Policy Opinions


Comprehensive Health Care for All, Not A Pipe Dream!
A recent AARP survey, asked older workers to name the single reason they planned to work past retirement age. “Need health benefits” was the top most reason. The Commerce Department’s Census Bureau reported 45 million US citizens are uninsured and another 50 million are underinsured. This makes about one third of our citizens. For rest of us health insurance is enormously expensive though utterly inadequate. Private health insurance premiums are rising at an unsustainable average of about 13 percent per year – and as much as 25 percent in some areas of the country. Coverage is shrinking, as more employers decide to cap their contributions to health insurance plans and workers find they cannot pay their rapidly expanding share. And with the rise in unemployment, more people are losing what limited coverage they had. Most Americans support the idea of universal health coverage, though our representatives may not.

A common remark is that “one-third is not a majority, so why fix something that isn’t broken?” What more evidence would it take to conclude as Senator John Breaux of Louisiana – “The system is collapsing around us”? Most of us have had our bouts and frustrations with the health care system. The complicated and costly insurance policies, as well as the high cost of doctors and hospitals, have plagued countless people. There are many horror stories of people having to wait for months for doctor’s appointment for preventive work, of not being able to afford prescription drugs, and not able to choose the best doctor for their ailments. The present system is not for cure and prevention, but a plain for profit business where public health is a commodity. Health care costs are the second greatest reason for bankruptcy in America (NYU Law Review). These are mainly small businesses, the main engine of our economy. The present heath care system hurts our economy as well. A May 2002 Institute of Medicine report indicates that about 20,000 people a year die prematurely due to lack of insurance (LeBow). That number should be zero, because those illnesses are preventable. According to Dr. LeBow, M.D, the author of Health Care Meltdown and former President of Physicians for a National Health Program, “American health care … robs people of their health, their money and their dignity.”

I have heard argument that health care is not a right but a privilege. I agree to an extent that every citizen needs to earn the privilege of healthcare by contributing to the society. Contrary to the widely held belief, currently, eighty percent of the uninsured are families of workers (UCLA Center for Health Policy Research). Some of us, such as some seniors and children, do not have the necessary health or skills to earn this privilege. Especially in case of children unless we take care and promote their health, we will not be able to have healthy contributing future citizens. Due to obfuscation and confusion campaign of vested interest of few, it is wrongly assumed by many that universal coverage is free and would put the government in debt. In many of the proposals for universal coverage, citizens will pay taxes for health care based on need, income and family size. This pay-in-advance system has worked in many countries.

Universal coverage has been implemented in most industrialized countries, including France, U.K., Italy, and Germany. According to the World Health Organization, the quality and fairness of health care in these countries is much better. It ranked for the universality and the quality France first, and the U.S 37th, behind even countries such as Columbia (World Health Organization Report 2000). But many argue that we are different due to our constitution; and that healthcare is not the responsibility of the government. Then whose responsibility is it in this “perfect union” of ours? The Declaration of Independence states that, “ all men …are endowed…with certain unalienable rights, that among these are life, liberty and pursuit of happiness.” The government needs to ensure these rights. To pursue happiness, one needs a good health. Our right to vote translates into the government’s responsibility to set up voting booths and the election commission. Similarly, our right to life and pursue happiness makes the government responsible for facilitating comprehensive health care for all. Just as the government protects our life and property from external enemy, it should facilitate protecting our health from the common invisible enemy, diseases and ailments.

One then would wonder if there are so many good reasons for universal health care, why is it not yet done? Is it due to the cost to provide universal health coverage? Does it deprive consumers free market based “free choice” and competition? Today we see that the market doesn’t provide the patient the best treatment for his money. In our market-based system the pressure is to increase total health-care expenditures, not reduce them. Presumably, as a nation we want to constrain the growth of health costs. But that’s simply not what health-care businesses do. Like all businesses, they want more, not fewer, customers — but only if they can pay. It leads to inflation of drug costs, treatment costs and administrative costs. Currently, the average American spends $5000 a year on health care, which is twice that of any other nation. If we eliminate the portion given to insurance companies and unnecessary administrative work, we will reduce the cost substantially. The Bureau of Labor found that the percent increase in health care administrators is about 100% every year for last five years. Most of us would not believe but as health-care dollar wends its way from employers to the doctors and hospitals that provide medical services, private insurers regularly skim off the top 10 percent to 25 percent of premiums for administrative costs, marketing and profits. The remainder is passed along a gantlet of satellite businesses – insurance brokers, disease-management and utilization-review companies, lawyers, consultants, billing agencies, information management firms and so on. Their function is often to limit services provide to patients in one-way or another. They, too, take a cut, including enough for their own administrative costs, marketing and profits. As much as half the health-care dollar never reaches doctors and hospitals – who themselves face high overhead costs in dealing with multiple insurers. Most of the unnecessary administrative work is it due to complex insurance policies and procedure. Private insurers and providers compete with one another to avoid getting stuck with high-cost patients, so they can keep more of their revenues. This drives the overhead costs higher. Administrative costs of these private insurers has increased on average by fifteen percent; compared to the three percent overhead of Medicare this is wasteful (LeBow). The “parasitic middlemen” health insurance brokers make health care unaffordable by taking commissions of up to 20 percent (J.D. Kleinke). Profiteering and fraud are rampant in the private health care sector. Recently, HCA/Colombia, the largest for-profit hospital chain, paid the first installment fine of $740 million to Medicare for overcharging it. Illinois Blue Cross paid a $140 million fine on similar charges. The market has created insurance companies and hospitals, which are like the proverbial wolf taking care of the sheep.

