Remember Health Care? It's Still a Problem

With two excellent Democratic candidates left, there has been some fear that our party would emulate Republicans and run our nomination process to maximize the probability of actually winning the presidency. So in the last month or so we have formed a circular firing squad to avoid the risk that such a win would sully our quest for personal and ideological purity.

It's hard to avoid killing each other in a tough nomination fight, but it's worth remembering that the differences between Senators Obama and Clinton are dwarfed by their differences with John McCain, and that a Democratic victory in November would change millions of people's lives for the better. It seems that we've stopped talking about this stuff lately.

I was reminded of this at a recent event at Northwestern University's Feinberg School of Medicine, in which emissaries from the various political camps discussed our different approaches of healthcare reform. I was ready to offer the familiar defenses of the Obama plan against charges leveled by Senator Clinton and her supporters. As it turned out, Senator McCain was the only other candidate represented there. So my beautiful Powerpoint slides were made somewhat moot.

The McCain representative argued six broad points:

(1) The problems of the uninsured are vastly overstated, and in any event are not getting worse.
(2) The United States has the best healthcare system in the world, while
(3) People in Canada, France, Germany, and other wealthy democracies are trapped in systems of rationed socialized medicine akin to a stereotyped image of the British National Health Service, circa 1952.
(4) That the Democrats are pushing for nanny-state solutions that emulate the highly rationed and inefficient models mentioned above.
(5) That innovations such as medical savings accounts would greatly improve our health care system by placing greater financial and decision-making responsibility on individual patients and their families.
(6) That a $2,500 federal tax rebate for individuals and $5,000 per family (to replace current federal tax benefits for health coverage), along with unspecified requirements on "any state receiving Medicaid to develop a financial 'risk adjustment' bonus" [See here] will ensure access to coverage among low-income families and individuals with pre-existing conditions.

He is a good guy, but he presents a crazy vision of what's wrong with our healthcare system. I believe that all six of the above points are wrong. To recapitulate some high points:

The problems faced by 47 million uninsured people (and millions more who are underinsured) are a national disgrace. Despite spending $2.1 trillion, we do not treat people decently. We leave almost 20 percent of our population uncovered, thus allowing our urban medical and public health infrastructures to buckle under an unsustainable financial load.

Our nation scores very poorly on international rankings of health system performance and public health. Although we have many excellent providers, many excellent technology, and spend tons of money, our financial and oversight systems are a mess. Considering what we have to work with, our healthcare system is decidedly mediocre.

Although American health care includes countless "market failures" and inefficiencies, there is little evidence that greater reliance on market solutions would address the worse problems we face. Many of our financing and access problems are actually predictable outcomes of a competitive insurance market, particularly in the market for individual health coverage.

The tax credits promised under the McCain plan don't come close to what is required to provide even minimal coverage to many low-income families, let alone those facing significant medical concerns. A vague requirement on states to address the problem is hardly a plan.

I realize that I'm making bullet-point arguments here on a range of complicated subjects. If you are reading Huffington Post, you probably already agree with me. If you are a health services researcher, you can probably cite trainloads of studies that refute the main arguments behind the McCain plan.

Every leading Democrat this year argued that our nation has a responsibility to seek universal coverage, to provide significant public resources to help low-income families buy health coverage, to reform insurance markets to forbid firms from discriminating on the basis of pre-existing conditions.

Whatever voters believe about Reverend Wright, Geraldine Ferraro, Governor Spitzer's sex life, and whatever else comes along, most Americans agree with us on this one. Most people hope that our next president will do something effective that helps the millions of people who can't afford health coverage.

We've stopped talking about the important stuff lately. Perhaps this is understandable since both Senator Clinton and Senator Obama have ambitious health plans and because a few other things have come up. It's still unfortunate, because we have more in common with each other than we do with Senator McCain, who is now getting a free ride.

I, for one, can't wait for this nominating contest to end, so we can turn our political firepower on our actual opponent instead of each other. Every day we are bogged down in campaign ephemera, many thousands of Americans are failing to get needed care, falling into medical bankruptcy, or are losing health insurance coverage. We need to put the focus back on that as soon as possible. If Americans seriously consider which party has the better plan to achieve universal coverage, we'll do alright come November.

Comments

[saibotchilizm]

I'm living the dream of the American healthcare system! I'm uninsured, and haven't been to a doctor in 2 years. Luckily, I'm a healthy 23-year-old without any major health problems (yet).

However, my grandmother, who IS insured, had to wait 4 hours in the ER before being seen because she hadn't been able to eat for 3 days due to stomach problems... And then they sent her home with no treatment, advice, or compassion.

From my experience, from medical school through actual medical practice, doctors are encouraged to be profiteering sleazebags. They drive BMWs, own mansions, and charge $250 per regular check-up. I think THAT culture deserves as much of the blame as the insurance companies.

