I’ve been waiting for universal health care legislation since 1949. But, of course, the opponents of such legislation don’t want us to do anything “hasty,” and “jam” legislation through Congress. They want “careful consideration” of health care reform as if 60 years of proposals, studies, and deliberation were not enough. Representing the opponents of universal health care, Republicans and a few Democrats are offering some principles that they believe should govern health care reform legislation. First, any reform should be the result of a bipartisan process. Second, we need to control costs and be fiscally responsible while we’re doing it. Third, anyone who wants to should have the right to keep their own coverage if they like it. They shouldn’t be forced into a Government Plan. And Fourth, any changes must ensure that all health care decisions are made by patients and their doctors. I’ll comment on these principles.
First, the principle of bipartisan process. Just how important is a bipartisan process to good health care reform? Will it lower the cost of health care? Will it improve its quality? Will it cure anybody? Will it create jobs? Does anybody outside the Beltway care about it? Of course, the opponents of universal health care want to assert bipartisanship as a sacred principle of Congressional action. To the extent they can sell that to the rest of us, the greater the chance they will have to make sure that the universal health care reform is no reform at all. And, if it doesn’t work, then guess who gets hung for failing to pass it? Not the Republicans. After all they don’t have big majorities in both houses of Congress, did they?
BTW, if the Democrats had a single payer plan on the table, would the Republicans be so aggressive in their opposition to a public option? Or has the Democrats’ “strategy” of taking it off the table shifted the whole debate to the right, because the Republicans and “blue dog” Dems now have nothing to lose by taking the extreme position of opposing a public option that would really work? Would any “blue dog” Democrat dare oppose a strong public option, if a single payer plan were a serious alternative? I doubt, because if they did, they’d look too much like Republicans rather than “moderate” Democrats and would be much too likely to be “primaried” next time around.
Second, controlling costs and being fiscally responsible. Another winner. What’s fiscally responsible for Republicans is any deficit created by Government expenditures or tax cuts that they like. And what’s fiscally irresponsible is any Government expenditure and tax increase that they don’t. And since they never met a tax cut they didn’t like, and they also never met a tax increase they liked, we can be excused for thinking that their notion of “fiscal responsibility” is simply that its a convenient tool they can use to complain about what Democrats want to do. A fiscally responsible health care reform is one that will lower costs for consumers so that 1) less of their income can be spent on health care than now, 2) no one will be driven into bankruptcy by health care costs, and 3) we have an end to foreclosures resulting from the economic hardships caused by health care expenditures. If we can achieve these three things through universal health care, the stimulus effect on the economy will translate into increased economic activity and increased tax revenues that drive down Governmental deficits. Any other kind of health care reform is not fiscally responsible, and we can be sure that any reform that continues to give carte blanche to the insurers to “control costs,” will be fiscally irresponsible because it will eat up far too much of the Federal Budget reimbursing the private sector for its exorbitantly price services, housing, and medicine.
What about the third principle, freedom to keep your current coverage if you like it? Well, this principle is important for those who like their health care now. But what about the freedom to get rid of coverage you don’t like and get into an alternative plan that will protect you from bankruptcy and foreclosure? Why isn’t that a fifth principle that ought to govern reform? Which and whose freedom is more important? A well-known simulation study by a firm owned by United Health Care (can you trust their results?) has estimated that 119 million people would shift their coverage if they could get into a public option plan that was priced like Medicare. In addition, 47 million others presumably don’t like their current health care plan at all, since it’s called “go to the emergency room, and if the cost of services is more than you can afford get sued later by the hospital and their associated physicians.” So, altogether, about 166 million would prefer a public option modeled on Medicare to their present circumstances. Isn’t their freedom to select a Medicare-type plan just as, or more important than the freedom of the 80 million or so who might still prefer privately-funded plans in that scenario? Of course, no one is suggesting that the 80 million or so who would prefer their current insurance would be forced to give it up. Even a single-payer Government solution could be structured so that people could keep their present coverage if they wanted to pay additional fees for it. And if the alternative passed by Congress were a public option Medicare-like plan, then those who wanted to could also keep their present coverage for as long as they liked.
Of course, those who oppose a public option with teeth, point out that a public plan would shape the health insurance market in such a way that prices might rise for those who who want to keep their present coverage, and that, over time, that coverage might disappear entirely because of the inability of one’s private plan to compete with a public option. Well, what can one say about this? One can be cheeky and point out that if Government plans are as bad as the supporters of the Insurance industry say, then the public option shouldn’t be able to compete with private plans in efficiency and quality health care, so why should the private companies worry? But this reply is disingenuous because everyone, including private insurers, knows very well by now that single payer plans in other wealthy countries around the world all deliver both lower costs and higher health care quality than private insurance in the US. Why else would life expectancy be greater and infant mortality lower in these countries than it is in the United States, and why else would the United States rank 37th in UN health care quality ratings? So, I won’t even pretend that private insurance companies will be able to compete with a single payer plan or even a Medicare-style public option plan. Instead, it seems clear to me that, in the long run, even if not immediately, those who like their current health insurance will probably have to adjust to its eventual disappearance. But, again, that is better than denying twice the number of people their freedom to participate in a Government-funded plan that suits them better than the current system, especially since the people who eventually will have to shift to the public option will, at least be getting a plan that will not leave them in bankruptcy, or with a foreclosed home, or with lack of coverage for illnesses they were sure were covered.
The fourth principle of the Republicans, of course, is that in developing a new system we should never let anyone get between patients and doctors. This, to my mind, is the most cynical and hypocritical of the Republican “principles,” other than “bipartisanship.” The private health insurance system we have now, which the Republicans have so vigorously defended and supported at the expense of so many millions of Americans, has done more than anyone to get between doctors and patients. In its implacable search for excessive profits, the insurance companies have done everything they can possibly do to constrain patients and doctors from making collective decisions that are best for patients. Instead, of decisions controlled by them, there are rigid rules adopted by private bureaucrats that prescribe the treatment options doctors have, and there are teams of bureaucrats reviewing insurance claims to find loopholes in policies that allow coverage and claims for payment to be denied. Bureaucrats have been between patients and doctors for many, many years now, and Republicans have been cheering them on. These bureaucrats are not creatures of the Government, but instead are creatures of overpaid health industry executives doing all they can to add to profits by refusing to authorize care for sick people, or by charging excessively for simple treatments and medicine. So, when Republicans say that they want to ensure that bureaucrats won’t stand between doctors and patients, they need to be honest and put forward proposals to regulate private insurance companies in order to ensure that their bureaucrats will not get between doctors and patients. But, will we ever see this from the Republicans? Perhaps, to quote my long-passed Grandmother, we’ll see it when we all meet on the Golden Bridge on the way to heaven. In the mean time, I guess we’ll just have to view this fourth principle as more “pie in the sky.”
The Republican four principles for universal health care reform are not principles at all. Rather they are constraints on universal health care designed to keep the present health care system with as little change as possible. But this time around we must have an end to this system. We have all had much more than “enough” of it. Not just in its high costs. But in its avoidable deaths, bankruptcies, foreclosures, and blighted lives of many millions of Americans. An end to it I say. And an end to the greed that has visited this system and its ills upon us.