We Want a Public Option to Obtain Health Care
(brought to you by FromDC2Iowa.blogspot.com*)
Links to Contents
Corporate Control
Silencing Public Option Advocates
What's "the Public Option"?
Why is this so important?
...What are we getting?
......Infant mortality
......Life expectancy
......Numbers covered
...What is it costing us?
......Administrative costs
......Externalities
What Americans Think: The Poll Results
Conclusion: Action
If the health insurance legislation that comes out of this year's Congress does not contain a "public option," as it's come to be called, it will be one of the most expensive consequences the American people have ever suffered for our system of campaign finance.
[May 20, 2009: Press-Citizen supports public option. "One of the main sticking points in the national debate is whether to include a government-sponsored insurance plan to compete with the multitudes of private coverage options. We view this option as an essential part of any substantive reform." Editorial, "Health Reform Needs to Include Public Option," Iowa City Press-Citizen, May 20, 2009.]
Corporate Control Run Riot. Years ago I documented that those who make campaign contributions in the $100,000 to $1,000,000 range end up getting back from the federal government, in one form or another, something between 1000-to-one and 2000-to-one on their "investment." Give a million get a billion. Nicholas Johnson, "Campaigns: You Pay $4 or $4000," Des Moines [Iowa] Sunday Register, July 21, 1996, p. C2.
I've seen little from this Congress -- or, I'm sad to say, from this White House -- that would lead me to believe things are any better now, 13 years later.
o When the phone companies were found to have illegally spied on American citizens Senator Barack Obama changed his position and voted to give them a base on balls, to grant them "amnesty."So why are we surprised that when it comes to our future health care that "having everyone at the White House table" turns out to mean everyone who makes a profit from hospitals, medical services, the marketing of over-priced proprietary pharmaceuticals, and the premiums on our sickness insurance?
o Senator Dick Durbin has acknowledged that Wall Street owns Washington ("the banks . . . frankly own the place"). The Obama Administration's multi-trillion-dollar give-aways to some of the nation's most generous campaign contributors did little to refute his assertion. After all, these were the very fellows who were willing to risk global economic collapse if it would fatten their multi-million-dollar bonus payments. See, e.g., Nicholas Johnson, "Obama's Potential Wall Street Downfall," April 12, 2009.
o It was obvious to all last fall that Chrysler and GM were headed for bankruptcy. No scenario that could pass the laugh test was found to suggest the contrary. And yet the Administration insisted on handing over billions of taxpayer dollars to the two companies.
o Now the Administration is offering billions to insurance companies that are in such good shape they are refusing to take the money.
Nor should we be surprised that those who want no more than to discuss the pros and cons of "universal, single-payer health care" are not only not invited to the Senate hearings, but are arrested and escorted out of the hearing room for showing up and talking to a committee chaired by the senator who received more campaign contributions from the special interests before him than any other senator.
Ed Schultz, "Arrested for Fighting for Health Reform," "The Ed Show," MSNBC, May 7, 2009 (Dr. Margaret Flowers).
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Let me make clear at the outset what I am and am not talking about. Because the effort has already begun to conflate "universal, single-payer health care" and "the public option" -- in the special interests' efforts to ridicule and defeat the latter.
Notwithstanding the truly overwhelming case that can be made for "universal, single-payer" -- even President Obama acknowledges that were we starting all over again it would clearly be the road to follow -- that's not what I'm advocating in this blog entry (though I discuss some of those features, below). The political and economic power of those who profit handsomely from the present, very profitable, "health care is a privilege" system, and the extent to which the people's "representatives" fear those interests, puts the odds of our ever getting the system used by every other industrialized nation in the world somewhere between very, very slim and none at all.
Public Option. So what's the "public option"?
We currently have a patchwork system. Forty-to-fifty million Americans, 15%, have no sickness insurance at all. For most of those who do have insurance the premium costs are split between the policy holder and his or her for-profit (or non-profit) employer.
But public plans are not unknown in our system. We have "Medicare" for the elderly, "Medicaid" for the very poor, military hospitals and doctors for those in the service, Veterans Administration hospitals for those who've returned to civilian life, programs that just cover children, and insurance programs for federal, state, county and city employees.
Notwithstanding the rhetoric of the "public option" opponents, most of the proposals that include a "public option" would not take anything away from anyone, nor impose anything on anyone. Every American could keep the sickness insurance program in which she or he is now enrolled. They could keep their doctor of choice. Nothing would change. But those employers or employees who wished to do so could opt out of what they have, and opt into a new public program modeled on those I've just mentioned that we already have. The "public option" is as American as apple pie and Medicare.
