Spinning Health Care: A Bad Case of Vertigo

"I want to cover everybody," President Obama said at his news conference Wednesday night. "Now, the truth is that unless you have a -- what's called a single-payer system, in which everybody's automatically covered, then you're probably not going to reach every single individual. . ."

The same conventional wisdom keeping single payer off Washington's table has been spinning for various "reform" plans with such accelerated RPMs that at this point the nation's "health care debate" is suffering from a severe case of vertigo.

"The overwhelming majority of Americans want health care, but millions of them can't afford it," Obama told the assembled journalists. "So the plan that has been -- that I've put forward and that -- what we're seeing in Congress would cover, the estimates are, at least 97 to 98 percent of Americans. There might still be people left out there who, even though there's an individual mandate, even though they are required to purchase health insurance, might still not get it, or despite a lot of subsidies, are still in such dire straits that it's still hard for them to afford it. And we may end up giving them some sort of hardship exemption."

That may sound good. But it's in the service of an agenda for "health care reform" that's seriously flawed.

Days ago, buried in a chart under the headline "How the Health Care Bills Compare," the New York Times provided some cogent yet cryptic information in the category of "Public Plan."

A key Senate committee had just approved a bill with a public plan that would "compete with private insurers," the Times chart explained on July 18. The public plan "would provide 'only the essential health benefits,' as defined by the bill, 'except in states that offer additional benefits.'"

Meanwhile, the newspaper noted, "Democrats from three House committees are working on a single plan." Under that plan, "Different levels of coverage -- 'basic, enhanced and premium' -- can be offered through the public option."

Those few grainy sentences, quickly swept beneath the waves from oceans of media, referred to a disturbing aspect of "public plan" scenarios. If the ostensible goal is health care for all, then -- at best -- some of the "all" would end up being much more equal than others.

The Republican Party is coming from such a right-wing place that any government action to improve health care access is ideologically unacceptable. In contrast, the broad outlines of a Democratic "public plan" at least embrace the precept that the not-so-tender-mercies of the market are insufficient to fully provide for the population's medical needs.

But as a practical matter, a "public plan" coexisting with the private health insurance system -- generally touted by U.S. media as the pole of real options farthest from the Republican "free market" fixation -- is inherently reconciled to major inequality in access to health care.

Even while straining to put forward a "public option" as some sort of stunning government intervention to level the health care playing field, media coverage rarely comes to terms with the situation that would actually remain under such a scenario.

How does "health care apartheid" strike you?

For the government to offer the public a multi-tier set of options for health insurance -- in the words of the New York Times, "different levels of coverage" such as "basic, enhanced and premium" -- is to imitate the approach of the corporate health care establishment.

After all, isn't it implicit that the government plan's "different levels of coverage," offered to the public, would be based on ability to pay?

Missing from the dominant health care debate -- not only along Pennsylvania Avenue but also along media row -- is a principle that could be debated and should be debated.

In a few words: Health care is a human right.

And a human right should not be contingent on ability to pay. Nor should it be divided into "basic, enhanced and premium."

Media accounts keep telling us that the current political debate on health care is unprecedented and groundbreaking. But an article in the latest edition of the Columbia Journalism Review, by seasoned health care reporter Trudy Lieberman, makes a convincing case that little has changed within the frames of media parameters.

The press "has mostly passed along the pronouncements of politicians and the major stakeholders who have the most to lose from wholesale reform," Lieberman writes. "By not challenging the status quo, the press has so far foreclosed a vibrant discussion of the full range of options, and also has not dug deeply into the few that are being discussed, thereby leaving citizens largely uninformed about an issue that will affect us all."

What we're seeing now is a slightly freshened version of a timeworn tap dance that ranges across a constricted media stage. As Lieberman notes: "Absent from the debate are not only single-payer systems like the ones in England and Canada, but other systems with multiple payers, like ones in Germany and Japan -- or, for that matter, any discussion of why a system that relies on competition among private insurers in The Netherlands hasn't resulted in lower prices for consumers, as advocates claimed."

