Saul Friedman | Gray Matters
Newsday
August 4, 2007
The middle-aged fellow who takes care of my yard had a stroke some weeks ago, but he doesn’t know how it affected him or whether another one may be coming.
That’s because he hasn’t had the $1,600 cash for the MRI he needs. He could not get health insurance, even if he could afford the huge premium, because he was not in the best of shape, and he can’t get it now because of his pre-existing condition – the stroke. So he hopes for the best.
That is not an unusual story. I haven’t yet seen “Sicko,” but I don’t need filmmaker Michael Moore to tell me (and most of us) that while American health care can be the best if you can get it, the health care distribution system is also the most backward, costly, unfair and inequitable in the civilized world.
The single most important reason: The multibillion dollar power of the private insurance industry stands in the way of genuine change.
The facts are well known, and unique to the United States. More than 43 million Americans, most with jobs, have no health insurance and no protection against illness or accident. More than nine million children are without health care coverage. People who are under 65 and have been laid off from jobs cannot get coverage unless they pay outrageous premiums.
Personal bankruptcies are increasing because of medical debt. And as Moore’s documentary shows, the 250 million Americans with insurance can’t count on coverage when they’re really and expensively sick. Any of these facts would be considered outrageous almost anywhere else in the world.
Forget the silly and mostly inaccurate nitpicking about Moore’s facts. We know from personal experience and from all we’ve read that his and our diagnosis of the American health care distribution system is correct. According to every poll, more than 70 percent of us know it needs to be fixed with a system that covers every American if they need it – whether it’s for the flu, a broken bone or a long battle with cancer.
How do we do this? So far, most of the Democratic presidential candidates favor giving most of the role of providing health care to insurance companies in partnership with employers and the federal government. How much government would be involved remains an issue. (The Republican candidates would provide tax breaks to buy insurance with little or no government involvement.)
The most important reason the candidates involve insurance companies is the fear that their power, along with other financial interests of the medical-industrial complex, would kill any universal coverage that doesn’t include a major role for the insurance industry.
But “Sicko” calls for an end to private health insurance (except for such services as cosmetic surgery) because, Moore says, insurance companies have an inherent conflict of interest. Their first obligation, under law, is to earn as much as possible for their shareholders. And that means they are obligated to spend as little as possible on health care, by limiting coverage to younger, healthy people or refusing as many claims as they can get away with, or restricting the services doctors and hospitals may provide. If your doctor can’t spend time with you, there’s an insurer in the room.
That’s why Moore was able to find 25,000 people with tales of insurance denials, some of them fatal. And that’s why Moore favors a publicly financed “single-payer” system, run by the government and with no role for the insurance companies.
But as my mail shows, there are misconceptions about what a “single-payer” system is. It is not the British model, in which health care providers work for the health service. That is not what advocates of single-payer system envision for the United States.
Indeed, the United States already has a couple of government-run, taxpayer-supported single-payer systems – Medicare, for persons over 65 and the disabled, and the Veterans Affairs health system, which provides doctors, hospitals, drugs and even long-term care for eligible veterans. Doctors and other medical personnel work for themselves. And both systems work remarkably well, despite this administration’s efforts to undermine them.
You would think, then, that a single-payer system that expands Medicare to cover every American, and not just the old and disabled, would be logical and reasonable. But Rep. Dennis Kucinich of Ohio is the only Democratic candidate to endorse the idea.
In addition, while surveying the possibilities for universal health coverage, most of the press and even the authoritative Kaiser Family Foundation’s new health care Web site, have failed to mention the only legislative proposal, endorsed by Kucinich and Moore, for a single-payer universal health plan: H.R. 676, the National Health Insurance Act, or “the Expanded and Improved Medicare for All Act.”
But one of the most influential voices for seniors, Jane Bryant Quinn, has endorsed what she called, in Newsweek, “an excellent template for universal care right under our noses; good old American Medicare. When you think of reform, think ‘Medicare for all.'”
That’s the intent of H.R. 676, introduced in 2005 by Rep. John Conyers (D-Mich.), with nearly 80 co-sponsors. It would be financed by tax increases on the wealthiest Americans plus appropriations and premiums to guarantee free medically necessary health care, drugs, and long-term care to every American. But most of the cost would be offset by the end of private insurance costs. Like Medicare before HMOs were permitted, insurance companies would be prohibited from selling policies that duplicated the benefits provided under the act.
The cost would be much less than the $12 billion a month we’re spending on Iraq because it would eliminate the need for employer contributions, Medicaid, the State Children’s Health Insurance Program and other state programs.
Radical? Judge for yourself. Medicare for All, which could be phased in gradually and administered within states as Medicare is, has been endorsed by 15,000 doctors, even more nurses and 20 state labor federations. If you have access to a computer, visit the Web site of Physicians for a National Health Plan (pnhp.org) and see what it says about a single-payer plan. And read Conyers’ bill by searching on your computer or at the library for H.R. 676.
WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at saulfriedman@comcast.net.