^{Posted on February 5, 2007}

Focus on patients, not profits

By Rose Ann DeMoro
South Florida Sun-Sentinel
February 5, 2007

Americans expecting relief from the meltdown of our health care system should watch out for the political mugging now unfolding in the current debate on health care reform.

From President Bush’s proposals to proposals in Washington and state capitols, to a recent procession of groups. there is a lot of talk about a new “consensus” on the need for action on what everyone agrees is a crisis careening out of control.

While some have declined to identify specific proposals, there’s been a steady stream of proposals that have a similar theme. They include tax deductions to encourage people to buy insurance, tax penalties to discourage people from using too much of that insurance, mandates that everyone be required to buy insurance, new taxes on employers to pay for more insurance, and expanding existing federal or state programs to buy insurance for the low-income.

No wonder the insurance industry is standing at the front of the line leading the cheers.

For those having trouble following the arcane details, here’s a cheat sheet. All the assorted health care proposals can be boiled down to two fundamental alternatives which go down very different paths.

One is the proposals (and throw in many of the state versions, including the much hyped Massachusetts and California plans) that expand the role of the big insurers and reinforce the role of the private market in health care — those same players that created the present problem by placing increased revenues and profits above patient health.

The other approach, a single-payer system such as Medicare, works. It’s far simpler, more comprehensive and more cost effective — a patient-based, not commercially driven direction.

Under single-payer one public entity collects all revenues and pays for all medically necessary services for everyone, delivered by our present, mostly private, doctors, hospitals, and other providers.

Our failure to enact such a system is the reason the U.S. ranks just 37th in health care quality and performance, according to the World Health Organization. Every other industrialized country has either a single-payer or national health system. We’re No. 1 in one category only: costs. We lag behind in almost all other indicators, including life spans, infant mortality, childhood immunization and per capita access to doctors, nurses, hospital beds and diagnostic equipment.

The primary reason for that disparity is the intrusive role of insurers and other health care corporate giants who siphon off billions of dollars in administrative waste, bureaucracy, profits and executive compensation — sacrificing, as needed, access, quality and affordability along the way.

And they’ve been wildly successful. The 20 largest HMOs in the U.S., for example, made $10.8 billion in profits in 2005, and UnitedHealth Group alone just posted $1.2 billion in profits for the last quarter of 2006. Drug companies make even more; the world’s 13 biggest reported $62 billion in profits in 2004.

Health care corporations have effectively used their economic clout to block real reform both in Washington and in state capitols, becoming the largest spenders on lobbying and setting up a parade of people who rotate back and forth from administration posts and congressional offices to the corporate boardrooms.

But, at a time when even middle class families are holding garage sales and spaghetti suppers to pay for medical bills, more than half the nation’s low income counties lack a health center and even large businesses stagger under the weight of ever rising health care costs, those who have profited off pain and suffering know the game could be up.

A result is the fervent campaign to browbeat a public desperate for genuine reform to lower their expectations, and accept the conventional wisdom that only market-based solutions are feasible.

We’ve heard this before. From abolition of slavery to women’s suffrage to enacting Social Security and Medicare to ending legal segregation, our history is filled with achievements that the pundits and avatars of the status quo said were not realistic.

A single-payer system is not just a dream, it’s legislation — HR 676.

Under HR 676, everyone is guaranteed choice of physician and comprehensive and uniform coverage, businesses are treated fairly, costs are controlled, administrative waste is slashed, and insurers could no longer deny care or continue to price people out of access to medical services.

Let’s stop looking for the worst solutions, and demand the best.

Rose Ann DeMoro is executive director of the 75,000-member California Nurses Association/National Nurses Organizing Committee.