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10 EXCELLENT REASONS FOR NATIONAL HEALTH CARE |
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10. It's what most Americans want -- and we can make it happen Joanne Landy and Oliver Fein The irony about the debate over national health insurance in the United States is that we have excellent hospitals, skilled practitioners, and the technological infrastructure -- and we're already spending enough money to insure everyone and to improve access to care for many who are covered today by inadequate plans. All we need is the political will. Although the barriers to single-payer reform are considerable, we ignore them at our peril. Private, for-profit insurance companies will of course fight tooth and nail against any system that will remove them from a significant role in the country's health care. Big Pharma too will use its clout to try to defeat single payer; the drug companies want multiple fragmented private purchasers rather than a single public payer with the power to negotiate lower prices for everyone. Moreover, most politicians are, right now, of little help. Too often they take money from and are then beholden to insurance and drug companies. (However, with sufficient popular pressure, many politicians would have to change their stance and could add important strength and credibility to the fight for single payer.) In addition, numerous economists and health care "experts" lend legitimacy to the current system by advocating market-oriented reforms, reforms that fail to be truly universal, and meanwhile pour more money into private insurance companies. Finally, while employers often complain about the high cost of private health insurance premiums, they have thus far chosen to deal with rising premiums by shifting costs to their employees rather than by supporting a public insurance solution. Overcoming these obstacles will require an informed public that demands meaningful change. The movement for single payer has made great strides, drawing on the fact that most people in this country have come to distrust insurance companies. But many Americans have grown increasingly distrustful of government in recent years. It is not uncommon to hear comments like "You mean you want the government that didn't rescue New Orleans after Katrina to solve the health care crisis? Forget it!" Understandably, those with health insurance fear that they will lose the benefits they have now and that the cost of a government-financed system will mean that they will have to pay extraordinarily high taxes and will end up even worse off than they are now. However, as the chapters in this book illustrate, the arguments against single payer don't measure up to the evidence. Here are some of the myths that need to be dispelled:
Everyone -- including most Democrats and some Republicans -- is talking about the need for universal health care coverage and cost controls. Although not everyone endorses single payer at this time, more and more people have jobs with no insurance, and those with insurance are seeing their employers reduce their benefits and increase their contributions for premiums, year by year. The latest General Motors-United Automobile Workers agreement points toward a grim future in which employers try to shed all responsibility for insuring their employees. Meanwhile, every study that compares single payer with tax deductions or tax subsidies to buy private health insurance shows that single payer costs less and guarantees better coverage to more people than all the other approaches. The evidence supports single payer, and increasing numbers of people in this country are seeing that we don't have to be stuck with the irrational, expensive, and cruel system we have. Michael Moore's SiCKO! has made an incalculable contribution to overcoming ignorance about what is possible: Moore has shown us that by cutting the wasteful and totally unnecessary private insurance industry out of our health care system we can have real universal health insurance. Of course there have been vicious attacks on Moore, but the strong positive response to SiCKO -- from Oprah to the New York Times to Jon Stewart -- has begun to puncture the traditional U.S. media blackout of the truth about single payer. Perhaps most important, Moore has made a convincing case that government can work for people and has brought outrage and a passion for justice to the fight for a humane health care system in the United States. He is among those helping to ignite the movement needed to make it a reality. In another hopeful sign, more and more groups are endorsing HR 676. This is the bill in the U.S. House of Representatives introduced by Michigan's John Conyers Jr., called the United States National Health Insurance Act or Expanded and Improved Medicare for All. As of this writing HR 676 has been endorsed by the National Organization for Women, the NAACP, and a wide variety of religious and civil groups, including We Be Illin', a group of young people reaching out to their peers to show why they urgently need single payer. HR676 has also been endorsed by 401 union organizations in 48 states including 104 Central Labor Councils and Area Labor Federations and 33 state AFL-CIOs (as of April 23, 2008). The AFL-CIO has adopted a policy statement favoring a Medicare-for-All approach. The Alliance of Retired Americans, but not to date the American Association of Retired Persons (AARP), reaffirmed its earlier support for HR 676 in September 2007. It is encouraging that all these groups have indicated their support for HR 676; the next challenge is gaining endorsement from more organizations and enlisting those that have already endorsed to deploy their resources in an active fight to pass the bill and actually bring single payer to fruition. More and more physicians are coming around to support a single-payer system. Physicians for a National Health Program (www.PNHP.org) has long advocated single-payer national health insurance, and more doctors are coming to agree with them. In a well-designed study of Massachusetts physicians drawn from the American Medical Association (AMA) master file, 62 percent supported single-payer reform. [9] In January 2008, the American College of Physicians, the second largest physician organization in the United States after the AMA, published a position paper recommending "Single-payer financing models, in which one government entity is the sole third-party payer of health care costs," as one pathway to reform. [10] Recently, the New York State Academy of Family Physicians gave testimony strongly endorsing single payer. The AMA does not have the stranglehold on physician