Football doesn’t generally have much to do with health care policy or politics – unless we’re talking about steroids or concussions perhaps. But when the Green Bay Packers visited President Obama at the White House in early August to celebrate their Super Bowl win, it offered the President and Congress a unique opportunity.
The visit occurred the very same day a three-judge panel of the 11th Circuit Court of Appeals struck down the so-called “individual mandate” – a requirement that Americans must have health insurance or pay a penalty starting in 2014, when the Affordable Care Act is implemented more fully. As reported in the New York Times, Chief Judge Joel Dubina and Circuit Judge Frank Hull found the government exceeded its authority by mandating that Americans "enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die."
Polls consistently show the “individual mandate” is the only provision of the Affordable Care Act that Americans dislike. But most health policy experts believe that without this type of strategy to encourage Americans to keep “skin-in-the-game”, there will be little to prevent them from trying to get a medical policy only when they get sick. And like bulk purchasing works, when the insured “pool” is larger, especially if it has healthier individuals in it, costs are lower for everyone who is covered in the “pool”. So, without the “individual mandate”, millions more Americans would remain uninsured, and costs would be expected to rise for those with insurance as well.
Now, most experts agree the Supreme Court will ultimately rule on the constitutionality of the “individual mandate” - likely in 2012. If it is struck down, the President and Congressional Democrats will need some sort of fix to keep the lion’s share of the Affordable Care Act intact – and to avoid appearing that they’ve had their biggest legislative accomplishment undermined right before an election.
That’s where the Green Bay Packers come in.
The Packers are the National Football League’s only non-profit publicly owned team. This football equivalent of a health insurance “public option” thrives in a sea of private competitors. It has been among the league’s most successful franchises - winning 4 Super Bowls and 12 NFL Championships.
At the White House, outspoken defensive star Charles Woodson presented President Obama with an honorary stock certificate making him “part-owner”, along with over 112,000 other Americans. Though perhaps not a perfect policy analogy, the Titletown non-profit public ownership concept this certificate represents just might be the ticket President Obama and Congress need to break out of their slump.
Short of the “single-payer system” many countries use successfully, one thing that would enable the function of the “individual mandate” to survive would be allowing Americans to participate in a publicly owned health insurance option. President Obama could provide the leadership Americans crave, reflect the Packers’ proven championship model in legislative policy, and propose that Congress pass a law allowing Americans to buy into a newly formed “public plan”. He could even propose that Americans have the option to buy into an improved Medicaid or Medicare program. This would provide Americans more choice and be an “end around” the requirement that Americans contract with a private insurance company – a main focus of the 11th Circuit’s constitutionality concerns with the “individual mandate”.
This is not necessarily the “Hail Mary” it might seem to be at first glance.
In their March, 2011 report Reducing the Deficit: Spending and Revenue Options, the non-partisan Congressional Budget Office offered a “public plan” as an option to lower the federal deficit by an estimated $88 Billion over 10 years. In addition they estimated “public plan” monthly premiums would be 5 to 7 percent lower on average, than the premiums of private plans offered in the health insurance exchanges or the employer market. Research suggests that if a “public plan” followed the principles of smart, value-based benefit design and purchasing, and invested in high quality primary care – like the well-coordinated care that Patient-Centered Primary Care Homes (Medical Homes) can provide - a “public plan” could save much more than the $88 Billion projected by the Congressional Budget Office.
So, if he proposed a smart and successful “Titletown” model as a choice for health coverage, President Obama could show Americans he’s listening to their concerns about health care, and at the same time challenge Congress to join him to lower the deficit, increase health insurance choice, improve health care quality, and reduce insurance costs for Americans.
Is that asking too much from a Bears fan?