Bandaid solutions will NOT work for health care

From Physicians for National Health Care

http://www.alternet.org/healthwellness/74039/

Although we spend far more than any other country in the world on health care, we have little to show for it except high prices, decreasing access, variable quality, underuse of essential care by vulnerable populations, and a significant amount of unnecessary and inappropriate care for those who can pay for it. Our enormous private health insurance industry of 1,300 insurers competes to cover healthier and lower-risk enrollees with more limited policies each year, while denying coverage of sicker individuals or raising premiums to unaffordable levels. That shifts the burden of the more costly care of sicker people to the public sector, defeating the whole principle of insurance: to spread risk broadly. Meanwhile, as the private insurance industry no longer finds growth in the employer-sponsored and individual markets, it has been shifting its sights to privatized public programs, including Medicare and Medicaid. Here it has found generous subsidies and little oversight from friendly conservatives in government.

Now would be the ideal time for leading Democrats to advance a progressive agenda for health care, such as Teddy Roosevelt did as a Progressive, with his call for national health insurance in 1912. The Republicans have been weakened by scandals, cronyism and incompetence, and have no new or credible ideas for health care reform. They still offer up only warmed-over ideas such as tax credits, health savings accounts, and how the competitive market can fix our problems, while limiting government's responsibility for care of the poor -- blatant social Darwinism. As William Greider recently observed in the Nation, "Democrats have a splendid opening to be substantive and political and righteous for working folks,all at once."

But so far, with only one exception, the Democratic presidential candidates have been disappointing, if not derelict, in reforming the system. In their misguided efforts to avoid too much controversy and to build a "centrist consensus," they are completely missing the target even before starting. Although Democrats in Congress united behind reauthorization of an expanded State Children's Health Insurance Program (SCHIP), that effort has diverted them from the real challenge -- how to reform the system to make accessible and comprehensive health care affordable for all Americans. That would require taking on powerful stakeholders, especially the insurance and drug industries, in the medical-industrial complex, now one-sixth of our economy. All but one of the Democratic presidential contenders shy away from that battle, usually with the limp excuse that real reform is not politically feasible.

<snip>

A fundamental mistake of all incremental efforts now underway across the country towards universal coverage is the disconnect between insurance and health care. Here we find an increasing gap. Many people with insurance find cost-sharing an increasing burden with benefits decreasing and out-of-pocket costs taking ever larger bites from their household income. "Underinsurance" is defined by the Commonwealth Fund as medical expenses amounting to 10 percent of annual income or more (5 percent for adults below 200 percent of the Federal Poverty Level, which is set at $41,300 for a family of four in 2007). Yet many millions of "insured" Americans are having to spend much more than that on health care. Two million people were forced into bankruptcy by medical bills in 2001, the most recent year for which data are available; three-fourths of them were employed and insured at the outset of their medical problems.

The Medicare-like public option is an interesting idea, but does not make sense for several reasons. We have yet to show that the political process can yield a level playing field for competition between public and private programs. Another round of government subsidies would give the private insurance industry yet another opportunity to further divide the risk pool, concentrating the sick in Medicare, which could threaten its future viability. We would likely march toward even more of a two-tier system than we have now, and Medicare would face an increased risk of becoming a welfare program for sick people with significant medical problems. It would perpetuate a role for private health insurance and accept the illusion that it provides a valuable adjunct to health care financing when it is already clear that it doesn't. The battle over the industry's future needs to be fought, as it inevitably will. The Medicare-like option would simply delay that battle, perhaps losing an opportunity for real reform. Whatever further structures were put in place to implement the Medicare-like plan could themselves add to the obstacles of replacing an obsolete private financing system. If Medicare became excessively saddled with the most expensive care of a smaller population without adequate funding, its conservative critics could correctly claim that, "The government program can't do the job."

not-for-profit, national health insurance. Everyone pays, everyone benefits. Simple and effective.

That's great! I mean the data, of course--what it represents really sucks.