Updated: Oct. 26, 2009
Well, not in the USA. Sometime in the near future, Congress will pass and the President will sign something called “health care reform”. In order to gain enough votes from those opposed to Comprehensive Affordable Universal Health Care (CAUHC) for passage by both chambers of Congress, the resulting bill will merely serve to make the appearance that Congress is serious about health care reform. That’s the best case scenario; the worst is an extraordinary amount of money will be spent, but we’ll fail to solve ANY of our health care problems. Any watered-down reform plan that does not create a more competitive environment and fundamentally reshape the health care system, is doomed to fail.
What kind of country gives tax breaks to those with jobs who have employer-provided health insurance, while leaving millions of poor, unemployed and underemployed without health insurance of any kind?
To answer that we look at the roadblocks to health care reform:
1. Big Food – Not matter how hard we try to reform health care, it is doomed in a culture where the food industry has relentlessly promoted overeating, while providing fast food that is of little or no nutritional value. I will not take the space here to go into detail; Michael Pollan has written a fine editorial in the Sept. 10 issue of the New York Times (“Big Food vs. Big Insurance”). I offer one quote from Mr. Pollan’s article: “Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.” Think about that, then go see the fine movie (or read the book), “Food, Inc.” There are many other resources at your bookstore or library including Michael Pollan’s book “In Defense of Food: An Eater’s Manifesto.” Suffice it to say, if we cannot bring obesity under control, health care costs will rise regardless of reform efforts.
2. Big Pharma – The pharmaceutical drug companies have contributed the most to the runaway costs of health care. This industry has unprecedented wealth, power and influence. They created and got put into law the Medicare Prescription Plan Part D, which has been a cruel joke on senior citizens. It accomplished little other than creating complicated plans that seniors can’t comprehend and legislated guarantees that prices cannot be negotiated. Americans pay many times more for the exact same drugs sold elsewhere in the world, no matter how one measures costs. Big Pharma’s miracle drugs may provide benefit to those fortunate enough to afford them, but also cause many thousands of deaths and injuries because of marketing for inappropriate patients, dosages and unapproved treatments, concealing negative side effects and inadequate testing. They have successfully suppressed or blocked the sale of affordable generic versions of their drugs. In some cases, generic drugs have become successful in the market place and Big Pharma has stepped in to block further sales by manipulating patent laws to eliminate competition.
3. Doctors – Doctors practice in a health care system that rewards providing more procedures. There is no incentive for keeping patients healthy, and plenty of incentive for treating patients. Additionally, the US is experiencing a growing shortage of general practice doctors and nurses. In the US system of unregulated health care costs and fees for services, physicians can earn huge incomes in specialty practices, while general practice doctors are overwhelmed with patients either unable to pay, or utilizing insurance plans whose profits are based on high premiums and low payments for routine health care. Single payor’s single greatest benefit is the dramatic reduction of health care billing and insurance processing resulting from changing the financial model. This would ultimately result in lower salaries for some health care professionals, to be sure, but many more will benefit from leveling the playing field. The so-called government option would offer a compromise solution, but, no matter; no reform will pass creating a single payor system or even a “government sponsored” option.
4. Health Care Providers – Short-sighted hospitals, clinics and other health care facilities are afraid their profits will suffer. They also benefit from our fee for services system where unnecessary treatment is seen as additional income. They fail to understand the efficiencies of the single-payor option, removing patient finances from the environment. An enormous portion of our health care costs are the result of processing patient health care billing and insurance. The current direction of health care and insurance in this country guarantees that providers will be burdened with more and more patients unable to pay for their services. What is wrong with a health care system where the wealthy from other countries come here for treatment, and Americans with modest means go to third world countries to get health care treatment by US trained doctors … for a fraction of the cost here!
5. Health Insurance Companies – While squealing like stuck pigs that they are getting squeezed by high costs and low premiums, health insurance companies are highly profitable businesses-just ask any financial adviser. They claim that the government plan will unfairly compete while at the same time insisting such a plan will be inefficient. They claim that insurance companies subsidize Medicare insurance because Medicare pays discounted fees (NPR interview with Wellpoint spokesman 7-15-09). Yet insurance companies also negotiate discounted fees, so in reality, it is those unfortunate millions without health insurance able to pay the full fee who subsidize the insured and those unable to pay.
