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Health Care Reform
Currently, 50 million people have no health insurance. Additionally, a like number have health insurance which is essentially worthless. These uninsured and underinsured people go without regular checkups and cannot seek needed medical care. They go to emergency rooms when their condition becomes serious. At that point, care is much more costly and the outcome is far less favorable. It is estimated that 45,000 Americans die unnecessarily each year directly due to lack of health insurance. The United States ranks below all other industrialized nations in health care effectiveness. We rank 31st in life expectancy, 37th in infant mortality, and 34th in maternal mortality. This puts us down with third world countries. In a Robert Wood Johnson Foundation and the Urban Institute study, the United States ranked last among 19 developed countries in avoiding preventable deaths. The only category where the United States ranks above average among developed nations is in life expectancy for those who have already reached the age of 65. This is obviously due to Medicare coverage. See the 11/04/09 NY Times Op Ed by Nicholas Kristof for a more complete discussion. The causes of our high health care costs and poor health outcomes are readily evident. The health insurers take 30% of every health dollar for profit and administrative costs. (With Medicare, it is 3%.) Health insurers select to insure only the healthy and cancel policies when those healthy become sick. The purpose of any insurance program (home, automobile, ...) is to collect low premiums from everyone to cover the costs of the few who encounter misfortune. It counts on the insurance company being an honest broker. The health insurers like pocketing premiums but go to great, unethical lengths to avoid paying claims. Clearly they are not honest brokers. Health insurer executives pay themselves lavishly from the resulting company profits. One such executive took $1.6 billion in a single year. That pay for one man would be enough to fund "Cadillac" health insurance policies for over 200,000 people! All of these other developed nations with much better health care results have universal health care. They have varying forms of Single Payer (enhanced Medicare for All). I recommend viewing the PBS Frontline documentary of five other nations' health care systems. Taiwan has the best system. They modeled it after the U.S. Medicare system, adding their enhancements. None of the other developed nations spend as much as half of what we do, per person, for health care. Over 60 percent of bankruptcies in the United States are due to medical expenses. A hundred million of our citizens are one major illness away from financial disaster. The other developed nations have no bankruptcies due to medical expenses. With our medical costs rising, the United States faces bankruptcy as a nation. Currently, half of the total costs of medical coverage come from the government. Most of the other half burdens our businesses making them less competitive in the world market. The obvious answer is to seek better health care results for our people at half the cost of our current system. It is no pipe dream. It has been demonstrated in 19 other nations. In the community of nations we are, in this matter, the village idiots. While our right wingers are used to that role, the rest of us are not. Our best course by far would be to implement an enhanced Medicare for All (aka Single Payer). Enhancements would include a drug benefit without the doughnut hole, no deductibles, and no caps. This system would be in position to implement cost beneficial preventive care, best medical practices and competitive prices programs to improve health care while lowering costs - as other countries have done. There would be some procedures which would likely be rejected, like a heart transplant for a ninety year old. But, people should be allowed to buy private policies to cover procedures outside of coverage. The cost of such a supplemental policy should be low because of the rarity of claims. House bill 676 is a good proposal to implement enhanced Medicare for All. While businesses would participate in funding, their costs would be a fraction of what they pay currently. Thus businesses would be more competitive in their markets and we would experience a resulting improvement in our economy. But, Single Payer would essentially close down the private health care industry. The only market left for them would be the supplemental policies noted above. While that would be good for the financial survival of our country and the well being of its citizens, it presents a political problem. There are an estimated 3000 health care lobbyists on Capitol Hill. They raise hundreds of millions of dollars for Congressional candidate campaigns. They spend many more millions on TV ads fighting health reform. As a consequence, they have an enormous influence on members of Congress. While virtually every Republican in Congress will reject any provision which does not meet with health insurer approval, that is also true for a minority of Democrats, Blue Dogs in particular. The only way that will change is if voters make it clear that they will take control of our nation from the lobbyists. Voters must investigate the issues and candidates and ignore the misleading 30 second TV spots, and meaningless glossy mailings. We need campaign finance control to limit campaign expenditures. If we can't get Single Payer, the next best choice is to have a robust public option. Robust means comprehensive coverage available to anyone who wants to buy it. It would cover enough people to give it clout in price negotiations with health providers and result in lower premiums. As we have seen in the last session of Congress, the health insurers will fight it about as hard as they will Single Payer. The estimates from public option opponents was that 130 million people would take the option if available. If we can't get Single Payer or the Public Option, the next best course would be legislation which would support and encourage the formation of not-for-profit health insurance cooperatives. Some other developed nations have included them in their systems. To start with, it would substantially cut (to 2 or 3%) the 30% administration and profit taken off the top by health insurers. Legislation chartering such cooperatives must limit administration costs and specifically restrict executive compensation. If carefully considered, they could have many of the advantages to the public of the Public Option while gaining the support of those who reject any government role (other than Medicare which everyone supports). The health insurers would fight this approach about as they would Single Payer because it too would eventually put them out of business. A few more notes: I have been active in the health care reform advocacy movement since before the 2008 Congressional campaign. I was Regional Director for Region 7 (eight counties) for the Single Payer Action Network, Ohio (SPAN-OHIO). See my 2006-2008 page on health care reform. Many seniors have said they want the government to stay out of health care and leave their (government) Medicare alone. What are those people smoking? See the Single Payer Top Ten list from Physicians for a National Health Program. Go to Physicians for a National Health Program web site.
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