Gutting the Health Care Plan: The Scorpion and the Congress
Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion's sting, but the scorpion reassures him that he'd do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. "It's just who I am," the scorpion replies.
I fear we're about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another element parallels our current challenge--appeasement of the insurance companies as the plan's centerpiece, and the inevitability that these same interests will betray us again.
The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies' approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.
Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.
Even if single payer isn't politically achievable yet, there's no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we've been so conditioned that we can't quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn't enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.
Instead, because we've accepted the premise that the private insurance companies have to be included, we're now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can't achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns in one of the best summaries of the game, "buy off legislators and officials as they've been doing for years."
But why assume that the insurance companies are our friends? Why appease them at all? It's not as if they've played a helpful role in our current system. Rather, they've gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they've made promises to cut costs, their promises are only that (like the scorpion's), and they're already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the "Swift Boat" attacks on John Kerry). We need to challenge the insurance companies, not appease them. There's no evidence that suggests they're constructive players, or are likely to do anything except defend their own parochial interest.
The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don't want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.
Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.
Links to call legislators:
https://writerep.house.gov/writerep/welcome.shtml
http://www.senate.gov/
http://nmlegis.gov/lcs/legislatorsearch.aspx
Paul Rogat Loeb is the author of The Impossible Will Take a Little While: A Citizen's Guide to Hope in a Time of Fear, named the #3 political book of 2004 by the History Channel and the American Book Association. His previous books include Soul of a Citizen: Living with Conviction in a Cynical Time. See www.paulloeb.org To receive his articles directly email sympa@lists.onenw.org with the subject line: subscribe paulloeb-articles
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As someone who has been discriminated against by the health insurance industry (after having paid through the nose for thirty years) to the point where my very life and everything I own is at stake.....
The "Beast That IS the Problem" is the health insurance industry. We cannot solve the problem by feeding it even more publicly financed corporate welfare dollars. If you become sick and under 65, you are in a Captive Market where you require mercy and morality for survuval. Unfortunately for us, our uniquely American health unsurance industry has absolutely none of either. They place profits before people, and money before morality. Gouge the healthy and deny the sick; that's how they make their trillions. They provide exactly the opposite of a healthy model for our people, and every other civilized nation on Earth (but ours) knows it.
We need a uniter, not a divider.
We NEED our government to protect us against the health insurance industry. Unfortunately we are unable to protect ourselves.
Dear Paul,
As usual you're out frony and ahead of the curve on this one, outstanding post. Agape, dapper
Use the included links to Congress to register your opinion on this issue !
I just did and it was interesting to note that many Congressmen and Women are blocking access to their sites from automated sites of special interest groups. One of the physician leaders from Physicians for a National Healthcare Program www.pnhp.o
So, I guess this means that those of us who have the time, need to sit down and hand write letters to each and every one of these Congress persons and mail them via U.S. Post Office service. We have time to that. The vote isn't tomorrow.
I did that, marijam, and since then 4 Senators have changed their views. Imagine if we all did this!!
Good article. The reform measures will disguise a rationing of medical services especially focused on the useless eaters, ( a weakling in the population) and a profit policy that serves the insurance companies. The HMO system must be terminated as unworkable and unconscion
Check out uber-Christian, Pat Robertson admit that private health care programs couldn't compete with a public system. Des he even realize what he just said?
http://pro
Well, he did tell the truth...wh
Senator Bernie Sanders was on C-Span and Democracy Now this morning, making a forceful and eloquent case for SINGLE PAYER. Ask your Senator to co-sponsor his bill, S 703 (no, Mr. Sanders did not boast about that, but I think it needs to be said).
Your representative in the House should sponsor Rep. John Conyers' bill, HR 676, also advocating for single payer.
YES WE CAN!
Amen. The press has failed us. If the "main stream media" wants to increase its circulation as well as its relevance, it should make a relentless crusade of exposing corrupt congressmen. These guys are ruining the country.
The health care sector includes (at a minimum) two types of people: those who are in it to make a living, and those who are in it to make a killing. The second group appears to be running the show.
I have read two articles on health care reform this morning and neither of them has mentioned the pharmaceutical companies. With all due respect, unless we find a way to control the greed of these people as we do the insurance companies, we will have only won half the battle.
Which partner are you worried about, insurance companies or the government? I'd worry about the one with a monopoly on deadly force.
False choice. Insurance companies cannot be partners. Only parasites. Eventually they kill the host - but only after they have eaten their fill.
The scorpion fable perfectly describes the situation. And the relationship between the insurance companies, the drug companies and the American public can be summarized as the relationship between the Walrus, the Carpenter and the innocent little oysters.