The variety of health care delivery systems abroad, in industrialized countries, spans a common assumption -- health care as a human right -- an assumption that doesn't cut the mass-media mustard in the United States. "What's common to all these systems," Lieberman points out, "is that everyone is entitled to health care and pays taxes to support the system, and medical costs are controlled by limits on spending. The specter of a system that takes a significant bite out of stakeholder profits in the U.S. is the real reason the debate is so restricted."

As Trudy Lieberman puts it, "Reform efforts have danced around this impasse for decades."

That helps to explain why so much media coverage of health care reform proposals is apt to be so baffling to most readers, listeners and viewers. When the big elephant (or, if you will, donkey) in the national newsroom is dependent on the insurance, pharmaceutical and hospital industries for financing, there's a distinct shortage of candor about the consequences of such ongoing intrusions. Newsgathering, media debate -- and, of course, health care -- suffer the consequences.

In the mid-1960s, Medicare became law with the stroke of a presidential pen. Lyndon Johnson was able to sign the measure despite a huge onslaught of opposition from right-wing politicians, their corporate backers and professional groups like the American Medical Association.

These days, the AMA may be somewhat more circumspect in its continuing opposition to progressive measures, but the overall balance of political power remains heavily tilted against health care for all.

"In the Senate," columnist Gail Collins noted in the July 23 New York Times, "everyone is waiting on Max Baucus of Montana. Nothing is going to happen on health care without the approval of Baucus," the chair of the Senate Finance Committee. As the Washington Post reported days ago, he "has emerged as a leading recipient of Senate campaign contributions from the hospitals, insurers and other medical interest groups hoping to shape the legislation to their advantage. Health-related companies and their employees gave Baucus's political committees nearly $1.5 million in 2007 and 2008."

Today, the kind of arguments heard during the early '60s against guaranteed health care for the elderly can now be heard against establishing a comprehensive single-payer system -- also known as Medicare for all. But now, the health care debate is trapped between a political establishment that doesn't want a single-payer system and news media that insist on ignoring its real potential.

Norman Solomon is national co-chair of the Healthcare NOT Warfare campaign. He is the author of many books including "War Made Easy: How Presidents and Pundits Keep Spinning Us to Death," which has been made into a documentary film of the same name. For information, go to: www.normansolomon.com

 

Comments

[johnashman]

To the author - you're mischaracterizing Republican response. They want reform, but there are other basic reforms that need to happen, such as tort reform, that Democrats refuse to allow. It is just as easy to say that Democrats are coming from such an extreme *left wing* position that Republicans simply have nothing useful to add, it's so utterly out of their basic belief system. What part of socialism are Republicans supposed to have a sensible input on? It's like asking an atheist to have input on Catholic dogma.

[johnashman]

My solution to health care -

http://64.203.97.61/SolutionsLab/Solution.aspx?Guid=2d50363e-00be-44e8-9251-9a6589ba820d

Very detailed and it will work. I challenge Barack Obama to a debate, his healthcare system versus mine.

[Lendall]

In a capitalist economy, the statements "health care is a human right" and "property is a human right" are always going to be inherently in conflict. The selling point for socialism (and I mean socialism, not totalitarian, Mao-ist or Stalinist communism) was that the government would own certain large industries, run those industries at a profit, and use that profit to fund "the welfare state." This is Hugo Chavez's idea in Venezuela, which (for the moment) is "lucky" enough to have an industry (oil) which can be profitable enough to achieve that objective. (This is not to say Chavez is not, in his own way, just another typical Latin American egomaniacal demagogue.) To put this another way, "the welfare state" (including "free" health care) was advertised as a benefit of socialism. The idea was not to support it through confiscatory taxation. We could easily nationalize Exxon, etc., and achieve the same thing. I am smart enough to know that this is not about to happen. What's my point? I believe that we should pay for a single payer plan -- NOT one based on private insurance, like the Obama plan -- by closing American military bases abroad and giving up playing global policeman. THEN let's nationalize Exxon.

[econ1]

A public option will become the largest provider of health care, just as Fannie and Freddie have become the largest holders of mortgages. The ability to tax will insure that. The question is only, do we care.

There will be tiers (good, better, best) because some people will choose to spend more on health care than on something else and they should have the right to do that.