What the sickness profiteers are already attempting to do is to confuse the two in the public mind. By arguing that a "public option" would mean the government would take over sickness care in our country -- take decisions away from doctors, indeed even take away our choice of doctors, putting our health in the hands of incompetent, uncaring bureaucrats, with this communist system -- they both despicably mis-characterize universal, single-payer systems and confuse them in our minds with the status-quo-plus-public-option proposals. (E.g., "'A government takeover of health care will put bureaucrats in charge of health care decisions that should be made by families and doctors,' Rep. Charles Boustany of Louisiana said in the Republican radio and Internet message. 'It will limit treatment options and lead to rationed care. And to pay for government health care your taxes will be raised. . . . That is something we cannot support.'" Darlene Superville, "Changes: Energy, Health Care 2 Areas Obama Cites," Associated Press/Washington Post, May 16, 2009.)
(Following an Old Creamery performance of "The Totally True Completely Fictional Story of the Mother of Jesse James" -- very much worth seeing, incidentally -- I had a health care conversation with a Canadian economist who had come south to volunteer with the rebuilding of Cedar Rapids. Needless to say, he was a great enthusiast for the Canadian (universal, single payer) system. But he explained that he had long since abandoned arguing with Americans about it, because our understanding has been so infected with the lies and misinformation propagated by our sickness profiteers -- and at least on the part of some, a real stubbornness in the refusal to accept actual data.)
Is the "public option" ideal? No; a majority of Americans -- and their doctors -- agree that the "universal, single-payer" approach of the world's health-care-is-a-right countries would be far better. See, e.g., Single Payer Action ("1,000,000 strong for single payer"); Leadership Conference for Guaranteed Health Care/The National Single Payer Alliance; and "Physicians for a National Health Program. (Many of those single-payer countries also permit the purchase of additional coverage by those who want and can afford it.) But given the power of the sickness profiteers and the elected officials they control it's all we have a prayer of getting.
Why is this so important? In case you're not already convinced that we have a broken, excessively expensive system that is giving us all too little for our money, let's look at some numbers -- with credit to HealthPacOnline for these "Health Care Statistics in the United States" (as well as many more on their site). [Most of the numbers, and language, below, is taken from that source.]
What are we getting?
Putting all the anecdotal stories and 'tis-'tain't arguments aside, there are a couple statistics that make country comparisons possible: infant mortality and life expectancy. You get what you pay for? Not, it turns out, when it comes to health care.
Notwithstanding the fact that we are paying more for our sickness insurance system than any of the "universal, single-payer" countries pay for health care -- both in total, and per capita (and not covering everyone at that) -- we rank far from number one by those statistical measures.
Infant Mortality. "Infant mortality" is the risk of death during the first year of life. It is related to the underlying health of the mother, public health practices, socioeconomic conditions, and availability and use of appropriate health care for infants and pregnant women. Sources: CDC and National Center for Health Statistics.
Ranking from the best (lowest) infant mortality to the worst (highest) the U.S. was 12th from the top in 1960. By 1990 it was 21st. It is now 43rd. Slovenia and Cuba do better than we do. Source: CIA Factbook (2008).
Life Expectancy. "Life expectancy at birth" is the average length of life ahead of each newborn baby. For this measure, obviously the higher the number the better. In the U.S. the average is 78.14 years. That ranks us 47th in the world. Source: CIA Factbook (2008).
Numbers covered. Presumably the more persons entitled to, and able to afford, health care the better. By definition, "universal" systems cover everyone -- usually at no, or very low, cost to the individual. In the U.S. over 15% (47 million) do not have health insurance. Source: US Census Bureau. The United States is the only wealthy, industrialized nation that does not have a universal health care system. Source: Institute of Medicine of the National Academy of Sciences.
In 2005 more than 40 million adults stated that they needed but did not receive one or more of these health services (medical care, prescription medicines, mental health care, dental care, or eyeglasses) because they could not afford it. Source: National Center for Health Statistics. To put lack of health care in a context of the range of challenges confronting the poor, see DeNeen L. Brown, "Poor? Pay Up; Having Little Money Often Means No Car, No Washing Machine, No Checking Account And No Break From Fees and High Prices," Washington Post, May 18, 2009.
The primary reason given for lack of health insurance coverage in 2005 was cost (more than 50%), lost job or a change in employment (24%), Medicaid benefits stopped (10%), ineligibility for family insurance coverage due to age or leaving school (8%). Source: National Center for Health Statistics.
So how does it work in other countries? Do doctors receive adequate compensation? How much do patients have to pay? Here's Michael Moore's interview of a participating physician in Great Britain from Moore's movie, "Sicko."
What is it costing us? The United States spends twice as much on health care per capita ($7,129) than any other country and spending continues to increase. In 2005, the national health care expenditures totaled $2 trillion. Source: National Center for Health Statistics.
The average family health insurance premium, provided through an employer health benefit program, was $11,480 in 2006. Employees paid an average of $2,973 towards the premium amount. Source: Kaiser Family Foundation.
Administrative costs. So how are the sickness profiteers doing under this "marketplace" system? Overhead under their system runs at a whopping 26%! But wouldn't government, or non-profit, systems cost even more? No. Non-profit insurance ends up operating with 16% overhead, and the "government bureaucrats" operating Medicare are able to do it at about 1/10th of the for-profit cost: an overhead of 3%. Source: Journal of American Medicine 2007.
