As President Obama ratchets up the pressure this week on Congress to vote on healthcare reform before the summer recess, it must be noted that the discussion does not connect the dots to our broken food system. And while I commend President Obama for taking on such a contentious subject with the aim of improving the lives of those suffering in our current economy, two thirds of the American people want a single-payer system and the option is not even on the table. Addressing these two issues will be critical for deep and lasting healthcare reform.
The United States is the only high-income industrialized country not using some form of a single-payer healthcare system. Single-payer could be an expanded form of Medicare, and actually ensures under the Civil Rights Act that no one will be denied care. Conversely, privatized insurance companies can and do deny care with near-impunity. The administrative simplicity of the single-payer system would save on overhead costs, while the costs of care would go down because the profit margins private insurers would be cut out of the equation.
Despite what anyone tells you, single-payer is not socialized medicine, and no ominous government bureaucracy would step in and deny or "ration" care. The critics of single-payer are either paid to tell you this, or are brainwashed by the multi-million dollar lobbying and advertising paid for by insurance companies and the pharmaceutical industry. It is in these two industries' interest of continued uber-profitability for our broken system to stay as is; sickness, to these corporations, is an opportunity.
Parallels can be drawn in agribusiness, which also profits from feeding us cheap calories, and doesn't want any changes coming out of Washington. Indeed, the healthcare debate is intimately intertwined with our food system. We spend twice as much per capita as Canada does on healthcare, and not because Canadians are "waiting in a line" and getting denied care; denied care has become our specialty. "Pre-existing condition" could quite possibly be the scariest phrase in our language for the 46 million uninsured.
In fact, we spend more on healthcare because of what we eat. And what we eat is related to the choices our politicians make on national, state and city-wide policies concerning what we feed our kids in school; what we allow advertisers to tell us about what to eat; food labeling; food accessibility in rural and urban areas; what crops we subsidize; whether or not the people who grow our food have access to healthcare (many don't) and more.
In these debates we don't ask: is healthcare a right or an option? Higher education is so expensive now that workers are bound to their workplace because of massive debt, feeling compelled to overwork in order to keep their health insurance, and therefore are too exhausted to cook. It's all related. It has been proven time and time again that what we eat correlates to our future incidences of preventable diseases, all on the rise, like diabetes, heart disease and cancer. Even the Centers for Disease Control released a study giving recommendations for changes in our communities that could lower the current rates of obesity -- these are great, but they put the impetus on the local level changes instead of nudging policy-makers. And still to bring all this up in the healthcare debate, it seems, would be political suicide.
It's possible that "the public option" that Obama is promoting is a necessary first step to an overhaul of the healthcare system. The good news is that this new plan seeks to better regulate insurance companies, and seeks to lower costs through competition (Paul Krugman said this in his column in yesterday's Times: "Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition"). Mandates require the uninsured to buy into an insurance program or pay a penalty. Medicaid would be expanded, and subsidies would be extended to cover some of the costs. These subsidies are said to be canceled out by other cost-cutting measures. So why are the insurance and pharmaceutical industries so happy? They have brought Harry and Louise back to throw their weight behind the plan, indicating that perhaps the competition fostered by the public option might not be enough. So how do we get from here to "real change that we can believe in?"
On Bill Moyers Journal this past Friday, Moyers spoke with Trudy Lieberman and Marcia Angell, two experts on health care reform, in continuation of his excellent recent coverage on the subject. (Hear him speaking with Dr. David Himmelstein and Dr. Sidney Wolfe on May 22 about the ins and outs of a single-payer healthcare system; with Robert Reich about the entrenched interests in Washington and the healthcare debate on June 12; with Wendell Potter, who spent 20 years in the insurance industry and give that perspective, from July 10th). Both of the experts on Moyer's program on Friday felt this system would not be a significant enough change, and might cost more than we think due to concessions to insurance companies. Angell, senior lecturer in social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine, said that she was worried that the insurance lobby would "use their clout in Congress to hobble the public option in some way. And have it become a dumping ground for the sickest patients, and then cream off the profitable ones for themselves. And then what people would decide is that the public option was no good."
I think we have to start all over on this. I really do. I think we have to go for a single payer system. You could institute that gradually. You could do it state by state. You could do it decade by decade. You could improve Medicare. That is, make it nonprofit. But extend it down to age 55 and age 45 and age 35. It would give the private insurance industry a chance to go into hurricanes, earthquakes or something. To get out of the health business. It could be done gradually. I think that has to be done. And it's the only thing that can be done.
The question, then, is how to do what Obama promised but has not yet delivered: get the lobbying interests out of Washington once and for all. It seems that this is the root of many of the problems we face (Reich gives an engaging insider perspective on this with Moyers, linked above). It is specifically the cause for preventing single-payer, something Obama supported before becoming President, from even being on the table for discussion. If we are ever to get anything done in the public's interest in this country, the necessary first step must involve campaign finance reform. Without the influence of industry buying off our politicians through campaign donations, it could be possible to implement the best option for reforming healthcare and to admit that sustainable agriculture is the only way to feed people as water and oil resources become scarce. Until then, we will keep pulling our teeth out with pliers and gorging on high fructose corn syrup, while the agribusiness, insurance and pharmaceutical industries profit on our suffering.