[HAP]

For some reason my reply to you didn't post. Please find an insurance policy for yourself, even if it is only catastrophic coverage. This is an understandable calculated risk, but a bad one.

[saibotchilizm]

The point of my post was more a "damned if you do, damned if you don't" perspective.

Even people who are covered, and covered well (like my grandmother, or my girlfriend, who has had a similar experience), are not sitting pretty. My grandmother was bounced off something like 4 doctors before one took the time to find out what was wrong with her-- a simple fungal infection that was cleared up in 3 days with the proper medication.

The point of my post was also to blast doctors. I have nothing but resentment for them, as I have met so many who I thought were such #@&%*@#bags.

Nurses, on the other hand,; I love you guys. Keep up the good work.

[Peddler]

The American National Health Plan......­.........J­ust say NO to illness!

[jdm58]

Why does America allow our healthcare to be gambled on Wall Street as a commodity? The less coverage the Health Insurance industry provides, the more profit it can claim on its balance sheets. People "invest" in companies that demonstrate profitability. So, covering everyone, or providing coverage at a lower rate, would be counter-intuitive to the industries bottom-line. The Republicans and the Wall Street gurus get this, and downplay how bad coverage is, in order to keep their investors happy. They are too far removed from what is going on in the lives of average Americans. For those who have portfolios, an effective way to protest this it to make sure that none of the investments are in the Health Insurance Industry. We have recently witnessed what a massive "sell" does to companies traded on Wall Street. It is up to us to keep the issue front and center, and stop getting side-tracked by race, gender, and religious issues.

[jmsent]

The only people who believe that McCain's suggestion will do anything at all to solve this mess, are those who haven't yet had to deal with the health insurance industry on a direct basis. These people are in willful denial of the horrible mess this country's health care system is in. But I don't think it's going to work anymore. More and more of the population feels the costs, the fear of losing coverage, the hassle of dealing with insurance companies, the out of pocket expenses in spite of having insurance. They clearly sense that the system is badly broken. To wit:

(1) The problems of the uninsured are vastly overstated, and in any event are not getting worse.

That's like saying "The bad news is I'm going to die tomorrow. The good news is it isn't getting any worse."

(5) That innovations such as medical savings accounts would greatly improve our health care system by placing greater financial and decision-making responsibility on individual patients and their families.

Substitute "scam" for "innovation" and you're much closer to the truth. Isn't the present system already placing greater financial responsibility on individual patients and their families? How is this an "improvement"? Oh, yes, and the logical extension of these HSA's is that people now get to go out and buy "individual policies". Ask anyone who's buying their own insurance what they think of this coverage. No portability, pre-existing conditions excluded whenever you switch policies, yearly premium increases of 15-20%, etc.

(6) That a $2,500 federal tax rebate for individuals and $5,000 per family (to replace current federal tax benefits for health coverage), along with unspecified requirements on "any state receiving Medicaid to develop a financial 'risk adjustment' bonus" [See here] will ensure access to coverage among low-income families and individuals with pre-existing conditions.

That's really gonna help the family dealing with a kid with cancer or any other catastrophic or chronic disease.

[Aaror]

The fastest way to deal with the "we have a great system," is to throw the facts back in the face of the person who says that.
"We spend more on healthcare than any other nation per capita." No we don't, we don't spend 12% of our GDP on health care. Look at the books of any medical insurer, every expense other than payment of claims is waste. The entire profit margin is waste. Then go to any Doctor or Hospital and ask what their medical billing office costs. That entire office is waste. We don't spend 12% on health care, we spend 6% on health care and 6% on buracracy. It is hilarious that the anti-buracracy repubs want to keep the current health care system.

[Sundialsvc4]

You cannot provide expensive services such as health care, except for "the rich will live and the poor will die, and if they are going to die then they had better do it and rid the world of the surplus population," UNLESS you have Real Wealth.

Real Wealth consists of one thing: domestic manufacturing, as in heavy industry. It means not only buying the things you need, but selling them too. This opportunity exists, just as it had existed for many generations before our own. But this generation fell victim to the siren call of "easy money." It crawled under the desks of its schoolrooms and in more ways than one kissed its own ahem goodbye.

No matter how many trillions of vaporous dollars this Government spends on this-or-that, those dollars do not actually exist. It doesn't matter much when you're selling the Department of Defense a $2,000 coffee machine, but it does matter when you contemplate that there are more than 320 million people in this country and that in a mere 70 years' time almost every single one of them (inclusive) will be dead, having required expensive health-care for, say, 5 to 15 years' time. The only way to pay for that ... the ONLY WAY ... is with a continuous fountain of real, not "borrowed," wealth. A healthy, genuine, we-buy AND we-sell, economy. Like we once had.

There is no other way to do it.

And, there is absolutely zero reason why "we, of all nations on this planet," cannot do it... and do it well.

[ProudLiberalDan]

You are right to bring the discussion about the campaign back to the issues. Health Care is the squandered issue of this campaign.

