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NAVIGATION PNHP RESOURCES
Posted on July 15, 2009

Patients are losing patience

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The flawed reforms on offer will not satisfy an American public demanding bold changes in US healthcare provision

Rose Ann DeMoro
The Guardian
Thursday 9 July 2009

With Barack Obama in the White House, large Democratic majorities in Congress, and a relentless focus in Washington on healthcare, this could have been the year the US finally joined the community of nations which guarantee healthcare for all their people.

But despite the alignment of these political stars, the escalating financial meltdown of the US healthcare system, and numerous polls showing overwhelming public support for systemic change, it looks like the opportunity could be lost again.

To be sure, something should be signed: “We’re going to make it happen this year,” President Obama repeated in a town hall meeting on 1 July. But at the price of accommodating conservatives in Congress, corporate interests, and the healthcare industry, Obama and the Democrats are poised to leave the private insurance system, largely responsible for the present crisis, entrenched in place.

Unlike many of his predecessors, President Obama has even praised the national health care systems that are second nature to citizens of the UK and other industrialised countries.

But, although Obama a few years ago described himself as an advocate of a “single payer” option — a system like Medicare in which the government pays all the bills but care remains delivered by mostly private doctors, hospitals, and clinics — now he and Congress have slammed the door on considering that approach.

When pressed by leading groups of nurses, doctors and thousands of grassroots activists who have campaigned for single payer, the president says, as he did again on 1 July, that it would be “hugely disruptive,” and that “we should … find a way to create a uniquely American solution to this problem.”

Of course, the US already has a “uniquely American” system — the reason for the disgraceful World Health Organization standings that place the US down in 37th place in its overall rankings, and an embarrassing 54th in healthcare “fairness”, barely edging out the impoverished African nations of Chad and Rwanda, but still behind Bangladesh.

While those other countries have a variety of approaches, the US has the distinction of being “the only nation on earth that barters human life for money,” as Geri Jenkins, RN, co-president of the nation’s largest nurses’ union, the California Nurses Association/National Nurses Organizing Committee, put it in recent testimony to Congress.

A system in which mostly for-profit insurance companies can dictate what coverage people get, deny medical care even when recommended by the patient’s doctor, and charge as much as they want.

The upshot is some 45 million people uninsured, 20,000 deaths annually due to lack of coverage, medical bills accounting for 62% of bankruptcies, half of all Americans skipping doctors visits or immunisations for their children because of high out-of-pocket costs, and a system less fair than Bangladesh.

Tragically, the basic structure behind these grim numbers will probably be preserved by the bill expected to emerge from Congress.

After considerable concessions to the healthcare industry and other corporate powers who dominate the legislative system through campaign contributions and other influence peddling, the principle terms will presumably include:

— a mandate on everyone now uninsured to buy private insurance or face financial penalties;

— public subsidies for those on low and moderate incomes to buy that insurance, amounting to a pass-through, or massive public bailout, to an insurance industry whose 18 largest companies recorded over $44bn in profits over the past three years;

— requirements that insurers finally agree to sell policies to people who have been ill in the past or are considered candidates for future health problems (a circumstance that would bewilder people in other countries);

— and, possibly, a public plan alternative for some, though fierce opposition from the insurers and Republicans makes this provision likely to be substantially eroded or eliminated.

Missing from this picture are serious cost controls that limit what insurers can charge — premiums alone have gone up four times faster than personal incomes in the US the past decade — and any expectation that private insurers will approve care decisions they now routinely deny because they don’t want to pay for them.

The public option has been touted by some progressives as a stalking horse for single payer, and by the president as the vehicle to “discipline” the private insurers to compete fairly. But those insurers have well-developed means to cherry-pick healthy patients, leaving the sick to what is likely to be an underfunded public plan that, like many public systems in the US today, would soon face daunting choices of cutting access and services.

How brilliantly pragmatic the left has become, many willing to settle for a flawed reform and unwilling to challenge the fundamental right of corporations to control our health.

But not nurses. They see the reality of the insurance-based system clearly and experience it painfully. And, like many single-payer activists, they worry that the new bill will fail to meet the president’s own stated goals of universality, control of rising medical costs, and improving the quality of care — and so waste much of the goodwill and public trust his historic election has created.