Prometheus 6

To begin with, not everyone makes the $165,000 a year or so that members of Congress do. In fact, at least 100,000 federal workers — at least 5 percent of the active work force — do not have health insurance. In many cases, according to the union that represents the workers, they consider even the cheapest options within the federal plan unaffordable. The lowest-priced family coverage offered by Blue Cross, for example, costs the employee about $2,400 a year....

“This is a private-based solution, with all of its foibles,” said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology who is advising various Democrats about the federal program as a possible model. It would probably have higher administrative costs and pose more of a risk of private insurers trying to enroll only the healthiest people, Mr. Gruber said, than if the government were to provide the insurance directly.

What will happen is, insurance companies will calculate the amount of coverage they are willing to provide for the amount of money the government is willing to spend and that will be called insurance. 

Health Plan Used by U.S. Is Debated as a Model
By REED ABELSON

It makes for a compelling stump speech. And the leading Democratic candidates for president are all saying pretty much the same thing: adapt the health care program that covers Congress and offer it to the 47 million Americans currently without insurance.

“The American people should have access to the same array of health care choices and benefits as the senators and representatives they elect,” Senator Hillary Rodham Clinton said as she introduced her health care plan last month.

Mrs. Clinton’s main rivals for the Democratic nomination, Senator Barack Obama and former Senator John Edwards, have made similar proposals to expand the Federal Employees Health Benefits Program.

The program gives members of Congress, along with about four million other active and retired government workers, a wide array of private insurance offerings with fairly generous benefits. But if this would be health care reform, it is reform with a small “r,” according to many nonpartisan experts.

While health policy experts acknowledge that the federal employees’ program could be a workable way to reach some of the uninsured, they also say there is nothing about it that would help address what they see as an underlying reason for the growing numbers of uninsured: the nation’s runaway medical costs. And without major changes, they say, the model would be sharply limited in achieving the goal of universal coverage for all Americans.

“It would be a very expensive system that would not necessarily be on the cutting edge,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a California group of employers that offer insurance to their workers.

“You don’t control costs by being big,” Mr. Lee said. True health reform is not a matter of simply covering more people, he said. Instead, it would require more fundamental changes in how care is delivered, he said, like making sure every diabetic gets the appropriate treatment.

To begin with, not everyone makes the $165,000 a year or so that members of Congress do. In fact, at least 100,000 federal workers — at least 5 percent of the active work force — do not have health insurance. In many cases, according to the union that represents the workers, they consider even the cheapest options within the federal plan unaffordable. The lowest-priced family coverage offered by Blue Cross, for example, costs the employee about $2,400 a year.

And despite the program’s federal imprimatur, the government currently plays only a limited role, preferring to let commercial insurers take the lead. Under an expansion of the program, the government’s main contribution might be the billions of dollars in subsidies necessary to pay for additional coverage.

“This is a private-based solution, with all of its foibles,” said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology who is advising various Democrats about the federal program as a possible model. It would probably have higher administrative costs and pose more of a risk of private insurers trying to enroll only the healthiest people, Mr. Gruber said, than if the government were to provide the insurance directly.