Nobody likes to hear the health care horror stories: emergency rooms clogged with sick people who otherwise can’t see doctors, patients skipping treatments to afford food for their children, deaths from easily curable diseases that weren’t detected. We don’t want this in America.
Universal health coverage has become almost a universal goal across the political spectrum. There’s a growing recognition that covering the uninsured– besides directly helping millions of people — would be good for business, the economy, and the taxpayers and premium-payers who now pick up the tab.
But that unity of purpose is hollow. The “how” is what matters, and that’s where we are deeply divided.
The Massachusetts health plan, adopted in April and celebrated as an example for other states, is almost as convoluted and unworkable as our current system because it doesn’t change the one thing that most needs to be changed: the reliance on profit-driven insurance companies.
In fact, those companies lobbied hard for this “reform.” What could be sweeter? The whole state is required to buy their products, no matter how substandard or overpriced, with taxpayers chipping in to ensure 100 percent sales.
The Massachusetts example, shaky as it is, brought a similar bill to life in the California Legislature. As numerous analysts immediately pointed out, however, a mandate to buy insurance has even less chance of success in this immense state, which has almost double the percentage of uninsured people, fewer employers providing coverage, and less state regulation of the insurance industry.
Again and again, independent financial studies have shown that health insurers waste 25-30 percent of the dollars we mean to spend on health care. They have gigantic profits and eye-popping executive salaries, and they spend huge sums on marketing and administrative tasks such as screening out unhealthy people and fighting claims. They make their money by denying rather than facilitating medical services.
Why don’t we get rid of these unneeded and costly middlemen? Because:
1. Insurance companies don’t want to be eliminated, and they have the power to get their way. The source of their power is the wealth they have amassed from our health care dollars over the decades.
2. As a nation, we revere the market system. We adhere unquestioningly to the belief that the marketplace can handle everything, even an endeavor as ill-suited to market forces as health care.
The natural market-driven behavior of insurers is to compete to cover only healthy people, to pay as little as possible of whatever medical costs they have, and to jack up prices for anyone likely to be unhealthy. No matter how you twist it and patch it, this is a lousy basis for providing health care to a population.
Nonpartisan experts who crunch the numbers generally agree the best way to achieve universal coverage is with a single, public health plan covering everyone. Then they dismiss the idea, saying it’s not politically feasible. See reasons 1 and 2 above.
True, that is our political reality in 2006. It is time to change it.
The math has been done. California could save roughly $22 billion a year in bureaucracy and excess costs by pooling everyone from the thousands of health insurers and government programs now covering Californians. That’s enough to give every state resident first-class coverage, including: doctors of your choice, hospital care, prescription drugs, vision, dental, mental health, and substance abuse treatment, even hospice and skilled nursing care.
Health care costs would come under control as the statewide health plan used its enormous bargaining power to negotiate lower prices, especially on drugs and medical equipment.
Instead of paying premiums and deductibles, people and businesses would pay graduated income and payroll taxes to fund the plan – and most would pay less than they now pay insurers. ”Tax” is a dirty word in the U.S., but try explaining the distinction to Massachusetts residents mandated to pay thousands of dollars a year to insurance companies. Sometimes a tax is themost efficient and fairest way to get something done. Who wants to shop for private garbage collection, road maintenance or fire protection? In health care, government programs such as Medicare and the Veterans Health Administration provide coverage superior to most private plans, with administrative costs of about 5 percent. Aside from the recent fiasco of the Bush administration’s privatized drug plan, Medicare is highly popular among those using it.
A public, nonprofit statewide health plan would be based on the original concept of insurance: create a large buying pool to spread the financial risk of illness so families don’t face bankruptcy when a health crisis strikes. The government agency would simply negotiate and pay the bills, not employ the doctors or own the hospitals.
Certainly the big insurers and pharmaceutical companies, who have the most to lose, will fight this plan. And they have the expensive lobbying and marketing operations to ensure their viewpoint is heard loud and often. Ordinary taxpayers and 45 million uninsured people have no such lobby, but with straight facts and enough voices, we can overcome the self-serving objections.
A statewide volunteer organization, Health Care for All, is building a
grass-roots movement to do just that, with a campaign called OneCareNOW. The California Democratic Party has put single-payer health care on its platform,and the League of Women Voters California, the California Nurses Association,and many other organizations are working hard for passage of a single-payer
bill in Sacramento.
The bill, SB 840 by Sen. Sheila Kuehl, D-Los Angeles, which would create a public agency providing comprehensive health insurance to all Californians for life, has already passed the Senate. Advocates are hoping for a full Assembly vote in August. Legislators and the governor need to hear that the people are ready for a major change — to a sensible and fair way of financing health care. California can show the nation how to do it right.
Susan Duerksen was a health-care reporter for the San Diego Union-Tribune for 16 years. She left in 2002, earned a master’s degree in public health, and now works as a public health researcher at San Diego State University, currently focusing on societal influences on childhood obesity. She is co-director of the San Diego chapter of Health Care for All, and can be reached at susand@onecarenow.org.
For further information, go to Health Care for All–California, and www.onecarenow.org.