The cost will be very high because health care is an inexhaustible desire (even if someone else is paying for it you can only eat so many burgers...not true with health care). There will be large lobbying efforts to get coverage for every program, procedure and drug and if the politicians can't resist adding them the costs will naturally rise to cover them. The UK is experiencing that today.

It will be interesting.

[krocklin]

Free healthcare coverage as a common right, as enjoyed in all other First World nations, is what is missing in all this discussion.
Compassion for other Americans is not there.

[Marcospinelli]

Single payer universal health care would NOT put Big Insurance & PhRma out of business.

If we went to single payer universal coverage, there would be a two-tiered system: Basic coverage for everyone and boutique coverage for those willing to pay for it. So you don't have to worry about poor Big Insurance & Big Pharma -- There will be work for all. Big Insurance & Big Pharma will just have to make smarter gambles, with no taxpayer bailouts.

[Marcospinelli]

I think that people mistakenly believe that Obama&Democrats want public health care.

If TheBushYears taught us nothing else, it's that anyone can sell anything to Americans, if you're stolid & relentless in your sales pitch & tactics. It's not that Bush&Rove were geniuses & knew something that nobody else knew; Bush&Rove were just more ruthless (clumsy & careless many political graybeards would say) in doing what politicians & the parties had gone to great lengths to hide from Americans.

Obama didn't get to be the first black president, vanquish the Clinton machine & the oldest, most experienced politicians in our nation's history (including the Rove machine) by not having mastered these skills. Nor do Democratic politicians (more incumbents than ever, in office longer) not know how to do it. How do you think Democrats managed to keep impeaching Bush&Cheney off the table & have us still reelecting them, not marching on Washington with torches&pitchforks?

Obama&Democrats know how to do it -- They don't want to do it.

The trick for them has been to keep the many different populist groups believing that they really do support our issues, but that they're merely inept. And to get us to keep voting for them in spite of their failure to deliver on any of our alleged shared objectives.

[quidam56]

Mitch McConnell says he's worried the best health care system in the world will begin to ration health care. That's what we already have. They're worried about people having to get in long lines just to get health care. We already have that too. http://www.wisecountyissues.com

[tegrat]

There are much better ways to debate this issue than insisting that "healthcare is a human right." Although you and I may agree on that, the fact is nobody on the right believes that, so using it as an argument is pointless and just further alienates them.
The real point that needs to be made is that multi-tiered systems create not only inequality but inefficiency as adverse selection is immediately introduced into the healthcare financing system (not to mention problems and costs of enrollment, means testing, and policing the system). Best to make your arguments on their undeniable economic merits, not on feel-good rhetoric that just alienates those you need to win over.
Single-payer, with its single comprehensive plan, has been shown over and over, both in analysis and real world experience, to be the best way to finance healthcare, both economically and in terms of what is most equitable.

[waynehil]

It is amazing that seniors over the age of 65 have a government run health plan and you have very few complaints. If a government run plan is so bad, how come most people under the age of 65, can't wait to get on it.
The mechanism is in place. We just need to expand the ages that qualify.
The American people in the next few months will get to see if leadership exists.
To those in Congress who are enjoying public healthcare, why not suspend your public heathcare until a bill is passed? I am sure that would speed the process.

[sixyfivepercentwater]

"seniors over the age of 65 have a government run health plan and you have very few complaints" Oh there are a lot of complaints. This is the plan that doesn't pay for drugs, you know. Medicare is flawed and bad and just plain not what anyone wants to model a health care system on.

[sixyfivepercentwater]

The only thing that makes sense is a single-payer system based on the systems which are now in place in Europe. Unfortunately that cannot happen, because the health insurance companies will block anything that cuts into their profits. Until and unless we manage to get rid of the balky, unworkable insurance companies which rob us blind while giving very little of quality in return, we will never solve the health care crisis.

[Marcospinelli]

"Unfortunately that cannot happen, because the health insurance companies will block anything that cuts into their profits."
==========­==========­==========­==========­==========­======

What do you think people are supposed to do with that information?

Do health insurance companies have more votes than the people? Of course not.

While Blue Dogs just got millions from the health insurance lobby for throwing a monkey wrench into this and their campaign coffers are flush, in the end it's voters who hold the keys to opening the door to single payer universal health care.

