Cape Care - Frequently Asked Questions
1. What is Cape Care?
Cape Care is an integrated, single-payer, population-based health care plan, specific to the needs and requirements of Cape Cod residents. Locally controlled and administered, it will provide all Barnstable County residents with health care coverage that is more comprehensive and more affordable than what is generally available today. The term "single-payer," when used by Cape Care, means publicly financed, privately delivered health care services.2. What's wrong with the current system?
Three issues: cost, access, and quality. The current system is wasteful, fragmented and subject to exploitation. While it works well for some people, health care is inequitably distributed across the board, and many individuals have inadequate coverage or none at all. Rising premiums, deductibles and co-payments, and soaring pharmaceutical costs will soon cause the current system to collapse. While insurers and the drug industry receive windfall profits, individuals as well as hospitals are being squeezed - Cape Cod hospitals being a prime example. As a society, our health outcomes rank 37th among 191 countries according to the World Health Organization. This while Massachusetts has the highest health care costs of anywhere on the planet!
3. Doesn't Massachusetts already have universal health insurance?
No, it does not. While it is true that around 400,000 people have obtained health insurance through the Commonwealth Connector, there are still many without insurance, and they now face steep penalties. And many of those who do have insurance have minimal coverage, so one serious illness could still leave them with tens of thousands of dollars in medical bills.
4. What about the Commonwealth Connector?
In April of 2006, Massachusetts enacted a law (known as Chapter 58) designed to extend health coverage to virtually all state residents by requiring residents to purchase private health insurance or pay a fine. The Commonwealth Connector (www.mahealthconnector.org) is the agency designated to connect residents to private health insurance providers, or in the case of those with limited incomes, to help provide them with low cost or free health insurance.
While we applaud the motivation behind the Massachusetts Health Reform of trying to provide universal health care coverage, we find it fails because it leaves the control in the hands of the same health insurance industry that is at the root of the current problems of both access and cost.
Our alternative for Barnstable County is Cape Care, a proposed community-owned system, which would use all the funds gathered for health care for the purposes of improving the health of all residents. Cape Care will meet Chapter 58's criteria of adequacy and seek approval as a health plan or "insurance" option for Barnstable residents. If, however, the funding for the Connector fails to keep up with rising costs, Cape Care could function independently and serve as a model for the state and the nation.
We will post related news articles on this page and invite your comments and questions at capecare (at) earthlink.net.
5. Who will be covered?
All residents of Barnstable County will be covered, without regard to employment status.
6. What kind of system do doctors and the general public want?
Recent respected polls have shown that a solid majority of people - between 64% and 67% -- favor government-guaranteed health insurance for all. In a 2004 study published in a major medical journal, 63.5% of Massachusetts physicians indicated that a single-payer system would "offer the best health care to the greatest number of people for a fixed amount of money." The Institute of Medicine, a prestigious group of fifty selected, pre-eminent physicians, has called for an urgent implementation of guaranteed health insurance for every American.
7. Is the Cape too small a pool for an independent health care system?
No. There are approximately 230,000 residents of Barnstable County, which is a large enough number to support an independent health care system.
8. I'm committed to working on a national single-payer plan. Why should I spend my time and resources on a Cape Cod plan?
We firmly believe that a universal, single-payer health care system would be best for the whole country, but such initiatives have proven difficult to achieve. Many experts believe that a regional system has a greater chance of success, and could be a model for the rest of the country.
9. Is this "socialized" medicine?
No. Socialized medicine implies that doctors, hospitals and other providers are employed and owned by the government. Under the Cape Care model, practices, hospitals, clinics, laboratories and other providers would remain privately owned, although the plan would be publicly financed. The key change to the current system is consolidated financing with a single payer: this means having a medical insurance plan available to all residents, with a single payer to whom all bills are submitted and by whom all bills are paid.
10. What about choice of health care providers?
Cape Care members will have free choice of doctors, dentists and other licensed providers.
