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?