As Gov. Arnold Schwarzenegger recovers from his fractured leg, he has access
to the finest medical care California has to offer, as he should. But don't
all Californians deserve the same degree of medical attention and health care
In a few days, the governor is expected to unveil a sweeping health care proposal, following the leaders of the Senate and Assembly, who already have proposed changes to the state's dysfunctional system.
Yet for all the talk of a "bipartisan" consensus for reform -- following
years of inaction despite a worsening crisis -- it appears most options being
suggested will exacerbate the problem, retard efforts to achieve genuine
reform and further enrich the corporate elite in the health care industry who
produced the present shambles.
If your head is spinning from reading all the various ideas being thrown
around, here's a Cliffs Notes version. Essentially, all the choices can be
distilled into two general areas -- patient-based reform with public
accountability, or market-based approaches.
In the market category fall most of the alternatives being swooned over today
by the insurance companies and others invested in pure market-based
solutions, the politicians who cater to them and those pundits who counsel us
to lower our expectations. Among these proposals are laws to force
individuals to purchase their own insurance; starting health savings
accounts; and expanded mandates that employers provide benefits for their
employees or pay into a pool for coverage for those without insurance.
Their common theme is a reliance on commercial mechanisms that created the
present crisis by sacrificing quality, affordability and access for private
profit. And all these solutions are doomed to repeat that cycle.
Consider the current fashion of the moment, the Massachusetts model. Every
adult in that state is required to buy insurance coverage by July or face
penalties. Subsidies are provided for low-income residents.
But the plan has gaping holes. Parents are not obligated to buy insurance for
their children. Moderate-income or even middle-income adults who would have
to spend hundreds of dollars more each month for full family coverage may
choose to gamble with their children's health or just cut back on other basic
Further, the plans available to middle-income residents typically have
deductibles that can run into thousands of dollars. Consumers are likely to
foot the bill for many health care services in addition to the premiums the
law would require them to pay. And, in the event of a serious illness or
accident, they may find their cut-rate plan abandons them to financial ruin.
Consumers are even likely to lose the choice of a physician because they will
be forced to pick among the doctors whose services are covered by the
low-cost plan they can afford.
The Massachusetts plan is loved by the health care industry because it
transfers huge pots of public money to private health care corporations.
Health savings accounts, marketed as "consumer-directed" solutions because
they pair a high-deductible plan with a tax-free personal spending account,
are similarly catastrophic. HSAs simply shift the cost of coverage from
insurers to individuals, promote rationing of care and do nothing to reduce
the number of uninsured.
Rather than reduce the bloated 30 percent of every health care dollar spent
on administrative overhead and waste, HSAs actually increase administrative
costs with servicing fees paid to the financial institutions that are
climbing over each other to grab their chunk of this new lucrative market.
By contrast, consider the approach in every other industrialized nation in
the world: either a national health system with public administration and
public hospitals and clinics, or a single-payer system, with one entity that
pays for all health care services with adequate funding to the private
caregiver, hospital and clinic of the consumer's choice.
Poll after poll documents that Americans overwhelmingly support either
approach. A single-payer system is not just a dream, it's legislation -- HR
676 in Congress, and a measure in California by Democratic state Sen. Sheila
Kuehl of Santa Monica, Senate Bill 840, which was vetoed by Schwarzenegger in
September. It will be reintroduced in 2007.
While politicians clamor to come up with inferior alternatives, it will be up
to all of us to remind them why this country's inferior market-based plans
will simply extend our national disgrace.