unaffordable, and there are no out-of-pocket maximums1. The goal eventually is to offer care for up to 100,000 individuals; about 20,000 were covered at last beat.
In effect, Tennessee has offered a system of support structures, supplementing but not competing with private insurers (while simultaneously existing in a gray zone between fiscally responsible and efficacious), an idea that is perhaps untenable to those who consider the public option a viable force. For the proponents of a public option, there are two classic arguments.
One is that insurers have fidelity to the bottom line and not necessarily to the care of the individual, seldom brooking those who are most stranded in unmoored straits. And two, evaluation of insurers on the consumer end is often difficult, while the individual is at the power of the insurance companies when disaster strikes. It’s an argument for market motility – movement away from private exclusivity and toward a viable government option. As Paul Krugman notes, in lieu of stringent regulation, it is perhaps the most realistic plan:
To have a workable system without the public option, you need to have effective regulation of the insurers. Given the realities of our money-dominated politics, you really have to worry whether that can be done – which is a reason to have a more or less automatic mechanism for disciplining the industry.
Meanwhile, the debate has been hijacked at town hall meetings by seething tribal ancients clamoring for a moment in the sun, vociferous and as astringent as territorial asps, which feeds back into the fear or reluctance of ordinary citizens to break away from the status quo as we uphold frail institutions that don’t necessarily offer solace but, in our current state of affairs, feel like they could topple with the slightest tinkering. And yet the status quo seems untenable: a Harvard report revealed that in 2007 62% of bankruptcies were due to medical costs, and 78% of those had insurance.
Despite the necessity of reform, it seems as though few voices can pierce the fractious din: when politicians presciently proclaim that government is part of the problem, they seem to do everything that is in their power to fulfill their own self-made prophecy of low expectations. Engaging in the democratic process of debate, it seems to me, is an involvement in an act of creation, directly patterning a piece of reform, and not an act of destruction.
Facing the prospects of runaway costs, Tennessee cut $1.6 billion from their healthcare programs and established Cover Tennessee at the cost of $100 million; some would say that you get what you pay for. And yet, to trump the modes of fiscal conservatism, as many fair citizens have in these town hall debates, it is directly contingent on us to produce a workable system that is fiscally responsible.
1. McAndrew, Clair(2009) CoverTN, Tennessee’s Barebones Health Plan: A Case Study. Families USA. [http://www.familiesusa.org/assets/pdfs/covertn-a-closer-look.pdf]