It's Time for a Real Debate on National Health Insurance
Editor’s note: This article from May, 1993 is important because it includes a quote from pollster Celinda Lake saying the more working Americans learn about the Canadian (single payer) system, “the higher the support goes.” In contrast, a proposal for a system based on competing private insurers was found “laughable.”
Public Health
by Jeff Cohen and Norman Solomon
May 12,1993
Page 78
When a coalition of groups concerned about health care held a loud public protest in midtown Manhattan on May 12 [1993], they didn’t set up their picket line outside a hospital or W insurance company headquarters or government agency.
Instead, they gathered in front of the New York Times building, and their demand was simple: “Stop rationing health care news!” The protesters are angry over the fact that the newspaper’s reporting routinely downplays a popular proposal-endorsed by 12 of New York City’s 14 members of Congress-to overhaul the American health system: a singlepayer system of publicly-financed health care.
Poll after poll has shown that most Americans favor tax-financed national health insurance. But at the New York Times and other national media, proponents are kept at the periphery of the health care debate. They include 58 members of Congress who, on March 3 [1993], introduced a bill-”The American Health Security Act”-to establish a Canadian-style, single-payer system.
In a single-payer system, private insurance companies are basically removed from health care. Instead, the government pays all health care providers, and controls fees and costs. As in Canada, consumers would choose their own doctors-but almost never receive a hospital or doctor bill. Insurance deductibles and co-payments are also eliminated.
By eliminating administrative waste and insurance company profits, the shift to a single-payer system would cut $67 billion per year from our country’s medical bill, according to the General Accounting Office-and $39 billion yearly in bureaucracy, according to the Congressional Budget Office. Of every health-care dollar spent in the U.S., 22 cents goes to administrators; in Canada, that figure is 10 cents.
A single-payer system has been endorsed by health care activists, seniors groups, labor unions and a number of regional dailies-including the Atlanta Journal-Constitution and St. Louis Post-Dispatch. A recent Times-Mirror poll found 41 percent of U.S. doctors in support.
After conducting extensive focus groups on health care, pollster Celinda Lake discovered that the more people are told about the Canadian system, “the higher the support goes.” In contrast, according to Lake, working Americans found the managed competition idea “laughable.”
But much of the national news coverage in recent weeks has been promoting Bill Clinton’s managed competition plan as the smart, new, “politically viable” option.
News reports trumpet the “consensus” behind managed competition: big insurance companies, most doctors, conservative Republican think tanks, George Bush, conservative Democratic think tanks, Hillary Rodham Clinton-and the wise men from the “Jackson Hole Group” who’ve been meeting in Wyoming for years to discuss “health care reform.”
In national media discourse, managed competition seems easier to tout than explain. Since no other country has ever tried such a system, it remains a complicated, untested theory.
The plan leaves the largest insurance companies in the center of the picture; after the federal government defines a minimum package of benefits, health care partnerships or superHMOs organized by insurance firms would “compete” to offer health packages. Meanwhile, giant “Health Insurance Purchasing Cooperatives” would be formed so that employers and consumers could search for the best deal. Between these behemoths would be the government, “managing the competition,” grading the medical providers and trying to restrain costs.
To the protesters outside the New York Times headquarters, the news tilt toward managed competition is explained by the clout of insurance companies and medical industry firms- which are major media advertisers. And, as it happens, four members of the New York Times board of directors are also directors of major insurance companies; two are directors of pharmaceutical companies.
While it’s far-fetched to hunt for a conspiracy, the imprint of the insurance industry is all over the managed competition idea. The Jackson Hole study group that originated the scheme is made up of big insurance companies like Prudential, Metropolitan Life, Aetna and Cigna, plus hospital and pharmaceutical interests. Insurers were important early contributors to Clinton’s presidential campaign, and donated $850,000 to the Democratic Party (and even more to the Republicans) for the 1992 elections.
Critics dismiss managed competition as a bureaucratic hoax that should be renamed the “Insurance Industry Preservation Act.” They warn that the freedom to choose one’s own doctor would be eroded. They say it’s absurd to leave “reform” to the Jackson Hole group of special interests who profit from the inefficient status quo.
Managed competition was the subject of a lengthy MacNeil-Lehrer NewsHour discussion on May 5 [1993]. The panel was made up of three government officials-a congressman, a governor and a state health commissioner-who said the Clinton approach would lower costs, and a fourth panelist, Dr. Steffie Woolhandler, who argued it would increase costs and bureaucracy. (Woolhandler founded Physicians for a National Health Program, representing thousands of doctors who support a single-payer system.)
Near the end of the discussion, anchor Robert MacNeil offered Woolhandler the last word “since you’re in the minority”-to which she responded: “Robert, I’m not in a minority. Polls are showing two-thirds of the American people support government-funded national health insurance.”
MacNeil then rephrased his question: “If this [managed competition] is the program that has a political consensus and the other one that you advocate [single-payer] is considered impossible politically at the moment, why are you then against the one that is viable?”
Because it won’t “provide Americans with the care they need,” the doctor replied.
But she could have offered another response: If much of the public supports national health insurance, and it’s not debated seriously in Washington or the national media because of the power of special interests like the insurance lobby, what does that say about the health of our democracy?
That is an issue journalists should be exploring.