Some say, universal coverage will turn a hospital into a Soviet-style grocery store, where there’s free soup, but there’s only one brand. However today, we even do not have “watery soup” for every one. They say that there will be health care rationing under universal coverage. If they mean the quality of service will suffer, then that is utterly bogus argument. There will be competition among care providers as they will be judged only by their patients; and will not have to deal with middlemen. If the argument is about choice of care providers, then in fact the present system does not provide that choice either to vast majority of us. On the contrary, under universal coverage, since health care is more affordable, due to routine check-ups diseases and ailments will be diagnosed early. The dependence on specialty and emergency care will be reduced, improving the quality of the care, and at the same time reducing the cost. Long waiting lists of three or more months to visit your gynecologist or dentist will become part of the past. Our focus will shift from reactionary to preventative.

Unlike many of the complicated proposals being drawn up such as managed care, universal coverage is straightforward. Maine has taken the lead and already passed a plan to universal coverage. The plan will provide low-cost coverage to all state residents by 2009. Premiums will be decided individually based on income, family size and the chosen plan. Illinois and some other states are in the process of passing similar bills. To complement all of these statewide measures, we need to exhort our representatives and senators to create a single–payer, comprehensible national health insurance program for all. Let’s smoke this pipe of comprehensive health coverage for all. Cheers!
Post submitted by SidSalvi (On February 05, 2004 at 10:46 pm)

Looking Back and Moving On…
Here we are. 2004. I’d like to take a brief timeout from the curent line of discussion to share two articles I’ve recently reviewed. The first reflects on the Top 10 Health Policy Stories of 2003, and the second is a Wish List for 2004. Both have been compiled by The Commonwealth Fund. It’s interesting to see how our original conference consensus and online discussions here have meandered into the topics listed below. What do you think? Do you agree or disagree with things on these lists?

My goal is really to capitalize on this opportunity we have…to show that health care is a policy area essential to the overall strength of the nation and that the current “system” is not as effective, efficient, or accessible as it needs to be. If we don’t step up to the plate, think big, and work towards change in health care, who will?!?

Now on to the articles:

The Top 10 Health Policy Stories of 2003 were topped by passage of major Medicare legislation and reports of a precipitous increase in the ranks of the uninsured, rising health insurance premiums, and the emergence of health care reform as a hot-button issue in the presidential campaign.

According to Commonwealth Fund president Karen Davis, 2003 was a “glass half-full” year in health policy. “Enactment of the Medicare legislation shows that we are ready to grapple with some of the most intransigent problems in our health care system,” Davis says, pointing to the challenge of getting patients needed medications, rising numbers of uninsured, and racial and ethnic disparities in care. “The fact that states are facing these problems, practitioners on the front lines of health care are working on solutions, and even the federal government is beginning to address these issues head-on, means that there is common ground on what needs fixing.”

Our Top 10 Health Policy Stories of 2003 are:

1) Major Medicare prescription drug legislation is enacted

2) The number of Americans lacking health insurance increases-again

3) Overall health care costs continue to rise, with patients bearing more of the burden

4) Presidential candidates embrace issue of covering the uninsured

5) Maine and California take the lead in enacting state-level expansions of health coverage

6) States band together to battle rising prescription drug costs

7) Research shows only 55% of Americans get indicated care

8) Clinical IT standards gain traction thanks to government efforts

9) Quality improvement efforts really start to make strides

10) Disparities in health care get renewed attention

Wish List for 2004:

From the passage of a Medicare prescription drug bill to the release of health reform plans by most of the presidential candidates, it’s clear that health care was a key item on the nation’s policy agenda in 2003. But it’s also clear that there is much yet to do to improve health care coverage and quality for Americans. In that spirit, The Commonwealth Fund has compiled a 2004 Wish List for the U.S. health care system.

