Expanding healthcare, cutting costs
By Rep. Dennis Kucinich (D-Ohio)
The Hill
Posted: 07/15/08 05:38 PM [ET]
Every child has an inherent right to healthcare. Without access to a structured system of healthcare, children are burdened with social, educational, financial and personal health disadvantages. Lack of access is directly connected to lack of insurance. Over 9 million children were uninsured in 2006 and their ranks are growing. Sixty-nine percent of the increase in uninsured children was from families whose income was more than 200 percent of the federal poverty level, which means they were unlikely to be covered by SCHIP or Medicaid. Most were from the middle class.
Data on underinsured children are scarcer but underinsured adults have increased by 20 million since 2000, to 51 million. Besides the obvious health problems that stem from being denied care, underinsurance is a responsible for families entering and staying in poverty. Roughly half of all bankruptcies in the U.S. are related to medical bills. Of those medical bankruptcies, over three-quarters had insurance before they got sick. Having insurance is not the same thing as being “covered” in the event of a serious illness.
In fact, as long as insurance companies make money by denying care, there will be underinsurance. Insurance companies further drive up costs by fragmenting risk pools, selling plans to the profitable healthy while abandoning the unhealthy and unprofitable to be covered by government plans. It takes enormous redundancy and bureaucracy to deny care and drive up costs. No other industrialized nation has administrative costs that approach that level.
When you consider that Americans pay about twice as much or more per capita for healthcare costs and that a third of the healthcare dollar goes to administrative activities you become aware that our system is really about insurance care more than healthcare. It is a racket benefiting a few insurance companies at the expense of the health of the American people, particularly our children.
Most major legislative fixes under consideration are incremental or fail to address the insurance industry problem. This may be because the insurance companies have great influence with both political parties. It also may be because private insurers wield so much clout on Wall Street.
Take SCHIP as an example. It rightly prioritizes the poor, but leaves out most of the middle class.
Covering kids is not enough. Covering parents maximizes the chances a child will get care. Tax breaks for individual insurance plans help the wealthy and subsidize a financially unsustainable healthcare model. Even a minimum of expansion of healthcare to children must strive to increase quality and lower costs.
It is time to let doctors return to the practice of medicine instead of having to fight with insurance companies. When Taiwan decided to overhaul its healthcare system, it chose a model that put the health of the Taiwanese people above the profits of insurance companies. Canada has had great success with their system even though underfunding by conservatives caused an increase in wait times for non-urgent care. If the U.S. also made that transition, studies have repeatedly shown that we would save at least $400 billion per year while guaranteeing all medically necessary healthcare to everyone. We now spend $2.1 trillion.
H.R. 676 embodies such a plan. Everyone in the U.S. would get a card that would allow access to any doctor at virtually any hospital. It saves money by dramatically lowering administrative costs, putting everyone in the same risk pool, and removing the perverse profit-seeking motive from healthcare. It would provide for a single high-quality standard of care that would replace the highly inequitable and regressive system that reserves the best healthcare for those who can pay.
It can be done without spending another dime beyond current levels. In other words, we’re already paying for high-quality, guaranteed healthcare; we’re just not getting it.
Independent healthcare experts will usually admit in hushed tones that a model for doctor- and patient-run healthcare like H.R. 676 is by far the best way to go. Then they shrug their shoulders as they echo the myth that it could never pass for political reasons. After all, the health insurance industry donates heavily to Democrats and Republicans in Washington.
The reality is that there has been a major groundswell of support. No other healthcare reform bill before Congress has more cosponsors, now at 91. A 2008 poll published in the Annals of Internal Medicine showed that 59 percent of all doctors and over 70 percent of pediatric subspecialties support a plan like H.R. 676. So do the American College of Physicians, deans of major medical schools, former editors of the New England Journal of Medicine, and former surgeons general.
They are joined by groups like the Presbyterian Church USA, the U.S. Conference of Mayors, state legislatures in Kentucky and New Hampshire, the AFL-CIO and SEIU. Finally, thousands of advocates all over the country represent the American people whose support for a plan like H.R. 676 is consistently greater than 50 percent.
It is not easy to stand up to the insurance industry but I have confidence that my colleagues can do it. I look forward to working with them to accelerate the momentum behind the bill until all children, and their parents, get the care they deserve and need.
Kucinich is a member of the House Education and Labor Committee.