AMUSING OPTIMISM IN TENNESSEE

The more "painless" it is, the more it will be overused and the more costs will skyrocket!

Gov. Phil Bredesen says his new healthcare program hit a "home run" Tuesday. BlueCross BlueShield of Tennessee won both of the contracts to offer health insurance to the working poor Tuesday in a new state plan, providing a benefits package that Bredesen said is a "no-brainer" for those eligible to enroll. The contracts were awarded for CoverTN, the main part of Bredesen's Cover Tennessee health insurance plan. CoverTN is targeted at the uninsured, working poor who are employed by small businesses.

Bredesen announced BlueCross BlueShield as the winner at a mid-afternoon news conference at the state Capitol. "I don't always get to stand up here and say `This is a home run,'" Bredesen said. "But this is a home run." Premiums for the benefit will be targeted at $150 a month, with the state paying $50, an individual's employer paying $50, and the individual chipping in $50. Of the $150 average premium, BlueCross BlueShield will devote $140 toward providing benefits, which is one of the main reasons the Chattanooga-based company won both contracts, Bredesen said. "This exceeds my fondest hopes," Bredesen said. Under the two plans offered to the uninsured working poor, benefits will include:

* Enrollees will pay an $8 or $10 co-pay for generic prescription drugs - depending on the plan selected - and a $25 co-pay for brand name scripts. Those covered will be subject to a $250 per quarter spending cap on the drug's costs.

* Coverage up to $15,000 for an enrollee admitted to a hospital who is receiving medical, surgical or psychiatric care. That comes with a $100 co-pay per admission to the hospital.

* One free adult physical exam per calendar year, subject to a five-visit limit for medical, surgical or preventative services.

The $50 average monthly premium for an individual could change, however, based on their age, weight and tobacco use. Bredesen said the premium could be as low as $34 a month or up to $99 a month. "If you're old and smoke and overweight, it'll cost you $99, but you probably won't be around that long," Bredesen quipped.

Dave Goetz, state commissioner of the Department of Finance and Administration, which has oversight of Cover Tennessee, said the two plans offer a "full complement of health benefits." "For the 600,000 people who are uninsured in this state, this is a great result," Goetz said.

Enrollment will start in the first few months of next year. State officials hope to have 45,000 Tennesseans in the program by June 2008. The state has budgeted $34 million this year to pay for Cover TN, but doesn't expect to spend that much. Goetz said it will cost about $30 million a year when 45,000 people are enrolled. Cover TN is mainly targeted at small businesses whose owners can't afford to offer their employees health insurance. Small businesses can qualify if they employ 25 or fewer full-time employees and have at least 50 percent of their workers earning less than $41,000 a year. Gary Selvy, the state director of the National Federation of Independent Business, said the price of the monthly premium is "very comfortable" for small businesses, especially. "This looks, on the surface, to be very attractive," Selvy said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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