“It seems a shame,” the Walrus said, “To play them such a trick, After we've brought them out so far, And made them trot so quick!”
The Carpenter said nothing but, “The butter's spread too thick!”
Another great and highly relevant metaphor..
PART 2 of 2
When it comes to the drug companies, most of the products they create are wonderful, but isn't it time that all countries where the products are sold share the R&D costs equally? If our government determines that we want to provide aid to a foreign country I would rather my money be provided in a more visible way (rather than me subsidizing the cost of their pills).
I wouldn't want to forget our own part in this mess. Those who engage in high risk behavior should be forced to assume a larger part of their healthcare cost. You tobacco users, clinically obese, sky-divin', drunk drivin', and non-helmit wearin' motorcyclists know who you are.
Let's not forget our liability and malpractice laws. We need to find ways to move those healthcare providers who generate the lawsuits out of direct patient care, put a cap on malpractice awards, and cut out the costs of defensive medicine that are built into the system.
Although I'm not really a fan of the Veterans Administration Healthcare System, their model comes closest to that which our country needs for a universal healthcare system. Employ all the healthcare providers (doctors, hospitals, and ancillary providers) mandate all salaries; create the formulary and negotiate the best prices paid for drugs; limit the insurance company functions to systems, record keeping and customer service; and cloak the employees & system in governmental protection from lawsuits.
As a young physician I was astonished how insurance whores expertly and inconspicuously inserted themselves into health care. Nature abhors a vacuum and 30 years ago, health care in the US was largely unregulated and extremely competitive. Physicians in order to get larger market shares for themselves embraced for profit HMOs, and provider networks. Referral patterns which were once based on finding the most competent specialists were abandoned in favor of who offered the best kick backs or lowest rates. The concept of capitation (pre payments) was inimical to physicians who had traditionally been "paid for what they do" (fee for service), and the financial aspects of health care were completely rewritten. The "holders on" diminished with time, and these days, the concept of solo practitioners is as obsolete as the corner drugstore (also a victim big business). The rhetoric of those opposed to health care reform has been deliberately deceptive, pitting evil "socialized medicine" against the freedom of choice and the family physician. Now those who have exploited not only physicians but American Health Care consumers wish to lead us to the promised land. And Senator Max Baucus wants us to all get along. Doesn't anyone smell a rat? Giordy
Important lesson--players like the Insurance Industry and Big Pharma will always use the image of the corner store, neighborhood physician or local entrepreneur to run cover for anti-competitive practices.
The segment that has always carried the load and continue to get a smaller and smaller piece of the pie !
PART 1 of 2
Just so you know where I'm coming from, I do support the development of a single payer system. Having said that, it amazes me that the public seem to think that the key battle is with the Insurance Companies. No matter what profits they earn or how much their CEOs make, the Insurance Companies represent a relatively small piece of the pie. Not nearly enough to fund free healthcare for all if they vanished tomorrow. The lion's share of the money in the system goes to the doctors, hospitals, pharmaceutical companies, and ancillary providers. Much of what they do is good, and it's necessary, but there's a reason why most doctors live in very nice homes, drive the Mercedes, and send their kids to private school... it's because they can give themselves a raise whenever they want. And they do. There is virtually no price competition in the healthcare world. And don't kid yourselves
Scarce, trained, healthcare employees have huge bargaining power when it comes to their salaries. Their professional societies continue to foist higher and higher education requirments on their membership, which both limits their numbers and unneccessarily increases the costs of entry to the professions. All of this translates to increased competition for employees => higher salaries => increased costs to the Healthcare system.
What a load of BUNK!
The way you put your last word all in caps made your argument totally convincing.
I wish I had thought of it.
Single payer, the only fair way. Everyone has access to the same coverage.
Republicans are using the same brainwashing, "the sky is falling" fear tactics as usual. Notice the only ones screaming this are the wealthy with excellent coverage and the insurance lobby (wealthy with excellent coverage).
Socialism, my behind. Police, fire, EMT/emergency services, road construction, parks systems, schools, just a few examples of your socialized tax money at work......
We have employer provided health care, very, very good insurance by any standard. Negotiating the copays vs deductibles, what is actually covered and what is not, is an absolute nightmare. It covers almost nothing for our child recently diagnosed with Type 1 Diabetes (an unexpected
In this reform, there will be some pain - better the insurance companies take the hit than the consumers.
I want the SAME healthcare for my family that Congress receives for life. Good enough for them, good enough for me. We are, after all, paying for their insurance through our tax money. Why should they have better coverage than us?
Read a suggestion (can't remember where, but probably HufPo) some time ago that members of Congress should have to suspend their coverage until they reach an agreement on true reform for the American people. What a wonderful idea......
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