In Reforming Health Care, the time is NOW

As the effort to reform our nation’s health care system intensifies, certain Republican leaders, industry front-groups and lobbyists are engaged in a last-ditch effort to frame the debate in an ideological way meant to distort the facts and strike fear into the hearts of Americans.
First is the lie that President Obama and the Democratic Party are proposing a sweeping overhaul of our medical infrastructure with the goal of micro-managing every element of your health care. Not five minutes after the President concluded a town hall meeting on the topic in Green Bay, during which he repeatedly and explicitly said that his proposed reforms would not change anything for people who had insurance and were satisfied with it, Republican leaders held press conferences stating that they were ‘absolutely opposed to government-run health care.’
Were they not listening? Or were they hoping that the American people were not listening? President Obama and others working towards a viable plan have taken great pains to reiterate their intentions. The government is not going to tell us which doctor to see or what tests we can have. But need I point out that our insurance companies already do this? The very development that Americans profess to fear most – the intrusion of an entity between the patient and the doctor- is already the status quo. This is precisely how managed care and insurance operate – by creating lists of doctors, procedures and medications that will and will not be covered.
The second series of lies are really myths about the quality of care Americans receive now versus what they will receive with a public single-payer plan option. A pamphlet I received from my health insurance provider makes the following assertions: the employer-based system will be destroyed, premiums will skyrocket, private insurance will be only for the wealthy, and there will be reduced innovation.
Hold on just one second. Aren’t all of those things happening NOW? Already? This is exactly the reason that we need health care reform!
The employer-based system is crumbling because small firms can’t afford to purchase it for their employees; a growing number of employees find the individual premiums prohibitively expensive; and because large corporations are continually downsizing their health insurance options and off-loading larger percentages of the premiums onto employees as a way to cut costs and raise stock prices.
Premiums themselves are certainly skyrocketing: just for the pleasure of being insured, we pay over $4000 per year for two healthy individuals. But who am I to complain? According to the National Coalition on Health Care, “in 2008, employer health insurance premiums increased by 5.0 percent – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,700.” (The Coalition took its statistics from the Henry J. Kaiser Family Foundation report on Employee Health Benefits: 2008 Survey published in September 2008). That same report notes that “since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period.”
Who was raising these premiums? It certainly wasn’t the government, because we don’t have socialized medicine in this country.
As for private insurance being only for the wealthy, this trend is already well-underway. As stated above, increasing numbers of middle-class people simply cannot afford to pay the premiums. A parallel problem is the fact that many lower-paying jobs simply do not offer health benefits at all. Many service jobs operate on an unofficial, cash basis, but even when the work is performed on the books it tends to be at small companies that cannot afford to offer health insurance. The situation is no better at larger retailers and even local government jobs because of the prevailing policy of hiring everyone at just-below fulltime –ensuring that few employees qualify for benefits even if that firm technically offers them.
46 million Americans – some 15% of the population – have no insurance. While a few of them may be wealthy individuals who either believe themselves to be invincible or able to pay for catastrophic illness, I would hazard a guess that at least 45 million of them would like to be covered, were it available and affordable.
Of course, the real inconvenient truth is that private insurance, while highly desired, is hardly a safety net at the moment. As a recent article on research reported in the American Journal of Medicine points out, medical bills were a factor in 60% of US personal bankruptcies, up 50% from six years ago. More than 75% of those families had medical insurance – plus they were well-educated, owned homes and were in professional occupations. Yet even with insurance, medical expenses in 92% of the cases exceeded 10% of their income.
Even more appalling is the pervasive practice of dropping patients from their insurance. "Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year,” quotes from the same article. Harvard's Dr. David Himmelstein adds grimly, “Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy… For middle-class Americans, health insurance offers little protection.”
And what of that threat of reduced innovation? Well this is already happening as well. In fields with huge financial incentives, such as coronary and neurological procedures, there have been huge gains. But in fields without a strong lobby or financial incentive – children’s health care, cancer, orphan diseases and preventative medicine – there is a lengthy backlog of promising research that dies in the laboratory test tubes for lack of adequate funding.
The greatest lie of all is the one underlying this debate: the notion that the best way to operate a national health care system is through the market. The market exists to make money, and people who are well do not make money for a medical industry that bills per procedure.
Yet the corollary to this truth is that national health care makes good sense for capitalism and for that American Dream we all seek. Our companies are put at a real disadvantage when they are forced to pay for rising premiums compared to manufacturers and firms overseas. This creates a perverse incentive to off-shore these jobs and also keeps real wages from rising – after all, what company is going to raise your salary when it is already paying that much again for your health insurance? Our current system is a terrible disincentive for entrepreneurism – that combination of innovation and elbow grease that we collectively believe built this nation – because it corrupts the risk/benefit analysis by making it incredibly reckless for anyone other than the very wealthy to set out on their own and develop a new product or a revolutionary work of art. It further makes very little sense in today’s mobile society – one in which individual workers are likely to be laid off and retrain for new jobs throughout their lifetime- for health insurance to be tied to employment. The new reality is one in which most of us will experience an ebb and flow in employment: family changes, chronic illness, periods of renewed education, and of course lay-offs. That is why health insurance must remain constant, and why any viable public plan must be created at the federal level.
According to The Nation magazine, “the healthcare industry tops the list for spending on lobbying in 2009, reporting about 127 million in expenditures for the first three months alone. The lobby’s (campaign) Conservatives for Patients’ Rights vows to spend $20 million to scare Americans about Obama’s reforms.” That sounds like an awful lot of extra money they have to spend – money coming directly from our monthly premiums. When an industry is willing to sacrifice so much to preserve the status quo – one that is doing untold harm to growing millions of Americans- we know it’s time for reform.

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