Posted on August 4, 2009

We need a single payer


By Laura McClure
The Daily Star (Oneonta, NY)
Published: August 01, 2009

People in our area, and across the country, desperately need health-care reform. If the reforms President Obama is urging pass Congress, many uninsured people will get access to some kind of insurance, and that could be a great thing for them. But it’s hard to exaggerate what a hash Congress and Obama have made of fixing our famously dysfunctional health-care system.

What we need is a single federal insurance plan that covers everyone from birth to death. An improved version of Medicare that stays with you no matter where you work — and once you’ve retired. We’d have complete choice of doctors and the full range of private and public hospitals to choose from.

What we wouldn’t have is 1,200 private insurance companies feeding off our need for health care — forcing hospitals and doctors to hire paper-pushers instead of people who actually provide care. Almost a third of the money we spend on health care in the U.S. can be attributed to insurance industry-generated waste.

One of the great virtues of such a “single-payer” system is that it would actually be cheaper than what we have now — and way cheaper than the trillion-dollar plan our politicians are now cooking up. Every industrialized country with a version of single-payer spends about half what we do — or less — for health care, and they have better health outcomes and more satisfied citizens.

Obama knows this. He used to be a vocal supporter of single-payer health care. He still says it would be the best system if we were starting from scratch. Instead, we’re starting with an antiquated employment-based system, a cobbled together mishmash of private and public health plans.

The sheer bureaucracy of it is driving us all insane. Yet now we’re thinking we should shovel a trillion more into this system to prop it up for awhile.

This is a staggering failure of political leadership. What are the politicians so afraid of? Well, the insurance industry. Republicans and Democrats, including Obama (big-time), were elected in part through the massive support of the insurance companies and other corporate interests with a stake in our current system. The guy who is ferrying legislation through the Senate to finance health-care reform, Max Baucus of Montana, a Democrat, is swimming in a sea of health industry money.

But I think it’s more than just money. It’s timidity — fear of real change. And that’s not just a problem politicians have. We’ve all got it. We get locked into our mind-sets and can’t get out.

Republicans tend to be imprisoned by their idea that government can’t do anything right and that all it does it waste money. Dear Republicans: If you are concerned about fiscal responsibility, please examine single-payer health care. It’s a bargain — and it’s the only way to cover everyone well without spending more money.

Republicans and some Democrats are also stuck on the idea that “competition” is always good.

They hope that competition _ including between private insurance companies and a public insurance plan — will save us money. Hmm. Don’t we already have plenty of insurance company competition — and a health-care system that costs way more than any other on the planet?

As for private-public competition, we’ve got that in the Medicare Advantage program, which allows private companies to pick off some Medicare recipients. This has caused the cost of Medicare to spiral up. Two international agencies _ the World Health Organization and the Organization for Economic Cooperation and Development — did studies of what happened when different countries tried introducing private competition into their health care systems with the aim of reducing cost. Both studies found that it increased costs and decreased the level of fairness in the system.

But there’s a larger philosophical problem here, Republicans. (I’ll get to Democrats soon!) Imagine someone is breaking into your house. You flip desperately through the yellow pages for private cops who will accept your crime insurance plan. You call seven of them. Unfortunately, they’ve all got data on you, and it turns out you were recently laid off from your job and aren’t that great a prospect. So only one private cop shows up (way too late), and makes a bid to provide some law enforcement — for a huge sum you can’t afford.

Thank goodness for our publicly funded, universal police force! There’s only one number to call, and the service is free at point of use. Yes, we pay taxes to support our cops. But we’re glad to, because they help keep us safe. Everyone’s covered. And nobody is making a calculation about whether you “deserve” police protection or not.

So what’s so different about a medical crisis? Instead of someone breaking into your house, you’ve got cancer or heart disease stalking you. You need care. You don’t need bills, deductibles, co-pays, or competing private companies angling for your money — or worse, denying you care.

But Republicans aren’t the only ones locked inside an ideological box. Many Democrats have the idea that any amount of money is okay to spend on “human needs.” We just need to swallow that bitter trillion-dollar pill in the interests of health care for all.

But this is one case where spending more money is not the answer. We need to spend less money — or at least no more than we are right now. The average family health care premium has jumped to almost $13,000. How much higher can it go? Health care is literally eating up the budget on the national level as well: The U.S. now spends 16 percent of its GDP on health care — compared to, say, less than 6 percent for education. By comparison, Canada spends 10 percent. Taiwan, which adopted a single-payer system in 1995 after a lot of shopping around, spends 6 percent of GDP on health care and has better health outcomes than we do. I wish we were that smart!

We’ve got to ask where all our money will be going. The current health-care proposals will use our tax dollars to help people buy private health insurance. This may increase the number of people who are considered “insured,” but it will also increase exponentially the profits and paper-pushing of insurance companies — which is why the insurance industry largely supports this reform. Providing more money for this system is like continually putting change in a pocket with a hole.

Another question we have to ask: Who suffers most from continually spiraling health-care costs? Even if the plan is partly financed through a tax on the very rich (which I’d be for), the real victims of rising costs will be poor and working class people. Just look at the state of Massachusetts, which passed a health reform bill not unlike the ones Congress is now considering. More people now have some kind of insurance coverage, but the plan is busting the budget.

The state has had to cut social services and ramped up premiums and co-pays for the health plan. The out-of pocket costs are so high, many of the newly “insured” can’t afford to go to the doctor or get their prescriptions filled. In a 2009 survey, 44 percent of low-income residents said they were hurt by the plan; 33 percent said they were helped. (Question: Are you “insured” if you don’t get that lump in your breast checked out because you just can’t swing the $1,000 deductible?)

Obama and others maintain that their reform plans will lower costs through things like computerized record-keeping and moving away from a fee-for-service approach. These are good ideas, but there’s little evidence they will save money any time soon. And unfortunately trying to implement any rational money-saving plan under our current system is like herding cats. There are so many players, many of whom are in it for themselves, and no one has sufficient clout to enforce the rules. Under a single-payer plan, money-saving reforms would be a lot easier to implement and ultimately more effective.

Some people — both Democrats and Republicans — just can’t fathom a reform that would involve eliminating an entire industry, namely the health insurance industry. What would happen to all those workers?

It’s a good question, and one that has been raised by Obama and many others, including local Rep. Michael Arcuri. Any Medicare-for-All program we enact needs to include a major transition plan for workers in this industry. The bill I support, HR 676, would give displaced insurance workers first dibs on jobs in the new health-care system and two years of unemployment benefits if they don’t find one. (Note: Even a more generous transition plan would be a drop in the bucket compared to the costs the insurance industry now imposes on us all.)

But is that really what our fear of true reform comes down to? An insistence on a jobs program for health insurance industry workers? Personally, I would support a major jobs program. But I’d want the jobs to be useful ones. And though I’m sure most insurance company employees are good people who do the best job they can, their role in our health-care system is to help their company make a profit off people’s desperate need for medical care. And we just can’t have that. We can’t afford it, and it’s wrong.

Whether the current health-care reform plans pass or fail, when it’s all over, we’re still going to have a big health-care mess on our hands. Someday we’re going to have to summon up all our courage and go for the real thing.

Laura McClure is a member of the Healthcare Work Group of the Coalition for Democracy of Central New York.