Why Can't America Have Universal Health Insurance?
Why Can’t America Have Universal Health Insurance?
01/14/04
By ~ David M. Fine of ‘The Mill’
During this jobless recovery, I have yet to find employment that provides health insurance. Luckily, I haven’t needed any real medical care and I don’t have kids. On the other hand, being uninsured is a risk, and unfortunately I cannot afford the $400 per month, more than my current monthly rent, to pay for health insurance.
According to most estimates I am just one of some 40 million Americans in a similar situation.
America can and should provide every American with affordable health care coverage. It is the moral thing to do. It is also the practical and sensible thing to do.
Today, almost half of all Americans either receive their health insurance from U.S. government programs - or have no insurance at all. It is a travesty that this wealthiest of wealthy nations insists on obstructing the health insurance coverage of some 40 million of its citizens because of a tired allegiance to an ostensibly “free-market” approach to delivery of health services. Let’s face it, going to the doctor or taking medicine or having surgery is not like shopping for a new car. Nor do we ever want it to be.
Yet, sadly, segments of America’s pro-profit health care system are riddled with sleazy used-car salesmen-type ventures that do nothing to improve the quality of care in this country.
One example of this is the increasing role of Pharmacy Benefit Managers (PBMs), intermediary companies which are making billions of dollars acting essentially as arbitrage agents between prescription drug companies and health plans. They buy prescription drugs in massive quantities at a huge discount and then sell them to health plans for a nice profit.
How do these companies improve the quality of care in America? They don’t, not one bit. They are supposed to reduce prescription drug costs, but really they are nothing but a parasitic drain on the U.S. healthcare system, a racket, and a boon to their shareholders.
(What’s more, in the new law signed by President Bush creating a prescription drug benefit in Medicare, the law forbids Medicare from using its leverage to negotiate cheaper drug prices with the pharmaceutical companies)
In fact, the large union AFSCME, with the help of Prescription Access Litigation, is currently suing the largest PBMs in the state of California (Medco, Express Scripts, Advance PCS, and Caremark Rx, Inc), alleging that the PBMs have actually contributed to an increase in the price of prescription drugs. The Justice Department is also suing Medco for alleged fraud.
Why do you think people are going to Canada to get their drugs these days?
“The organizations that were created to make prescription drugs more affordable are cutting inside deals with drug companies and driving up costs. It’s corporate greed like this that is chipping away at the paychecks of hard working men and women across the country,” AFSCME President Gerald W. McEntee said in a press release.
But PBMs are just one example of the problems inherent in a pro-profit health care system.
The organization Physicians for a National Health Program (PNHP) reports that a study by researchers at Harvard Medical School and Public Citizen to be published in this week’s International Journal of Health Services found that health care bureaucracy cost the United States $399.4 billion last year.
The study also found that a national health insurance program could save at least $286 billion annually on paperwork alone.
Why the enormous savings? The United States’ Kafkaesque payment system drives up administrative costs for doctors and hospitals, who must deal with hundreds of different insurance plans - at least 755 in Seattle alone - each with different coverage and payment rules, and referral networks. According to PNHP, in Canada, doctors bill a single insurance plan, using just one standard form.
America has struggled over the issue of providing National Health Insurance since Harry Truman was President. Massachusetts Senator Ted Kennedy pushed hard for a national health insurance plan back in 1970, and President Nixon was amenable to the idea, only for it to fizzle. Since then, Kennedy has pursued an incrementalist approach.
Nevertheless, the infrastructure for such a system currently exists. Our U.S. Government already accounts for almost half of all health care expenditures. In 2003 we spent $242 billion on Medicare and $162.5 billion on Medicaid, the combined expenditures of which are projected to grow by $34 billion this year. In 2004, Medicare covered more than 41 million Americans of 65 years and older, plus some Americans with disabilities and end-stage renal disease. Another 42.4 million Americans are insured by Medicaid.
SCHIP, the national health insurance program for uninsured children under 19 years of age whose parents’ income is too high to qualify for Medicaid, is projected to cost an additional $5 billion this year. In 2002, the U.S. Department of Health and Human Services estimates that 4.2 million kids were enrolled in SCHIP.
Most of the Democrat Presidential candidates are proposing some kind of expanded health coverage. Only Dennis Kucinich and Carol Moseley Braun have come out in support of a single-payer system (though Al Sharpton wants to make access to health care a “human right”). Howard Dean, a doctor, says he’ll expand Medicaid and SCHIP to cover adults at 185 percent of the poverty line, provide tax-breaks for those buying health insurance on their own, and have the federal government pay 70 percent of COBRA premiums for transitional workers.
While Dean’s proposals, if enacted, would improve health coverage in America, they wouldn’t realize the bureaucratic savings of a single-payer system, nor would it cut out drains on the system like PBMs. We’ll be increasing our federal health care expenditures, while not reaping any of the savings benefits of a national health insurance program.
Eventually, America should transform the state-based Medicaid program into an AmeriCare national health insurance program. The federal government would set the general guidelines and provide block-grants to the states, but the states would retain some independence in managing their systems, thus keeping an element of health care variety and experimentation within the nation as a whole.
America’s national health insurance plan would remain uniquely American.
For most of America’s history, people remained in their same job for life. Today, that’s changing, making our employer-based health insurance program considerably less relevant. Pegging health insurance to your job not only deprives workers of the freedom of greater job mobility but also creates undue anxiety about job loss - if you have a family, loss of your job may mean loss of family health benefits, or at the very least, back-breaking monthly payments through COBRA.
It’s long overdue that America became sensible about health coverage. America’s health system’s problems and rising costs aren’t due to government involvement but are created by a system trying to manage competition in a service industry where competition isn’t applicable. What we get are gazillions of different health plans, a bureaucratic nightmare, skyrocketing drug costs, intermittent coverage, millions of uninsured, and private companies that try to make a killing in the business without regard to providing decent care.
I think we can all agree that providing health care shouldn’t be about making a killing.