We still need a single-payer health care system (a.k.a. "Medicare for All").

Kucinich supported what we really need.

John Edwards proposed a reasonable transitionary plan that I could still enthusiastically support.

Clinton ripped off Edwards plan.

Now we are left with Obama's weak, non-universal approach. It leaves 15 million people behind on paper, which means millions more in practice.

His proposals are still light-years ahead of anything McCain would support or agree to doing, so Obama is preferable in November.

But what a squandered opportunity.

I believe it is Obama's weak non-universal health care proposals that is keeping Edwards from endorsing him. And if so, I agree with Edwards on this.

[texanna]

ProudLiberalDan, you've just voiced one of my big concerns about Sen. Obama. Couple his non-universal plan with his post-partisan, unity talk and I think we will fall further short of our goal to fix our healthcare crisis, since the Republicans are all for the current "free market" conditions. Still, some is better than none, I just wish I didn't have to settle for such a less-than condition on this big issue.

[ProudLiberalDan]

That the tragedy of this, the squandered opportunity.

This was the year to go for single-payer health care because our financial institutions are falling apart and the system needs overhaul.

The fact that the Democrats have already compromised on this means that what token reforms if any get through Congress will have very little effect.

If you don't go for single-payer, you won't get anywhere close. If you've already given away the store to conservatives, they'll take it.

[ExPatriot70]

Mc Cains representative needs to have a enema with drain cleaner he is so full of it. I retired to a country with a universal health care system and while it is not perfect it does work and it will not cause me to go with out needed care or go bankrupt to get the care I need. My contribution is $77 a month for complete coverage. In the U.S I would pay three times that for the medications I need each month.
As I said the system is not perfect but it does work. the doctors and dentist are as well trained and as good as any I ever had in the U.S. Also I have the option of going to private practice doctors/dentists if I so chose and I have done this on different occasions and the cost of going private is about 1/4 that of similar procedures in the U.S . Yes everyone here is covered as far as I know.

[ReasonIsMyReligion]

How many people have lost their homes over medical bills? And how many of them had insurance?

[Merlin7]

Whatever plan is adopted, there is no excuse for insurance companies being part of the solution. Insurance companies provide no service. They merely add a huge surcharge to the cost of providing health care. But tell that to politicians and their eyes glaze over with fear. The politicians fear that the insurance companies will use their huge profits to defeat them in their re-election campaigns. That's the only reason the continued existence of health insurance is tolerated.

Consider this: Why not have Defense Insurance Companies? The Pentagon would pay a premium of current-sp­ending-plu­s-25-perce­nt to some company to replace lost equipment. Absurd? Of course. But that's essentially what Hillary and Obama want to do to provide universal health care.

The bottom line, of course, is that no universal health care will be provided and the public will be cheated again. And four years from now we will have the same conversation again, just as we have had it periodically for the past 40 years or so.

[jmpurser]

You seriously think the Democrat's problem is one of striving for ideological PURITY???

Amazing.

[HAP]

I'm kindof being polite here... We do like to tear each other apart.

[uglicoyote]

Back in 93 when Hillary was pushing for a health care program, she failed miserably and now blames ads from the other side and resistance from opponents for the failure. I don't believe she has accpeted any responsibility for her failure. Yet, some in congress say that it was possible to develop a compromise plan even then that would have passed and been put into place. It would have been incremental, not containing some of what Hillary wanted. She wanted it all, would not compromise and because of her intransigence, we have gone another fifteen years without any health care program. Should she be elected, (an unlikely possibility) I believe that she could screw it up again. I've seen nothing in her actions in this election that would indicate anything other than more of the same.

[texanna]

Back in '93 the Congress was controlled by the NeoCon Republicans who had no intention of changing the status quo. They were wolves in sheep's clothing, to be sure, feigning a conciliatory spirit to be made privy to the findings and the intended recommendations of the Health Care Reform Task Force. They then took that information and before anything could actually be proposed they killed the findings, the proposed recommendations and they started by discrediting and smearing Sen. Clinton as a presumptive nobody who had no standing to be doing this in the first place. Remember, at that time, the country was more conservative than progressive, Clinton having been elected with a 43% majority of the popular vote. I think that Sen. Clinton has acknowledged that she did not handle working with the opposition very well, and did learn quite a bit about how to work more successfully with them in the future.

[usna73]

I think you are incorrect. The Dems controlled the Congress in 1993. While your other remarks are accurate, Clinton did not handle this properly.

In 1993 I sat on a small business council which worked on the subject with giant insurers, wh had multiiple lines of products, life haelth etc. Among them were Met life etc. Each proposed that they would administer a plan within confines of a Federal program and could do so more cheaply than the government itself. Clinton balked. The rest is history. Companies like Met exited the business and gave vultures like United Health Care the ability to dominate. The results are clear.

Clinton missed a gigantic oppportunity. That's why I support Obama.