Comments like yours serve to discourage Americans into thinking it's futile. It isn't.

[PrawnSprat]

There is another humongous elephant in the room of public discourse on this subject...and that is that, as people with common sense either know now or will be concluding in the next few years, that no country can have a hyper military system, such as the US does, where military spending in the US is greater than the next dozen countries beneath it combined, and at the same time have the quality universal health care that Britain, France, Japan, etc., have. Unfortunately Democrats are scared stiff of announcing this publicly for fear of being branded as sissies and losers by a rabid GOP and all right wingers, including the Blue Dog Dems. There seems no way out of this dilemma, especially if there's another domestic terrorist attack, because then spending on enhanced 'security' and military capability will trounce any sissy health care bleeding-heart stories and problems.

[Bernique]

So Prawn, you're saying it's guns or butter? I go for the butter. Anyone else with me?

[kathy001]

Butter!!

[DIdaho]

Well, I'd agree in philosophy but it ain't gonna happen. People with more wealth and income will always have more and better - better, bigger houses, more and better food - their kids will go to better schools and sleep on softer beds.

And even under single payer, rich people will buy better rooms, pay for optional and experimental services... there's no end, so this is a moot argument.

But while it's true the rich eat better, that's not an excuse to allow starvation. They have bigger homes, but that doesn't justify homelessness. They go to private schools, but that doesn't mean you shouldn't have public education.

A "basic" plan people can actually afford that covers them for most of the required medical services - infection, broken bones, chronic disease - is just fine with me. It might just be a first step, but it's a lot better than the nothing we've got now.

[kathy001]

Very well said. I agree.

[snesich]

Well, Single-Payer is the only system that really makes sense.

However, in the interim, a Public Option WOULD be a vast improvement over the status quo. And it would be a foundation to work from.

Why do you think the Republicans, the insurance companies and much of the media is so hysterical and adamant in their opposition to a Public Option? Because they know it WOULD make a vast difference and it would undercut their "Big Government Is Always Bad" Boogeyman scare tactic.

Sometimes you have to walk before you can run. And I don't want to see genuine Health Care Reform go down the tubes for another 16 years because we let the perfect plan be the enemy of the good beginning.

[Marcospinelli]

Public option plans have been tried in several states, & in every case they've failed to reduce costs or increase coverage. The only proven way of accomplishing both goals (based on a half-century's track record in Europe & Canada) is a nonprofit, single payer approach.

For a detailed analysis of the pitfalls of the public options:

http://www.commondreams.org/print/43440

http://www.pnhp.org/facts/singlepayer_faq.php#public-option

We've waited over 35 years after being given that same argument, "We can fix it later, get single payer universal health care once we get our feet in the door with employer-based".

This is it. This is the time. If Obama and Democrats can't get it done, they need to be ousted. And they will be.

[Bernique]

Not -for-Profit is the key to evening out the stakes for the health care providers, and their patients. If sick people make the "insurance" rich there will be more sick people (whether they are or not).

[Marcospinelli]

You do know, don't you, that Obama dropped the public option last night, don't you?

[expired]

Health Care: The Public Plan Option

These Democratic Senators have NOT agreed to support it:
Senator Blanche Lincoln (D-AR)

Senator Tom Carper (D-DE)

Senator Maria Cantwell (D-WA)

Senator Ron Wyden (D-OR)

Senator Bill Nelson (D-FL)

Senator Ben Nelson (D-NE)

Senator Mary Landrieu (D-LA)

Senator Kent Conrad (D-ND)

Senator Max Baucus (D-MT)

Senator Dianne Feinstein (D-CA)

Senator Evan Bayh (D-IN)

Senator Mark Pryor (D-AR)

Senator Joe Lieberman (I-CT)

Senator Mark Warner (D-VA)

These names are reported by The Hill here and here

Update: Senator Kay Hagan (D-NC) says she supports a public option.
Update: Senator Jeff Binghaman (D-NM) says he supports a public option.

You can also contact the White House and voice your opinion
Comments: 202-456-1111
Switchboard: 202-456-1414

[johnashman]

Bravo. Good for them.