6. Politics & Fear – Even under intense pressure, it is clear that few in the US Congress are comfortable with taking on any of the entities above in an attempt to bring health care costs under control. Politicians of all parties and public office talk health reform but fear the power these entities possess. The Republican Party is kicking off the 2010 Congressional campaign, aggressively defending the interests of Big Business and their wealthy base by opposing health care reform. In a no holds barred blitz, they are saturating the media space with misinformation, lies and half-truths. The extent and depth of the lies health care reform opponents are spreading are almost beyond belief. Nothing in the proposed health care reform will (a) force seniors to have end of life counseling, or establish “death panels”, (b) ration or deny health care for seniors (or any other group), (c) establish government-run, socialist or single-payor health care, (d) cut off health care after some set dollar limit, (e) result in a government takeover of health care, and a litany of other false claims. Nonetheless, health care reform opponents and their polito-terrorists are relentlessly leveraging the most potent tool any political faction has ever employed: FEAR. One of my favorites is that government will come between the patient and his treatment. This is completely without truth; few would say that about Medicare and government subsidized employer-provided insurance. Yet health insurance companies today very definitely DO come between patient and doctor. Nearly every day, a story is told of someone seriously ill and their insurance company’s refusal to cover their care. Oh yes, one final fear stems from this country’s enduring bigotry. Certainly not all, but far too many opponents of health care reform believe this nation is meant for white, Caucasian, Judeo-Christian people exclusively. Persons of other races, nationalities or religious beliefs are demonized. Our black president has been insulted in front of Congress and millions of television viewers by a Republican Congressman. The stakes are high and this poisonous element of our nation will not rest until this president is removed and those demonized “minorities” marginalized.
7. Greed, Fraud, Corruption & Waste – Ours is a culture of greed; it affects every aspect of life. A large segment of our population expresses satisfaction with our current state of health care and insurance. Who are these people? Essentially two groups. Those who benefit from the status quo – the wealthy who can afford the best care, and those covered by employer-provided health insurance. Why are THEY satisfied? Because the government subsidizes their insurance with tax breaks, and their “insurance” discounts health care for them. They could care less about the uninsured, as long as they get all the “care” they want at an acceptable discount. Meanwhile we leave the poor, the unemployed, many self-employed, and ANYONE who has a pre-existing condition – without care.
Medicare and health insurance fraud is rampant. No health care system can be cost-effective with runaway fraud. Almost every day, some corrupt health care provider or phoney patient is stealing millions from Medicare. CBS News on 60 minutes (Oct. 25, 2009) reported: “Medicare fraud – estimated now to total about $60 billion a year – has become one of, if not the most profitable, crimes in America.” They go on to explain that it is easier to steal from Medicare than any other kind of crime and the financial reward is greater. This assessment may be far too conservative; Thomson Reuters, a day later (Oct. 26, 2009), reported that waste in health care may approach or even exceed $800 billion a year. They report $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams. They go on to blame administrative inefficiency and redundant paperwork for 18% of health care waste, medical mistakes for 11%, a paper-based system that discourages sharing of medical records accounts for 6%, preventable conditions such as uncontrolled diabetes for $30 to $50 billion, and the granddaddy – unnecessary care, drugs and tests to protect against malpractice accounting for 37% of health care waste. To this consider that overhead for physicians and doctors is far higher than other countries like Canada, yet “Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, while having a unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations.
8. Denial – Americans believe we have the best of everything. That is largely a matter of pride rather than fact. The US has the most expensive health care system (both care costs AND insurance) on earth with outcomes inferior to the health care of all other industrialized nations. Our death rate among infants is among the highest, we are more likely to suffer from chronic illness, and least effective in curbing deaths from preventable disease than any other prosperous nation. We pay more for prescription drugs than any other nation on earth; far more. Every wealthy country other than the United States guarantees essential care to all citizens. Other nations, including third world countries have successful single-payor or government option health care systems that work. A recent poll revealed Canadian’s regarded their health care system superior to America’s by a margin of 10 to 1 — in spite of widely publicized examples of discontent. Americans have been taught to fear such concepts, in spite of the fact that we already have a successful single-payor health care system called Medicare. And, by the way, surveys show Medicare patients are more satisfied with their care than those with private insurance. Is Medicare perfect? No, but it works, and millions depend on this “government-run”, “socialist” program.
Health care reform opponents propagate stories of people in these countries having to wait long periods of time for non-emergency procedures, but those stories are not typical and are usually severely exaggerated. These stories pale compared to the tragedies suffered here in the US because of lost or denied insurance coverage and lack of access to health care. Health care reform opponents predict staggering costs in the future for health care reform, but are in complete denial of the fact that health care unchanged will continue to experience soaring costs in the future.
Once again, America will say “NO” to providing affordable comprehensive health care for every citizen. Paul Krugman (NY Times) wrote: “At this point, all that stands in the way of universal health care in America is the greed of the medical-industrial complex, the lies of the right-wing propaganda machine and the gullibility of voters who believe those lies.” In reality, CAUHC is already dead. Health care reformists seem caught off guard by anti-reform activists and have been ineffective in neutralizing them. The fact is that about 60% of Americans are satisfied with their health care, and while that leaves a substantial minority with anywhere from inadequate to non-existent care, the majority either don’t want to change the status quo because they fear it will adversely affect them, or they simply don’t care about the plight of the “withouts”. Those with employer-provided health insurance are best able to cope because, ironically, the government IS involved in their health insurance in the form of tax-free premiums. Like the other “inconvenient truth”, climate change, the preferred time to deal with the health care crisis is some other day.
In a future post, I’ll propose some things that CAN be done to improve health care without CAUHC.
http://wp.me/pwx2s-3-healthcaredoomed
