Occupy Health Care? Will 'Medicare for all' catch fire?

Maybe 'Medicare for All' can catch fire as a populist slogan

By James Hill and Samuel Levey
Iowa City Press-Citizen, March 22, 2012

Even as voices from the Occupy Wall Street movement have faded in recent months, the conversations they started continue. Wall Street greed, corporate recklessness and growing economic inequality are still in the news and still being talked about — along with other grievances caught up in the movement’s wide net.

Problems in the health care sector are among them; many can be found posted on websites along with demands for change, often under a banner of “Occupy Health Care.”

No doubt the U.S. health care system is a worthy offender and deserves such attention. Consider the massive out-of-control spending ($2.6 trillion in 2010, more than 16 percent of GDP), the glaring inefficiencies, the stubbornly high number of medical errors and the persistent waste, fraud and abuse.

Of these, the offense that ought to merit a storm of protest is the ever-climbing cost of health care. In 2011, the national bill for health care increased by 4.5 percent, health insurance premiums rose by 9 percent, and the average cost of employer-provided coverage for a family exceeded $15,000. Today costs continue on an upward spiral of national spending.

Some supporters of President Obama’s Affordable Care Act of 2010 believe the legislation will be able to “bend the curve” of spending when fully implemented, as it is intended to do, by reducing costs over the long term.

And it’s true that restructuring the delivery of health care could have a notable effect on cost. As economist David Cutler notes, “The potential savings from delivery system reform are enormous. ... (Given enough time,) 30 percent of annual medical spending — nearly $2,300 per person — could be eliminated without any adverse health consequence.”

But much skepticism remains. Many strong supporters of health care reform who rallied behind Obama’s early efforts now doubt the ACA will halt the inexorable rise in health care cost.

Former New England Journal of Medicine editor Arnold Relman asks, “If neither party is proposing effective solutions to the cost crisis and political deadlock in Washington is preventing the consideration of new ideas, are we doomed to witness a slowly collapsing health care system that eventually will provide adequate care only to those who can afford to pay?”

Other critics take a similarly dim view of the Affordable Care Act’s prospects for cost control. For physicians Steffie Woolhandler and David Himmelstein, the blame is not in political gridlock but the enormous influence of corporations, from health insurers to pharmaceutical companies, in the making of American health care policy.

As long as health care is run as a bottom-line business with financial incentives driving it, they argue, the overtreatment of patients and rising administrative overhead will continue, pushing up overall costs.

While Relman finds encouraging possibilities for cost-control in the trend toward multispecialty group practices and salaried physicians, he remains a firm believer in the superior virtues of the program Congress once again failed to pass: comprehensive national health insurance.

Like Woolhandler and Himmelstein, Relman favors universal coverage under a single-payer, taxpayer-supported public system. Under this system, advocates argue, the bedeviling problems of patient overtreatment and excessive administrative costs can be brought under control via prepaid comprehensive care while health care insurance is extended to all Americans — features not possible under the act.

The response of such single-payer stalwarts to the achievement of Affordable Care Act is tepid support at best. And in the minds of many liberal reform advocates, the act is inadequate health care legislation, not something to celebrate and feel good about.

Perhaps that dissatisfaction is now working its way into a new health care rhetoric that appears to align itself somewhat with the rhetoric of the Occupy movement. Starr, himself an admitted “strong reformer,” describes the ideological/class lines on which health care in American has been fought over its history, then wonders if the “special interests were arrayed on one side and the suffering masses on the other, the conflict would fit easily into a familiar populist picture of the world.”

A populist picture is perhaps what Woolhandler and Himmelstein have in mind. America is now divided on the issue of health care financing, they argue, and “while the American people want an expanded and improved Medicare for All — that is a single-payer system — corporations dead set against single-payer reform have come to dictate the agendas of both political parties. Hence, the only way to win national health insurance is to build a popular movement to counter corporate power.”

If “Medicare for All” can catch fire as a populist slogan, just as “Occupy Wall Street” did in 2011, under the force of widening economic and political divisions, perhaps a full-blown Occupy Health Care movement will emerge.

For that to happen, however — for reformers to have more than a scattering of websites to show for their efforts — the movement will need something more to move it forward: a visible groundswell of discontent.

Jim Hill is a writer who lives in Coralville. Samuel Levey is a professor in the Department of Health Management and Policy in the University of Iowa College of Public Health.|head