Posted on January 10, 2007

We can afford to go for the gold: universal health care


The money is already in the system — let’s just do it!

Guest Columnist
Houston Chronicle

Advocates for children and elected officials are meeting this week in more than 35 cities nationwide with the admirable goal of increasing children’s health insurance coverage.

Unfortunately, the centerpiece of their discussions — the state programs for low-income children (S-CHIP and Medicaid) — offers little hope of universal care for children.

As a physician, I know that the best way to provide comprehensive, universal care to children is to provide it to all Texans: through a single-payer “Medicare for All” system for the state.

Because I am a pediatrician who faces the reality of our state’s health crisis day in and day out, I know intimately the futility of such band-aid programs. The advocates who fight to maintain and defend them do great work to promote child well being: I benefit from their efforts every day. But despite good intentions, the efforts of incremental health system reformers have failed to herald meaningful steps toward universal coverage — either for children or for our nation as a whole — because they do not address the reason so many Texans are uninsured in the first place: skyrocketing health care costs. Even S-CHIP, the largest coverage expansion in a generation, made only a small dent in the number of uninsured children because the government program could not keep up with eroding private coverage. Although 5 million children have been added since 1997, the number of uninsured children still stands at 9 million.

Even if every uninsured child in Texas eligible for CHIP or Medicaid were to be covered, half of the 1.4 million uninsured children would remain uninsured. More than 5 million Texans would still lack health insurance. Expansion of public programs would do nothing to curb costs of premiums for small-business owners in Texas, who have seen increases up to 75 percent in the past three years. Focusing on expanding current programs deludes us into thinking we are fixing the problem of the uninsured. In reality, it does little more than entrench us further in a failed, expensive, unjust health care system.

There is an alternative. Our current system allowing private insurers to cover the healthy and profitable while screening out everyone else allows one-third of our health spending to be diverted to needless bureaucracy and paperwork. Eliminating the private insurance companies and replacing them with a single public payer would save more than $350 billion per year, enough to provide coverage for all of the uninsured. Combined with what we’re already paying for health care, this is sufficient to provide comprehensive coverage to everyone without any additional spending.

I know what you’re thinking: Why reach for the “pie in the sky” when we actually have a chance with children? (Forget the fact that we’ve had this chance for years.) The answer is that S-CHIP and Medicaid don’t give us a chance to provide good coverage to children. They buy us an expensive and inadequate band-aid. And as long as we allow for-profit insurance companies, it will keep falling off like tape in water.

I propose that child advocates at this week’s town hall meetings stop supporting changes that are guaranteed to fail. I propose that we stop thinking of universal health care as “pie in the sky,” as institutional forces once called the abolition of slavery, women’s right to vote and the Civil Rights Act. We can have whatever kind of health care system we want. We don’t need to spend more money, we already spend enough. We don’t need to sacrifice quality or ration care any more than we do now.

Texans — and all Americans — want a health care system that is affordable, accountable, accessible, comprehensive, universal and just. We have many examples: Medicare, the Veterans Administration, the rest of the industrialized world. The only lasting, affordable, feasible solution to our health care crisis is national health insurance — an expanded and improved Medicare for All, which continues to be publicly financed and privately delivered.

Child advocates this week and our new state and federal legislators should stop looking for piecemeal solutions and instead support a system where everyone pays into it equitably and every one takes out according to medical need; a health care system that excludes no one and is accountable to the people it serves; a health care system that is comprehensive and just, because that is what we as Americans, young and old alike, deserve.

Malinow, a pediatrician at Ben Taub General Hospital, is president of Physicians for a National Health Program. The Houston town meeting will be held from 9:30 a.m. to noon Thursday at Texas Children’s Hospital’s Feigin Center.