Barbara O'Brien
Health Care Props and Patches
Governor Arnold Schwarzenegger's proposal for providing universal health care for all Californians has put the health care issue in the news. However, we're still not having the frank, substantive national discussion needed to confront and resolve America's ongoing health care crisis.
Further, the governor's proposal is not so much a plan as it is a "series of patches," according to New York Times columnist Paul Krugman.
It forces everyone to buy health insurance, whether they think they need it or not; it provides financial aid to low-income families, to help them bear the cost; and it imposes "community rating" on insurance companies, basically requiring them to sell insurance to everyone at the same price.As a result, the plan requires a much more intrusive government role than a single-payer system. Instead of reducing paperwork, the plan adds three new bureaucracies: one to police individuals to make sure they buy insurance, one to determine if they're poor enough to receive aid, and one to police insurers to make sure they don't discriminate against the unwell.
Deborah Burger writes for the San Fransisco Chronicle that the California plan is similar to the plan in place in Massachusetts.
A mandate on individuals to buy insurance is the centerpiece of the Massachusetts health plan as well. The experience there to date does not recommend this approach. Many people are choosing not to sign up, even with the tax penalties, because they cannot afford the plans, and due to funding problems, the state has cut back on public education about the program. That's in a state with 500,000 uninsured as compared to California's 6.5 million uninsured.
Professor Krugman writes in his column that last year the California legislature passed a single-payer plan for the state that would have been similar to Medicare. Residents would have paid fees into a state fund that would have insured everyone. But Governor Schwarzenegger vetoed this plan and substituted one that kept private insurers in the loop.
The smart, well-intentioned economists who devised the plan think they're being more politically realistic than single-payer advocates -- that it's necessary to placate the insurers. But that's what Bill and Hillary Clinton thought, too -- only to find that their plan's complexity confused the public, while the insurance industry went all-out to defeat it anyway.
Indeed, the Schwarzenegger plan is facing a backlash from businesses and insurers, according to Elisabeth Eaves of Forbes.
"This is a tremendous burden on employers," says Sally Pipes, president of the Pacific Research Institute, a San Francisco-based policy think tank. "It could result in businesses moving out of state, or limit new entrants to the market."
It seems ironic to me that the so-called "market-based" system would be bad for, well, markets. The "free market" ideology so beloved by the American Right says that "free markets" will, like a natural ecosystem, provide the best possible solution to all problems as long as government regulations don't interfere. It doesn't matter how many real-world examples to the contrary you can throw at this argument. It's a religious faith that cannot be shaken.
Thus, we cannot have a substantive national discussion about health care in America because, as soon as the word "government" crosses anyone's lips, knees will jerk and shrieks of "socialized medicine!" will fill the air. As a result, the only thing most Americans know about how other nations provide universal health care is that there are waiting lines in Canada.
The biggest concern most people have about a national system is cost. They worry that increased taxes will take more money out of their pockets. They're not seeing how much money is hemorrhaging out of all of our pockets because of the mess of a system we have now.
I recommend this paper (PDF file) by the Bureau of Labor Education at the University of Maine on the U.S. health care system. It's short -- eight pages -- but it argues clearly and starkly that the U.S. does not have the best health care system in the world, only the most expensive.
Burger of the Chronicle continues,
A market-based system always puts increased revenues and profits over the health and well-being of those patients it is supposed to serve. As was the clear intent of a number of the free-market architects of the plan, it reinforces and expands the role of the market in health care, the very source of the present crisis. If the governor's goal is truly universal health coverage, improved quality and effective cost controls, the state should embark on the same tried-and-true course taken by every other industrialized nation, either a national health system, or a single-payer approach as embodied in the single-payer bill, SB840 authored by state Sen. Sheila Kuehl. Kuehl's bill was vetoed by the governor last year. It will be reintroduced this year.Under a single-payer system, such as Medicare, one public entity collects all the financing and pays for all medical services through the existing private-care delivery system, with adequate funding for our doctors, hospitals, clinics, and other care.
It's the only plan that assures everyone is covered with one high standard of benefits and care, as opposed to good care for the wealthy only. It assures choice of physician, reduces administrative waste, provides commonsense budgeting, and ends insurance industry interference in the form of high premiums, high deductibles and denials of care.
Yes. Now, if we can just find a way to slip that information past the right-wing news media filters and to the public, maybe we could get the national health care system overhaul we desperately need.
Update: See Stirling Newberry on a holistic approach to universal health care.
Barbara O'Brien: Author Bio | Other Posts
Posted at 2:07 PM, Jan 12, 2007 in
Health Care
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