And so how is this "competitive" system doing in getting costs under control? Not so well. From 2000 to 2006, overall inflation has increased 3.5% and wages by 3.8%. Sickness insurance premiums? Not 3.5%, not 3.8%, but by a whopping 87%! Source: Kaiser Family Foundation.
Our high costs of sickness insurance compared with the health care costs in other countries, the much higher costs of for-profit administration than public systems, and the inability of the private system to control costs, could all be cited as good reasons for supporting a universal, single-payer system. Only because of the political realities discussed above, that is not what is being proposed here. Among the many advantages of the public option, however, is the role it could play in helping to control the escalating costs of the sickness profiteers' system. True "competition" can benefit from the benchmarks offered by including public systems in the market. That's a part of what the public option could do.
Externalities. There are other economic consequences of our system. For example, about half of the bankruptcy filings in the United States are due to medical expenses. Source: Health Affairs Journal 2005.
And at least a part of the challenge confronting our auto companies -- and all other American companies trading globally -- is because their workers' sickness care costs must be embedded in the prices for their products. And yet those U.S. companies are competing with companies for which those costs are covered by universal coverage plans. (Among the 84.2% of Americans who are blessed with some form of sickness insurance, 59.7% of that 84.2% had coverage provided by their employer. Source: US Census Bureau.)
What Americans Think: The Poll Results. Although most polling frames the issue in terms of "health insurance" rather than "health care" that is not to say the polls juxtapose the two; the pollsters simply don't give the participants that choice. In the one poll that did ask the "health care" question ("Do you think it's the government's responsibility to make sure that everyone in the United States has adequate health care?") 60% responded in the affirmative in a November 6-10, 2008, poll. (This, and the following poll results, are from PollingReport.com.)
Even when the questions are framed in terms of, say, "universal health insurance," the nature of the questions are such that one can reasonably assume the percentage responses would be similar, if not identical, if the pollsters had substituted, say, "universal health care" for "universal health insurance."
In short, while the questions and results vary, it's fair to say that the constituents are well out ahead of a Congress dependent on contributions from the sickness profiteers when it comes to the public's support of universal coverage, the federal government's involvement, and a willingness to pay more taxes to accomplish that goal -- by numbers ranging from pluralities of one-third to majorities of two-thirds and more.
Here are some illustrations from 2009.
o The goal of "universal health insurance for every American" in 2009 is the "most important," or one of the "top 2-3," national priorities say 58% of those polled April 30-May 3, 2009.If Congress and the Senate truly cared about "representing" their constituents our message to them is clear. At a minimum they need to include a public option in whatever health care legislation they ultimately pass.
o During April 22-26, 2009, 49% said our health care system needs "fundamental changes" and 38% said we need to "completely rebuild" it -- a total of 87%.
o April 1-5, 2009, 57% indicated they'd be "willing to pay highter taxes so that all Americans have health insurance they cannot lose."
o March 12-15, 2009, 77% said they were "dissatisfied" with "the total cost of health care in this country."
o The largest percentage, though only slightly more than one-third (36%), in a February 26-March 1, 2009, poll believed that the "federal government" should have the "most responsibility for helping ensure that Americans receive health insurance coverage" (24% thought "business," and 31% thought "individuals themselves").
o A larger percentage, 59%, thought "the government in Washington [should] provide national health insurance" (compared to 32% who thought it should be limited to "private enterprise"), in a January 11-15, 2009, poll.
o Asked during February 18-19, 2009, whether they would "favor . . . a program that would increase the federal government's influence over the country's health care system . . . to lower costs and provide . . . coverage to more," 72% said yes.
Conclusion: Action. The "public option" won't solve all these problems, but it will help provide the competition that can bring down costs and prices, and it will enable us to proudly join the community of nations that make health care a right. Moreover, given the sickness profiteers control of our elected "representatives" a "public option" is about all we can hope for.
But to get it we need do more than "keep hope alive." Congress will give us nothing the sickness profiteers don't want us to have. We will have to take it from Congress. Forcefully. Threatening to run candidates against them. Overwhelming them with email, calls and letters. Making clear that "We're mad as hell, and we're not going to take it anymore."
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* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source -- even if I have to embed it myself. -- Nicholas Johnson
2 comments:
There is going to be a financial transaction for services no matter what you do. That means that health care is a good like any other good. Micro-Economics 101. Notions like "fair", etc. are very naive in this case. It's like saying gravity isn't fair.
Get rid of insurance altogether except maybe for catastrophic policies to prevent financial ruin. Doctors and other providers will only be able to charge what the market will bear and costs for things like basic office visits would be substantially lower.
The fight for HR 676 single payer, equitable health care (Medicare) for all is the fight for the strongest possible "public option".
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