Health reform critics wonder how to pay for proposals

Denise Cattoni doesn't consider herself a rabble rouser. She just doesn't think government should try to do more than what's needed. That includes messing around with the majority of Americans who already have health insurance.

"Any way you look at it, the country is just so broke," she said.

Cattoni, who lives in Lisle, is the coordinator of the Illinois Tea Party Patriots, an anti-tax organization that has organized public protests this year, triggered largely by the $787 billion American Recovery and Reinvestment Act of 2009. She felt called to action by the nationwide movement's mission, expressed in its acronym: Taxed Enough Already.

"We don't like doing protests. This isn't fun for anybody," Cattoni said. "I've never done anything like this in my life, nor do I want to."

The stance taken by Cattoni's group has local support. Almost half of the Naperville readers who responded to a recent survey conducted by The Sun said they would not be willing to pay more taxes to ensure better health care for all -- some driving the point home with multiple exclamation points.

About half said they wouldn't mind paying more, although several qualified their response by specifying that they would want assurances that undocumented immigrants would not receive benefits.

"A First-World country takes care of its own with a safety net (and doesn't) throw people under the bus," Sandie Loechle wrote.

Allowing people to buy coverage from out-of-state providers would help contain costs, Cattoni said.

"Free enterprise usually works. Hold these guys' noses to the fire," she said. "They know what they're doing."

Several of the survey respondents agree.

"More competitive insurance companies should be allowed to cross state lines!!" wrote reader Sarah Gust. "Government needs to get their noses out of people's health!!!!"

Requiring health savings accounts would lower premiums, too, Cattoni said, and allowing small businesses to band together to purchase coverage would give their owners greater buying power.

Americans generally believe taking care of the underprivileged is important. A recent Gallup poll found that despite the poor economy and rising unemployment, two out of three adults polled in September said they had given to charities within the previous 12 months.

On the logistics of taking care of those in need, however, perspectives differ -- especially when it involves health care.

Although a late October CNN poll found more than six out of 10 of those surveyed said they would like to see the federal government offer alternative coverage that would compete with private insurers' plans, the tax protesters and others maintain a wariness of including a public option in the health care reform package.

"We all believe that there needs to be something done with health care, and I think that's what's so frustrating, that people keep saying it has to be the public option or it has to be nothing," Cattoni said. "Obviously, insurance costs have skyrocketed. We all know that. There has to be something done to bring insurance costs down."

Professionals give mixed reports on their experiences working with the existing public health care systems, Medicaid and Medicare.

The Illinois Hospital Association, headquartered in Naperville, contends that taxpayers could get a lot more bang for their buck if government did a better job of managing money.

The state receives just 75 cents for every tax dollar it sends to Washington, according to the IHA. Only five states fare worse on the return of federal revenue. And while Illinois serves 4.1 percent of the nation's Medicaid population, it receives only 3.3 percent of federal Medicaid funds. The shortfall costs the state more than $1 billion a year, the hospital organization says. The system also is hounded by payment delays.

"We're not anxious to see large numbers of additional people in public programs," said Howard Peters, senior vice president for government relations for the IHA.

He also believes that if there is a public option program added to the final bill, it's important for participation to be voluntary. The rates also must be established through negotiations, he said, "not by government -- by an independent entity."

Dr. Margaret Kirkegaard, medical director for Illinois Health Connect, a primary-care case management program for Illinois Medicaid, sees benefits and drawbacks in the government-run health care system.

"From my perspective, I practice one day a week in a residency program. There is a big difference between working in Medicaid versus private insurance," she said. "If you recommend a treatment to someone with private insurance, it is up to the patient to decide to receive treatment."

Patients with private insurance can weigh their options, Kirkegaard said. They can consider procedures and providers, and are able to make their decisions based on their financial situation and their medical need.

"If you're with someone on public insurance, there is no flexibility to work outside the program," she said, adding that this can make health care harder to navigate and can lead to frustration.

"On the other hand, without that, the patient would have no access to care," she said.

While Congress debates the array of health care plans on the table, the consumers wait. And many of them worry.

"The overall public is just scared," said Cattoni, who asserts that voters just want politicians to listen to what they have to say, particularly about the confusing matter of health care reform.

"People just call me crying."

Anonymous respondents to The Sun’s call for reader input on the health care reform issue gave these perspectives on tapping the taxpayer to come up with more money. Some estimates place the public’s bill for providing a public option, one of the more controversial pieces of proposed reform, at more than $1 trillion over the next decade.

Those who said they’re willing to pay more said:

“I would like a public plan available to people who do not have health care coverage, but it has to be as simple as possible in terms of administration — i.e., very computerized and electronic. Many small business owners need this kind of affordable coverage.”

“Yes, if the key word is Americans only.”

“Yes/not illegal immigrants.”

“Right now, the health care system is set up so insurance companies, drug companies, hospitals, physicians can’t lose — they need to be brought back into the ‘real world’ of competition similar to retail. ... No more ‘wealth care for billionaires,’ I say. We are effectively subsidizing health care now — so they don’t have any motivation to improve.”

Those unwilling to paymore taxes said:

“It is NOT a right for all America.”

“We will (pay more) if Obamacare goes through.”

“I have a limited income, so no — it’s currently hard to make ends meet.”

“Leave (health care) the way it is.”