“My wish is that 2004 will be the year the nation makes real progress in reforming the health care system” says Fund President Karen Davis. “There are many exciting opportunities to make changes that will improve health care for millions of Americans. Our aim should be high-performance health care—high-quality, safe, efficient, and accessible to all. While that sounds daunting, it is possible to achieve.”

To help get there, The Fund wishes:

Wish # 1: That most low-income seniors will sign up for Medicare discount cards and the $600 drug benefit under the new Medicare law.

Wish # 2: That the president elected in 2004 has as one of his or her top three campaign pledges to reduce the number of Americans without health insurance from the current 16% to less than 8% by 2010.

Wish # 3: That health care inflation in 2004 is less than 7%.

Wish # 4: That a dozen states enact legislation to cover at least 80% of their uninsured.

Wish # 5: That by year’s end, at least one-third of physicians routinely use an electronic medical record and one-third of hospitals adopt computerized physician order entry systems.

Wish # 6: That more payers begin to offer incentives for improving health care quality.

Wish # 7: That at least half of physicians routinely perform standardized developmental screens on young children.

Wish # 8: That at least 10% of the nation’s 18,000 nursing homes formally adopt one of the promising resident-centered approaches now improving care.

Wish # 9: That U.S. health care leaders adopt at least three innovative approaches that are showing success in other countries in fostering quality improvement in the U.S.

Wish # 10: Good health and peace for all!
Post submitted by DanielleThompson (On January 14, 2004 at 11:03 pm)

So far…
Hey everyone,

It looks like the first question we should tackle is whether or not the Democratic Party should advocate a single payer plan. In favor of such a system, we’ve heard several points:

1. It’s more cost effective

2. It’s more “humane” (Jesse, elaborate?)

3. It’s more efficient (risk pool argument)

4. It controls (eliminates?) profit motive

5. It works in Canada

We’ve also heard the following obstacle to passing a single payer plan:

It would destroy the insurance companies, which form a powerful lobbying group.

Based on what I remember of our conversation in Washington, I’m going to throw out a series of arguments against a single payer plan. I’d like to start the conversation from there.

1. It may cost less in GDP (we can argue about that), but it would certainly cost more in taxes. Voters are more concerned with how much they pay in taxes than with how much we spend in our economy, and, right wrong or indifferent, we can’t pass something the voters don’t want. That provides an obstacle to passage that we just can’t overcome because it’s inevitably the case the single payer would mean at least a shortcome increase in taxes.

2. It involves too much government bureaucracy. Talk to the French and the Italians, and they’ll tell you that the paperwork is enough to kill you if the malpractice doesn’t.

3. Americans don’t trust government bureaucracy. Note: this is a different point from point 2 in that it’s a democratic point instead of an empirical point. People won’t support a system that involves even just a little bit of government bureacracy.

4. We can have an argument about whether single payer would decrease scientific innovation and quality of care. It seems possible though maybe not likely that it would.

5. It will inevitably limit personal choice, as all universal programs do, making it somewhat arbitrary. We can argue about whether that matters.

6. There is likely to be a lag between a new need arising and its being met, and that lag will inevitably be longer under a single payer approach than it would under a free market or competitive approach.

A concession: Many arguments we came up with against single payer approaches center on the idea that it won’t and can’t pass on the national level. It might work if it did pass, assuming that the drafters could come up with some way to leash the bureacracy, but the argument might be inconsequential given that the national government would never pass it.

A factual point: Canada does not have a national single payer. Some of the provinces have single payers, and every province has universal coverage. But there is no national insurance organ that covers 100% of the insurance needs of all Canadian citizens. Also, Canada is currently debating privatization and a turn to American-style coverage. (Though they may be “debating” such a turn the same way Americans are “debating” single payer approaches.)

The consensus coming out of Washington was that we should work within the current system to make it better and then create a government fallback insurer to catch all the people who currently lack insurance.

Other possibilities proposed included:

1. A Canadian-style state-centered plan, forcing states to pass their own plans the same way we forced them to raise the drinking age (think unfunded mandate).

2. Modelling health insurance after mortgage insurance, the Fannie Mae model.

For now, let’s all focus our debating attention on this question of insurance and insurance regulation. The main question for debate right now: Should we advocate a single payer plan?

Please try not to repeat any points already made unless you want to elaborate a point. Please try to think both empirically (what’s the best system?) and pragmatically (what can pass?). Please be concise! I’ll try to summarize points made as we go.

It’s all yours…

Post submitted by AbbyMoncrieff (On November 08, 2003 at 10:47 pm)

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