Bizarro World of Health Care Reform: Standing Language On Its Head

Dialogue around health care reform recalls 1980s Saturday Night Live skits about a parallel universe called Bizarro World, where perverse meaning prevails and language is stood on its head. References then included presidential appointments, e.g., a Secretary of Interior fond of strip mining and air pollution, and a Secretary of Education seeking to destroy the department.

Twenty-first century Bizzaro World consists of a health care reform "debate" that eliminates from consideration "the one reform that simultaneously solves the problem of cost, quality, and universal inclusion" i.e., "comprehensive national health insurance, or Medicare-for-All," - writes Robert Kuttner (The Policy That Dare Not Speak Its Name).

Rather than make the best case for health care reform, Democrats have acquiesced to corporate lobbies and Republican masters of distortion, distraction and demonization. Scripted rhetoric by Frank Luntz warns of "government-takeover" and "government bureaucrats standing between doctors and patients." Luntz's slogans, e.g., the "Kerry flip-flop," are faithfully regurgitated by Republicans and their mouthpieces, and broadcast by media until they become conventional wisdom -- "Repetition increases believability."

There is a purposeful confusion of issues -- multi-payer insurance bureaucracy frequently comes between patients and doctors. Medicare-for-All actually permits full choice of providers and hospitals, absent bureaucracy of private insurances. Warnings about need to "change doctors" actually apply to private plans, where employers may change plans annually.

Right-wing media remains predictably on script, but even mainstream broadcasts often adopt the political right's terms of debate. NPR's Steve Inskeep recently questioned Juan Williams about a public plan, "Has the White House found any effective way to .... say this is not going to become creeping socialism?"

Creeping socialism? Corporate socialism remains at the center of our "uniquely American" failed, fragmented, U.S. health insurance model that emulates theWall Street norm of privatized profit and socialized risk. Taxpayers and consumers bear the bulk of health and financial risk. Republicans like Sen. Lindsay Graham define ideal reform as taxpayer-subsidized private insurances -- in the mode of the multi- billion dollar taxpayer giveaway to Big Insurance and Big Pharma for 2003 Medicare prescription drug reform. A proposed mandate to purchase insurance is yet another gift to enhance insurers' bottom lines.

The primary allegiance of U.S. private health insurers is to shareholders and their profits, not to policy-holder health care access. They guarantee profits by increasing premiums, co-pays and deductibles. Sen. Bernie Sanders observes that in 2006 the six largest insurance companies made $11 billion in profits even after paying direct health care, administrative and marketing costs. The insurance and pharmaceutical industries each spent more than $1 billion lobbying over the 9-year period ending in 2007. Still more misplaced priorities: numbers of health insurance bureaucrats have increased at 25 times the rate of numbers of physicians over the past 30 years.

In a recent soft interview on NPR American Health Insurance Plans (AHIP) CEO Karen Ignani cited the need for quality, affordable coverage for all, and called for evidenced-based medicine and redress of overuse of medical tests and procedures. She failed to mention that all are issues best remedied by a single-payer insurance model.

"Affordable" is underwriters' code for stripped-down catastrophic or minimum benefit policies, increased deductibles and co-pays, and lower caps, contributing to growing legions of under-insured. In Massachusetts, as elsewhere, many of the formerly uninsured are now under-insured who cannot afford health care, resulting in the trend of insured seeking non-emergency care in emergency rooms.

The president's promise of "keeping the coverage you have" is increasingly a pipe dream, as is binding insurance to employment. As annual premium increases outpace wage increases 3 to 1, employers and individuals are moving to policies of under-insurance . A recent study reveals that 62% of personal bankruptcies are attributable to medical bills -- 75% of those bankrupted are insured.

More facts generally not heard in Washington:

Determining "best medical practice" is facilitated by single-payer transparency, and impeded by private insurance proprietary data. Single payer transparency also permits rewarding providers based on outcomes, as done in the U.K., instead of reimbursement by quantity of procedures, resulting in overuse.

Single payer permits annual negotiation of fair provider reimbursements and global hospital budgets. Redundant health care coverages, e.g., automobile insurance and Workers Compensation, would be eliminated. Eliminating multiple categories of public coverage, e.g., 20 different categories of Medicaid in Colorado alone, each requiring different means testing, annual re-authorizations, etc., would significantly pare administrative costs and eliminate barriers to care.

Even the AMA/Republicans' favorite issue of medical malpractice would be mitigated by lifetime health coverage with single payer, thus eliminating litigation for future medical costs.

Best-kept secret: No extra monies are required to implement single-payer health care. Nearly $400 billion in annual savings is possible by moving away from the multiple insurance bureaucracy, while providing upgraded coverage for all. Furthermore, only single-payer can relieve budget-squeezed cities and states of inflationary health costs for their employees, while stimulating economic recovery.

Economies of scale possible with a single-risk-pool insurance cannot be achieved with Sen. Kent Conrad's Coop Model or bipartisan compromise with for-profit insurances that practiceDenial Management (initially denying one-third of U.S. health claims) and policy rescission. Testifying before Congress, insurers Wellpoint, Assurant and UnitedHealth, acknowledged the practice of searching for excuses to cancel coverage. The three rescinded more than 20,000 policies over a 5-year period, saving their companies more than $300 million in medical claims -- a practice they refused to renounce under oath.

