^{Posted on October 20, 2000}

HEALTH CARE CHOICES by Marty Jezer

From the Brattleboro (VT) Reformer, 10/20/00

Health insurance has been an issue of political contention - as well it should be.

The Republicans want to go back to the days of competition between insurance companies and no community rating. I remember those days well. I was working in the building trades and my company gave us health insurance as a benefit. Then the wife of one of our workers got cancer. The Prudential agent informed us that Prudential was canceling our insurance. Feeling apologetic, he bought us breakfast.

Vermont ultimately instituted community rating. Insurance companies can no longer "cherry pick" the healthiest Vermonters. They now have to insure everyone who can pay the premium. Republicans, from Ruth Dwyer down, want to put an end to this, and give the insurance companies the right to turn down potential customers with pre-existing health conditions that might cost them money.

The alternative, they suggest, is a special pool for at-risk people. The private insurers get the healthy clients (and healthy profits); the public assumes the cost of providing health care services for those who need it most. When this cost escalates, as it most surely will, the GOP will, I am sure, use that as evidence of public sector inefficiency.

Some Republicans talk about personal responsibility. Those who have unhealthy lifestyles -- who smoke, over-eat, have unprotected sex, etc., ought to pay higher premiums, they say. That sounds good, especially to people who are smug and, at the moment, healthy. But many diseases involve a genetic predisposition: a tendency to obesity, heart disease, diabetes, some cancers, etc. run in families. Should fat people pay a higher premium rate? How about people who sky-dive, ski, or cross the street and risk getting hit by a car? The idea is unworkable -- and it's socially divisive. Better that the community share individual risk and pay a fair rate, common for all.

At the other end of the debate is single-payer. Many Democrats favor it and it's the centerpiece of the Progressive platform. Every western democracy has a single-payer system in one form or another. It's neither new nor experimental.

For a brief period, I lived part of each year in Montreal. While I was insured by Blue Cross my then partner, who taught in Montreal, was insured under Quebec's single-payer system. Our child was born under that system. Critics of single-payer talk about government control of health care. The facts are: we chose our own doctors, chose our own hospital, and even had a private birthing room. Because Quebec emphasizes prevention, we were also able to attend free birthing classes. We never had to pay a bill for these services. In the single-payer system, the health care providers bill the government. There are no bills, no premiums, no deductibles, and no co-payments. Patients aren't overwhelmed with confusing paperwork.

Instead of premiums, deductibles, and co-payments, Canadians pay for their health care through taxes. Because there are no marketing and sales promotion costs, no advertising costs, lower administrative costs (because there is almost no paperwork), Canadian health care is delivered at a much lower cost per capita than our health care. In Canada, health costs have been stabilized at about 9% of the national economy compared to about 14% in the United States. Single-payer mandates that all Canadians have access to health care, no matter where they live. This means flying health care providers in and out of the far North. Even with that added cost, health care delivery is cheaper than it is in our densely-populated country.

In most health categories, including infant mortality, Canada has a better record than the United States. Critics point out that some Canadians come to the United States for health care service, and this is true. Patients cross the border for elective surgery (surgery not based on medical need) which is not given priority in Canada. In some cities, there is overcrowding, but American cities have that problem too. In border areas, patients come to the U.S. for cat-scans and other high-tech procedures. This happens because in areas of low population density, it is cheaper to pay American hospitals that have the expensive technology than it is to buy the technology and use it rarely. But the Canadian patients using American facilities are still covered by their single-payer insurance.

I was jogging on Mount Royal in Montreal one day when I felt a pain in my chest. I went to the first doctor's office I could find and, without first asking for my insurance credentials (the receptionist assumed I had a Quebec health care card), a doctor checked my heart and concluded, correctly, that I had pulled a muscle. When it came time to pay, the doctor (who had no need to employ an in-house insurance administrator) didn't want to deal with my Blue Cross insurance because the paper work was complicated. I offered to pay cash. She waved me away. "I deal with patients, not bills," she said tartly. To be sure, many American doctors would have given me gratis service in that situation. But American doctors do have to deal with insurance forms and billing procedures -- and that is wasted money which patients subsidize by inflated premiums and higher medical costs.

Single-payer insurance eases the administrative burden for health care providers. It allows businesses, school boards, and local governments to get out of the insurance business -- big savings to them. (Workers could get the insurance benefit in the form of higher pay). Every Vermonter would have a health insurance card. We'd pay higher taxes but would pay no premiums, deductibles, or co-payments. When we see a doctor or go to a hospital, we'd show our card. The health care provider would bill the single-payer entity. End of transaction. End of paperwork. End of financial worry.

Dr. Dynasaur, Medicare and Veteran's health care are single-payer systems. They work! Why can't single-payer work for us all?

Marty Jezer is a free-lance writer who lives in Brattleboro, Vermont. He welcomes comments at mjez@sover.net.