opinion that it once had. Its membership has fallen to 27 percent of physicians. The AMA no longer represents the majority of practicing physicians in the United States. Many physicians are furious with the second-guessing and interference by the private insurance industry, which denies claims and delays treatment and payment. Physicians become frustrated and patients suffer when each private insurance company's pharmaceutical formulary is different, so that patients can't get certain medications or have higher co-pays. Private insurance company rules on prior approvals result in delay or denial of patient care. Physicians feel ethically compromised. The physician is ultimately accountable to the patient, whereas the insurance company has a responsibility only to its stockholders to maximize profits. The majority of the public favor national health insurance. A full 68 percent said in the September 2006 ABC/Kaiser/USA Today poll that "providing health care coverage for all Americans" was more important than "holding down taxes." [11] The more recent CNN/Opinion Research Corporation poll (May 2007) finds similar results. Asked whether the "government should provide a national health insurance program for all Americans even if this would require higher taxes," 64 percent of the sample said yes, while just 35 percent said no. When CNN asked that same question in January 1995, 55 percent answered yes and 37 percent said no. This is not an explicit endorsement of single payer, of course. It does suggest, though, that more than a majority of Americans see government and higher taxes as part of the solution to the health care crisis -- even when they have not been informed that lower premiums, deductibles, and co-pays would compensate most people for their higher taxes under a single-payer system. Halfway solutions won't work, particularly those that put more taxpayer money into helping people buy more private health insurance. Private health insurance is not only extremely costly; it will also result in more and more under-insurance and will actually move us away from achieving quality universal coverage. In order to maintain profits and control their costs, private insurers will jack up deductibles and co-pays and cut benefits. Private insurers will do all they can to recruit the healthy and avoid the sick, who are burdened with pre-existing conditions. That's the fallacy of the "level the playing field" argument put forward by politicians and pundits who propose that we offer Medicare to everyone and let it compete with private health insurance. The competition will not be fair, because private insurers will figure out how to attract the well by offering perks like free health-club memberships and by advertising aggressively among healthier groups, and how to skip over the less healthy by undermarketing to high-risk populations, even if they are legally required to insure all applicants. This will inevitably leave a disproportionate number of the sick to Medicare, which will in turn raise Medicare premiums, which will make it less attractive to healthy people than private insurance. Many reformers advocate regulating private insurance to prevent these abuses, but the record of government regulation in this country is poor. The private industry being regulated uses its clout to constrain and distort government intervention. Moreover, no one has proposed comprehensive regulations to curb the worst features of the insurance industry, its built-in desire to avoid paying claims. Most regulation being proposed primarily involves selling insurance, not actually paying for health care. We already have a clear example of how private health insurance avoids regulation when it coexists with public health insurance when we compare traditional Medicare to Medicare Advantage in which private insurance companies provide coverage. These private plans receive 12 to 18 percent more funding than traditional Medicare and yet have been fraught with major problems. "Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers according to a review of 91 audit reports conducted by the New York Times." [12] The companies reviewed included three of the largest participants in the Medicare market, United Health, Humana, and Wellpoint. The problems, described in the audit reports, include "the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.... The audits document widespread violations of patients' rights and consumer protection standards. Some violations could directly affect the health of patients -- for example, by delaying access to urgently needed medications." The danger of halfway solutions is not only that they won't work but also that their failure can discredit the whole effort on behalf of universal coverage. The public will blame the advocates for universal coverage for the lack of improvement in affordability and coverage. Moreover, the halfway measures that have been proposed add legitimacy and resources to the private insurance companies, who will use those assets to fight single payer every step of the way. The movement for single-payer National Health Insurance in the United States must come from the bottom up, and by the power of our numbers must bring enough politicians over to our side. It won't be easy, given the array of forces that will oppose it. But political outcomes are never determined only by the wishes of powerful elites. And some of the elites (e.g., businesses outside the health insurance and pharmaceutical industries) could potentially be moved by a determined popular movement and by the unwillingness of their employees to accept the growing restrictions and cutbacks on coverage that are generally the preferred response of business. Building a powerful movement will require a creative combination of activism and education about how the public can start to make their government respond to the needs of ordinary people. It will be a challenge, but the only alternative to a single-payer system is to consign the people of our country to a more and more brutal health care system. The single-payer movement not only can win a humane health care system but also can contribute, in the words of Michael Moore, to making the United States more of a "we" society than a "me" society, one in which the individual and the society can truly flourish.
_______________ Note: Joanne Landy, MPH, MA, is the former executive director of the New York Metro Chapter of Physicians for a National Health Program. Oliver Fein, MD, is a practicing general internist, Professor of Clinical Medicine and Public Health, and Associate Dean at the Weill Cornell Medical College.
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