Future of Health Care Is Nasty, Brutish and Short

If a meaningful health reform plan doesn't pass, life in the U.S. will be inhumane and our country will begin to look like Great Britain after World War I -- hobbled and facing unrelenting poverty.
As I discovered in researching my new book Audacity of Help: Obama's Economic Plan and the Remaking of America, for an individual family, medical insurance now claims 20 percent of median income. That's compared to 8 percent in 1987, according to the New America Foundation, a progressive research organization in Washington.

"If we do not make health insurance more affordable," states the Foundation in its 'Next Social Contract' report, "a majority of working Americans will be uninsured by 2020."

Those who are worried about health care or medical bills are not productive members of society. We may have socialized medicine for the near-poor, unemployed and uninsured. But it's the costliest and most inefficient care imaginable. Millions of pets receive better care.

Employers who don't offer coverage are less competitive in a global marketplace. Uninsured workers end up in emergency rooms -- or simply call 911 -- demanding costly care that taxpayers will ultimately finance.

Aside from the numbers that are repeated ad nauseum, there is a darker reality brewing.

If nothing is done, life expectancies will drop in the U.S., more employers will go out of business and we will bankrupt ourselves while the Chinese and Indians create a clean energy industry, produce jobs, vacuum up global capital and raise their living standard. Uninsured and under-insured Americans visit doctors less frequently, pay more for care and have the highest rate of preventable deaths before age 75.

This Hobbesian vision springs to mind because we have failed to declare health care a basic human right. It should be an amendment to our constitution. Until we do that, you won't have a moral/political basis for core principles. If Teddy Roosevelt, Mahatma Gandhi and Martin Luther King were alive today, I'd bet they would agree with me.

President Obama's health care speech last night was a mere template for reform, though, and not the actual article. The legislation we need has to come from a Congress willing to defy the status quo, insurance companies and show some leadership for the future.

Of course we need protection from the "pre-existing condition" and "drop you if you're sick" scams the insurers have been getting away with for years. That should be the bedrock of any legislation.

Then there's the flawed system that few have discussed: the lack of a strong cop over the insurance industry. Federal regulation is needed -- a combination of the US Department of Justice and the Federal Aviation Administration.

Right now, weak state regulators not only turn a blind eye to the worst practices, they greenlight most rate increases. I know because I've been a victim of these abuses.

Insurers should also be held legally accountable for any abuses and should be prosecuted by effective watchdogs.

New federal regulation also can effectively create a national marketplace for insurance. At present, you can't sell insurance across state lines. The companies like it that way because they often indirectly control state regulators and legislatures. They'd rather have 50 inspector Clouseaus watching them.

I'm not sure if President Obama's "insurance marketplace" is the same thing as a national market pitting every insurer against each other to offer the best policy at the lowest price, but it should be.

Even so, the president's "exchange" doesn't kick in until 2013. In the interim, a high-risk pool will cover what the industry calls "uninsurable" policyholders. This is fraught with peril since state insurance pools can be unaffordable as well. I know people who've been in them. Small pools of sick people are rotten ideas. You have to spread risks around in a huge, diverse pool. And that's what a national marketplace would do.

Independent commissions, which the White House has proposed, should seriously examine the fee-for-service system and study capping what providers charge in a public-private model.

As medical researcher Dr. Richard Moore stated in a recent paper: "there should be no profit in medical care. Doctors, nurses and technicians should be well paid, but no one should make a profit nor should any administrators receive those obscene salaries running up into the millions per year."

If you consider health care to be an essential human service like a fire or police department, it makes no moral sense to make a profit from human suffering. Health care is civil, gender, age, disability and children's rights all rolled into one issue. We can address this now. We all deserve better.

John F. Wasik, author of The Audacity of Help: Obama's Economic Plan and the Remaking of America, is the author of twelve books, including The Cul-de-Sac Syndrome and The Merchant of Power. He speaks widely and writes a weekly Bloomberg News column that reaches readers of five continents and which earned him the 2009 Peter Lisagor award for journalism. He lives in Chicago.
For more information please visit www.audacityofhelp.net

Comments

[mbaty]

Agree. Health care is or should be a right in America, because it is America. We cannot offer financial rewards for keeping people sick and expect to have an effective health care system. This may not be the goal of doctors individually, but the problem remains that if you say to me you want me to be well, while you are getting paid if I remain sick, there is a clear conflict of interests. Because survival is tied to money in America, you get a "survival of the richest" system. Someday, when profits have been divorced from health care, the majority of people will be well, the majority of diseases will be eradicated or easily cured, and all chronic conditions will be easily manageable, because the incentive will be to keep people healthy, the incentive will be to keep costs down for everyone.

[ajwriter]

Why pay for a whole bunch of government to control insurers, when we could just eliminate the insurance industry's incentive to shake down the public?

I agree with Raul Garcia above.

[GrahamInCanada]

Excellent.

The only criticism I can make is that the comparison to Great Britain after World War I would have been more apt if a comparison was made to Germany after World War I.

I only say this because I believe an America hobbled and facing unrelenting poverty is at risk of acting more like Germany than Great Britain.

[research]

The USA is not paying reparations, yet. No comparison to Germany.

[GrahamInCanada]

Cause and effect, cause and effect.

I said that I believe America hobbled and facing unrelenting poverty would more likely have the effects of being hobbled and facing unrelenting poverty seen after World War I in Germany, not in the UK.

I did not comment on the cause of being hobbled and facing unrelenting poverty, or compare the causes in the US to causes in the UK and Germany. I commented only on the effect.

[dayala]

sobering indeed, the future of this country's viability is at stake and half the country is virtually clueless, where and how did Americans become this dumbed-down.

[capitaldysfunction]

Eyebrows were raised in the 09-09-09 Las Vegas Review Journal about Nevada state insurance regulators sponsoring a cruise on a mountain lake with insurance industry representatives.

Let's hope they don't get married.

[research]

Well said.

Just because it's against the law to refuse insurance for preexisting conditions, or drop people who get sick, Doesn't say anything about how much the insurance companies can CHARGE.

And without enforcement, the sick person will be dead long before the case works it's way through the courts.

[ajwriter]

It was obvious to me last night that the federal government is pretty detached from insurance regulation, which is done in the states. Preexisting conditions, etc., are just the tip of the iceberg.

None of the proposed rules deals with the fact that the thrust of insurance business practices is to figure out how to avoid honoring their contracts. They'll come up with even more odious practices to discourage sick people and get them to switch to other companies. It will be a race to the bottom, as anyone offering good coverage would get sick people on their rolls -- can't have that.

Right now, insurance companies use determinations of medical necessity, and they've even gotten involved in tainting medical practice guidelines, to avoid paying for care. There are other tactics. And overwhelming vulnerable people with paperwork and bureaucracy is their stock in trade.

For-profit insurance is a failed business model. No other country finances primary healthcare with for-profit health insurance.

[research]

I agree, though I see a very much reduced role for private ins5ruance above and beyond medicare for all.

[woodnthrifty]

Exactly! Cobra is a good idea, but very few people who lose their jobs can afford the Cobra rates.

By taking the over 65, the disabled, the very poor, off the health care rolls with Medicare and Medicaid, government is subsidizing private Health Care profits.

[Raul Garcia]

Leaving health insurance companies as the primary middle man in health care, is flawed and fatal.

[woodnthrifty]

Sounds like a potential "Hit Man" between me and my doctor. Deny care.....m­ake higher profit.