A parallel public plan will at best realize modest administrative savings, testified Dr. David Himmelstein of Physicians for a National Health Program. Lewin Senior VP John Sheils evaluated such a Colorado proposal in 2007 and informed state reformers that a parallel public plan functions as just one more insurance of many, failing to achieve the economies of scale or the large cost-savings possible with a single-payer model.

Even the compromise of an optional public plan will require our leaders to get past the doublespeak and Washington lobbyists. If they cannot, they should provide aid to states that are standing by with comprehensive reform proposals. If not now, when?

Comments

[perspectoff]

Wow! Great article!

25% of every health care dollar goes to administrative overhead (mostly insurance companies and billing).

Compare that to only 21% that goes to physicians and allied health care professionals. (The rest goes to drugs and hospitals.­)

No, insurance agencies will fight tooth and nail not to give up their piece of the pie. Their lawyers and PR mininformation experts are working overtime to fool the public.

Extremely insightful article.

[Michele Swenson - Huffpost Blogger]

Some Democrats mistakenly define U.S. health care problems as simply a need to insure the uninsured. At a health care Town Hall meeting in Virginia Wednesday Pres. Obama attributed uncompensated health care to the uninsured, which adds $1,000 to the health costs of each U.S. family. However, uncompensated medical costs cannot be attributed solely to the uninsured. Numbers of underinsured have increased over a decade, as insurers have sold slimmer benefit policies and passed on more costs to policy holders.

The American Hospital Association TrendWatch Reports reveal that out-of-pocket health costs rose 70% from 1995-2005; simultaneously, uncompensated medical care rose 65%. This increase of underinsured is coincident with increasing numbers carrying catastrophic coverage. Consequently, some hospitals ask for upfront payment of deductibles by holders of catastrophic policies before admission.

In 2007 Consumer Reports http://www.consumeraffairs.com/news04/2007/08/cu_insurance.htmll) revealed that 24 percent of Americans are living with skeletal health insurance (the underinsured). Overall Forty-nine percent of Americans surveyed said they were “somewhat” to “completely” unprepared to cope with a costly medical emergency over the coming year.

For-profit health insurances will always shift costs to policy holders to protect their bottom lines, regardless of attempted regulation. Providing different levels of coverage in anticipation of what health care any one person might need is at best a game of chance. Underwriting should be eliminated, and administration simplified to provide everyone access to the care they need.

[jmpurser]

Thank you for an excellent article! We really need more like this to educate Americans both about the Single Payer system and it's many advantages as well as the back room deals being cut right now to sell Americans down the river!

[Pacifist2]

I guess the Democrats, who could easily pass a single payer health care plan which covers everyone with no deductables and copays and no exclusions­,,......I guess the Democrats would rather pocket the campaign cash from the health insurance, hospital and medical drugs and supplies companies:

Oh well there is always another election coming up and we ought to vote out the scoundrels who have betrayed us.

http://www.dailybreeze.com/ci_12712516

[pontesisto]

If you would like to help pressure Congress to pass single payer health care please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

[hsr0601]

Human health, in a sense, may precede all the other basic human rights as everything means nothing for someone without it. As far as my common sense goes, the major role of government will be to protect basic rights of the public from any threat. That is why all of the industrialized countries have public policy in place, I guess. Under this premise, the strong public option needs to be cited as a part of 'PROTECTION' like anti-trust law rather than intervention. The intention to introduce the public choice would be to protect the uninsured, economy and keep the medical industry honest, not be to drive it out. Hopefully, the health industry can provide reasonable prices and quality service via tireless innovations like most of the EUROPE, otherwise the potential start-ups will likely fill in the blanks with competitive deals over the long term.

[jhNY]

The concept of Bizarro World, the trope upon which you hang this essay, derives not from Saturday Night Live, but from DC Comics' Superman.

Generally speaking, the more pressure applied to language by lawyers, the more bizarro the outcome.

[scottgreene]

The product of health insurance is to provide you with medical coverage when you need it.
Unlike other businesses that need to provide you with their product in order to make any money, health insurance companies actually make more money for themselves when they restrict and do not pay claims.
In other words, they make more money when they do NOT provide the product that you have paid them for.

Read the 50 to 70 pages of your health insurance contract.
Pay particular attention to the section entitled “limitations and exclusions”.
People’s health is not a product that needs to be left to the whims of money motivated CEO’s and stockholders.
If that is your thinking, you might as well have your police and fire department protection based on insurance premiums you pay.
Then you can go to the police and fire protection insurance page for ‘limitations and exclusions’ on whether or not the police or fire department would come out to your house in the event of an emergency.

The point is, you would never think of discriminating against another citizen if he was the victim of a fire or crime.
So why would you be ok with health insurance companies discriminating against fellow citizens who have pre-existing medical conditions?

[wendy82551]

Great article! The notion that we now have "free choice" would be laughable, if it weren't for the fact that untold thousands of people have died in the hands of profiteering insurance companies. America's health care delivery system is a complete mess, the victim of profiteers and no coherent structure for determining best practices or appropriate care. Doctors spend most of their time and money just filling out insurance forms. It's just an insane system, and as you point out, there's no way that we could NOT benefit from a public system. My only complaint is with the bought-and-paid-for Democrats who refuse to give the people what they have very clearly said they want.

[tompar]

Great article, as always. You do the research and report on it. Thanks. tom parsons