11. Will I be able to use health care providers that are located off-Cape?
Yes, Cape Care members will be able to see providers of their choosing, whether on the Cape or not. Cape residents who experience an injury or illness while traveling in the U.S. would have their emergency care paid for by Cape Care.
12. What will Cape Care do about the shortage of primary care physicians on the Cape?
This is currently a significant problem. The Cape Care physician fee schedule will be structured to compensate primary care physicians at a higher level than they receive now. The simplified billing structure will lighten the administrative burden for all providers. These features of the plan will help draw primary care physicians to the Cape to join or set up practices, while retaining the ones we already have.
13. How will Cape Care avoid waiting lists, like we hear about in some other countries?
Waiting lists for surgical procedures is a function of hospital capacity, not health coverage. There is sufficient capacity, both on the Cape and elsewhere in Massachusetts, to avoid waiting lists, especially for serious conditions.
14. What about people with Medicare or MassHealth?
People with Medicare will be free to join Cape Care, and will have broader provider choice. The amount that Medicare pays for their health care will be transferred to Cape Care. The same will apply to those with MassHealth. We expect Cape Care to offer several benefits to its members that Medicare does not offer, such as a better prescription drug plan, making it a more attractive alternative to seniors than Medicare.
15. What about non-residents, snowbirds and tourists?
Cape Care will initially only be available to residents of Barnstable County; it may be possible to extend it to residents of Martha's Vineyard and Nantucket at a later date. Tourists who need medical attention while vacationing on the Cape will have to submit claims to their own health insurance providers. Snowbirds will be eligible to join Cape Care if their primary residence for income tax purposes is Cape Cod.
16. What services will be covered?
Cape Care will cover all acute medical care, including inpatient, outpatient and emergency care and emergency transportation; mental health and substance abuse services; laboratory and radiology services; rehabilitation services including physical therapy; expanded preventive care and wellness services including nutrition and health education; vision and hearing care; chiropractic care; acupuncture; prescription medications; home health care; hospice care; medical equipment and supplies; and social work services. In addition to all this, Cape Care anticipates covering dental care and long term care - services not typically covered by most insurance today.
17. How will Cape Care be financed?
With Massachusetts health care costs being so high, Cape Care will provide opportunities to significantly reduce spending that now goes to administrative waste, and to reduce costs through better preventive care services and through bulk purchasing of pharmaceuticals. Cape Care will capture Federal and State health care dollars from programs including Medicare and MassHealth for enrolled members. We anticipate the balance of Cape Care's funding to come from a modest tax on residents.
18. Will employers have to contribute to the cost of health insurance?
It is the intention of Cape Care to divorce health coverage from employment; in other words, if you lose your job, you wouldn't lose your health care. However, we do envision a small payroll tax on employers to help fund Cape Care, a contribution far less than the cost of actually providing health coverage. One benefit of universal health care for employers would be to make the Cape a more desirable place to live and work, helping to attract a larger pool of workers.
19. I already have insurance. Why should I have to pay taxes for others to have insurance?
A universal health care system is for the good of the entire community. By virtue of being a true "system," instead of the inefficient, disjointed patchwork of insurance plans that we have now, it will improve quality, provide more comprehensive benefits, control costs, improve access to health care services and make the Cape a more desirable place to live as well as to practice medicine. But most importantly, it is the right thing to do. Cape Cod will be able to proudly show off our health care system to the nation, knowing in our hearts that we have made health care truly accessible to all residents. Enrollment will not be mandatory; however, it is Cape Care's intent to offer a health plan that attracts nearly all residents through its design for cost control, comprehensive benefits, wide provider acceptance, and integrated quality of care.
20. Are these FAQ authoritative?
Not entirely; due to the abbreviated nature of this FAQ and the evolution of the draft model plan, some of these answers may be incomplete or inaccurate. The draft model plan is the authoritative document from which this simplified description is derived.