Thursday, November 19, 2009

Health Reform Deformed: Is the Best Option Being Ignored?:

Call me a pre-existing condition. Until seven years ago when I was diagnosed with Parkinson's disease, I was the kind of physically fit, healthy person insurance companies love to enroll. Overnight I became someone to shun, damaged goods certain to need extra medical care and thus to erode a company's profits. I am currently covered under my wife's employer-provided insurance--these days that means that the employee picks up much to all of the extra cost of dependents, unless they have a better plan ass part of their employment agreement. Should my wife's coverage end for any reason, I am unlikely to find an affordable policy.

Given that reality and my belief that whatever its final shape, health care reform, if enacted, is going to affect us all, I have followed the current debate intently--my wife would say obsessively. I have done so with a growing sense of dismay, as it becomes clearer with each additional page that this reform will, as written to date, dump me and people like me into the backwash of Medicaid or some messy, expensive, buying combine.

Thus, I use “debate” advisedly because it is delusional for our elected officials to say they are seriously discussing health-care reform when the simplest, most practical and most comprehensive solution--a single-payer plan that provides all Americans with cradle to grave coverage--is not on the table. A bill expanding Medicare to cover all Americans has languished in a House committee years and was not even brought out for consideration this year.

Physicians for a National Health Plan, an advocacy group, estimates that a single-payer would save $350 billion a year that now goes to administrative costs of insurance companies and health-care providers. Such a plan would relieve people from worry over whether they can afford treatment. It would free employers from the continually rising cost of providing insurance for their employees, and it would give employees now working for insurance in jobs they dislike the opportunity to try something else. But we do not engage in that discussion.

Instead, what we see and hear of single payer in the media or from our fearful leaders are lame excuses: it will never fly, it is not possible in America, it is socialistic, the transition would prove too disruptive, Americans won't stand for it, with a reminder of the town hall incivilities of August.

The best the House could offer was a watered down public option, along with expansion of Medicaid, evisceration of Medicare, and a resounding declaration that women have no right to control their own bodies. The bill that Senate Majority leader Harry Reid, the worst majority leader in my memory, offers up a "public option" that never had guts in the first place. It would allow states to "opt out," which sounds more than vaguely like granting them the power to secede from the Union or decide not to abide by any civil rights legislation. The completely untested logic behind the public option is that a government run insurance program would compete with private insurers to hold prices down and, one hopes, quality up.

The aim of both House and proposed Senate bills is to create purchasing cooperatives that would provide small businesses and uninsured people an opportunity to purchase coverage at “affordable prices” whatever those are. No one could be denied insurance, and the government would help families buy plans. We are told that this approach would bring fiscal sanity to skyrocketing insurance rates.
That is hard to see in light of the fact that reform as it is shaping up would not meet Obama's fundamental goal of insuring the uninsured. Millions would remain uncovered, including illegal immigrants, who nonetheless would as a matter of law and medical ethics have to be covered should they appear at a hospital.

 A month ago private insurers said that unless everyone who is uninsured is forced to purchase insurance from them or pay hefty fines, they will have to raise premiums considerably. These are the same insurance companies that stand to collect tens of billions of dollars in new policy premiums should reform pass without a public option--or with an opt-out. As I read the Senate bill it would be possible for a big company in an opt-out state to pay a relatively modest fine, compared with what coverage would cost them, and dump all their employees into the combine or buying cooperative, where they would  have to buy private insurance.

The insurance industry has long declared that it would be unable to compete against a federal insurance provider in a truly free market. Because people would flock to the more economical “public option,” Private insurers argue that because consumers, given a choice, would flock to a publc option, it is little more than a stalking horse for the dread single payer. So be it, true believers in capitalism claim the market is never wrong, so they should embrace its decision the opportunity to let it decide.
Instead, the insurance industry wants to design the field, write the rules, and choose the referees. The Obama Administration meanwhile long ago negotiated away to no one in particular all its advantages.

As I have followed the debate, I have also talked to people about health care. A common incomprehension and an unexpected consensus have emerged from my conversations with trades people, mechanics, lawyers, doctors, architects, academics, business owners, shopkeepers, morning lap swimmers at the public pool, local politicians, and other writers of various ethnic, religious and political persuasions.

They find incomprehensible the convoluted, complicated bills currently or soon to be before them. That is largely because they accept that access to medical care is a fundamental right, as President Barack Obama seemed to recognize in his September 9 speech to Congress, and they agree that the government should guarantee that right through a universal, single player insurance plan, achieved, for example, through expansion of Medicare.

My informal survey participants find especially troublesome the way members of Congress and, with caveats, President Obama have managed to transform society's moral obligation to provide health care for all into a legal mandate that everyone buy health insurance or pay a fine. Absent a robust public option that means from one of the private insurers President Obama and his allies in Congress have spent months vilifying as rapacious and irresponsible.
No wonder people are alienated and disgusted. A Jamaican ironworker, who had come to install a wrought iron gate at the top of our stairs a month ago (October 31, 2009, posting), captured the attitude of most people I know when he looked at me and said, “Americans are crazy” because of our inability simply to provide health care for all.

Not long after, my internist, a rock-solid Republican, declared he would not vote for a Republican again because the party had offered not alternatives. Then, he said, "I beginning to thing that maybe there shouldn't be profit in healthcare."

I couldn't disagree. Some services like police and fire protection and health insurance are meant to protect and enhance all our lives, not to produce profits for a few and heartache for many. If that be socialism, then Call me Socialistic.

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