RADICAL ACTION: HEALTH CARE
Universal health care is within our grasp if only we can accept the simple reality that "insurance" adds nothing to the delivery of medical services.
Insurance industry spokesmen will claim that the delivery of health care "starts with insurance": as though doctors, nurses, clinics, hospitals, pharmacies, and so forth are clinically unable to apply their skills and facilities to the sick and wounded unless they come into through the "insurance door." The folly of this conceit has become largely ignored during the last half century because of two significant developments, one is marketing, the other political.
Marketing
Back in the 1950's, the insurance industry was searching for ways to expand its product line. After all, there are only so many ways to package life insurance. They hit upon "sickness and accident insurance" as a way to sell more product to existing customers and to broaden the customer base by protecting people from the costs of an unexpected illness or a serious accident. Here was a product that could be sold to people who disdained life insurance for one reason or another. The general public didn't necessarily jump on sickness and accident insurance initially, but sales took off when the insurance industry got together with the labor movement and began to add S and A coverage to the collective bargaining mix. Soon it became a desirable perk in the booming U.S. economy where companies were competing to attract good workers. This was a marketing idea that worked miracles for the insurance industry's bottom line. The tragedy is that now people think it is the employer's DUTY to provide health insurance. It helped the insurance industry greatly, but hurt lot of companies substantially, including the auto manufacturers who must complete with foreign auto makers who are not saddled with huge health insurance costs.
Skyrocketing costs
By the time millions of workers were covered, causing billions of dollars to flow into insurance industry reserves, there was created a really massive amount of cash, just laying on the table. At the same time, people who now had their doctor bills paid by someone else were understandably going to the doctor more often. This is called "utilization. " In many cases, this increased utilization had an overall beneficial effect on the public health since it encouraged preventive medicine. It also encouraged development of more effective and expensive forms of diagnosis and treatment, with major breakthroughs in testing and treatment protocols, especially pharmaceuticals. Though it saved countless lives, it also multiplied the costs of health care exponentially, costs the "insurers" merely passed on to the "insured."
The result is a system in this country which is thoroughly analyzed and debated but never allowed to change substantially. The insurance industry controls health care delivery and those without insurance, (some 40 million people) often go without health care, a situation unique among developed nations.
Political
The question, and it is a fundamental one is: why does this situation persist? Why cannot the United States take advantage of the experience of other countries and construct a health care system that serves everyone, just as so many other aspects of our society are designed to be shared by all? The answer, quite simply, is that our political system is based on bribes (only we call them "campaign contributions"). A politician's primary, and absolutely controlling objective over all else, is to get elected and then to get reelected. That this takes pots and pots of money is no surprise, and neither is the fact that one of the deepest pockets in the fund-raising game is the insurance industry. Any attempt by anyone to install a health care delivery system that does not include insurance will be attacked, overtly, covertly, and every other way by the big guns of K street and every other avenue of influence available. A good example is the "Harry and Louise" advertising campaign that helped destroy the Clinton administration's attempt at improving the system in the early '80s. The Clinton plan was poorly designed and should have been substantially modified. However, its defeat was primarily an insurance industry accomplishment, as has been the defeat of every other single-payer initiative before or since.
Therefore, radical action is needed and now, to get the insurance industry out of the health-care business. Insurance has no place in medicine. It adds nothing, nothing that cannot be provided more equitably and at far less overhead cost by a single-payer system.
What kind of system is best?
There are lots of different programs in use throughout the developed world, but one of the best is in use right here in the United States. It covers everyone in its target groups, no restrictions on pre-existing conditions, premiums are affordable, administrative overhead costs are minimal, a fraction of insurance industry costs. This system has been in use and proven itself for generations. It is called Medicare and its experience and methodology in covering the most difficult segment of the population, the seniors, are readily transferable to the population as a whole.
Medicare controls costs by putting a cap on specific charges by doctors and hospitals. It controls utilization by analyzing the claims of all providers for each individual patient, and is subject to congressional oversight which helps protect individuals from egregious denials of service and dangerous delays which are only too often experienced by "insured" patients.
Opposition
The naysayers will decry another bureaucracy, a costly entitlement program of social engineering. It is their favorite battle cry against anything designed to make things better for those who do not have it all. The trouble is, it does not hold water in the single-payer debate. Consider for just a moment the massive amounts of cash being funneled to the insurance industry every month in the form of premiums. How much does your employer pay on your behalf? How much do you pay for private insurance? If uninsured, how often do you put off necessary medical attention because you cannot afford it? How many hospitals are struggling to keep emergency rooms open because they are overwhelmed by "uninsured" patients?
You could take the total amount of insurance premiums now going to the insurance industry,( including above-average profits, and huge executive salaries), cut that amount in half, and it would probably be more than enough to cover a single payer system like Medicare, even with some of Medicare's flaws corrected, principally the amount it pays providers. The old saw based on the "inherent inefficiency of government bureaucracies" also bombs when you compare Medicare's total overhead cost against that of the insurers.
Radical action needed
Politicians, some well-meaning, are trying to broaden health care delivery to include at least some of those presently uninsured, but they're all still on the insurance industry leash. They want to provide "insurance" to the "uninsured." They want employers and even doctors to help foot the bill. One prominent governor has been opposed to any single-payer plan on the foolish notion that it would "limit choices and innovation while forcing rationing and long waiting lines for care." These insurance talking points are baloney. All doctors would very likely support Medicare if the reimbursement was more reasonable. For that matter, a single-payer system should require all doctors to participate or lose their license,. . And how long are waiting lines at emergency rooms now? The answer is simple and compelling. Single-payer systems work well elsewhere and we already have a working system here in the form of Medicare. With a few improvements, it could be rolled out to cover everyone and the results would be historic: everyone would be covered, the care would be better, and the overall cost would be far less.
Who will carry the ball?
