By Saul Friedman
Newsday
March 31, 2007
I have not seen the case for publicly supported universal health care put any better than this, and by someone who knows what he’s talking about:
“I am proposing the federal government as the single payer of health care in this country. Only the federal government has the ability to fund one large risk pool through a payroll deduction. As the single payer, the federal government could negotiate hospital and physician payments even more effectively than it does now with Medicare.
“A single pool of funds, collected and administered by the government, would expand Medicare and replace Medicaid, SCHIP (State Children’s Health Insurance Program), the VA health-care system, and private health insurance, including the health care aspect of Worker’s Compensation. … Also eliminated would be the tax credit – or subsidy – given to companies for providing health insurance to their employees. In other words, the current, inefficient patchwork of payment systems would disappear, to be replaced by one nationwide program available to every citizen.”
The writer was Robert Gumbiner, an M.D. and a pioneer of the controversial concept of managed care, which has been a vain attempt to reduce the soaring costs of the volatile for-profit health-care system. Gumbiner founded FHP, in California, one of the nation’s earliest and largest HMOs, which was swallowed up in a merger with PacifiCare 10 years ago.
His present views, written for the Physicians for a National Health Program Web site, underscore what I’ve been reporting – that the American public, thousands of doctors and a number of business leaders, governors and members of Congress are arriving at the conclusion that it’s time the United States joined most other industrialized nations in adopting universal health care.
The issue is what path we should take.
How can we preserve what’s best in the nation’s current system and move as smoothly as possible to medicine that’s publicly financed? How can we avoid the Clintons’ mistake of 1993 in trying to please every interest and coming up with a complex, top-heavy system that could not get through even a friendly Congress and White House?
One popular answer, which we reported on nearly 10 years ago, came from Dr. Marcia Angell, in the New England Journal of Medicine, which she edited. We called it “Medicare For All.” Now a senior lecturer at Harvard Medical School, she repeated her suggestion recently in the Boston Globe.
Criticizing various proposals because they depend on private, for-profit insurance companies, Angell wrote: “They all have the same fatal flaw … no workable mechanism to control costs. … We need to change the system completely and get the insurance industry as well as employers out of it. … It would make much more sense to extend Medicare to everyone. …
“This could be done gradually by dropping the eligibility age a decade at a time, while phasing out the insurance companies. … Medicare is not perfect, but its problems are readily fixed. It is far more efficient than private insurance … and since it is administered by a single public agency, controlling costs would be possible.”
“Medicare for All,” is the subtitle of the most serious universal health-coverage bill before Congress, legislation that would turn her proposal into law: “The U.S. National Healthcare Insurance Act,” HR676, re-introduced in January by Rep. John Conyers (D-Mich.). It was supported in the last Congress by about 80 members, but the Republican leadership gave it no chance to move.
The bill isn’t yet high on the list of legislative priorities in the new Congress, primarily because most Republicans and President George W. Bush still are wedded to putting the insurance industry in charge. While every Democratic presidential candidate supports universal coverage, only Dennis Kucinich currently favors a “single-payer” solution like Medicare.
Nevertheless, Conyers and Sen. Edward M. Kennedy (D-Mass.), who favors another version of Medicare for All, now chair committees that could give their proposals some serious attention, perhaps readying for the day when they have the White House on their side. The mainstream press, and even AARP, have been ignoring their proposals, but you may study Conyers’ bill by entering its number, HR 676, at http://thomas.loc.gov/ or visit Conyers’ Web site: http://www.house.gov/conyers/.
Conyers’ brief summary of the legislation says it would establish “an American national health insurance program” that, like Medicare, would provide publicly financed but privately delivered free health care to all Americans, who would be free to choose their doctors and hospitals. Benefits, according to the Congressional Research Service summary, would include “all medically necessary care, such as primary care and prevention, prescription drugs, emergency care and mental health services.”
The legislation would put out of business the hundreds of profit-taking middlemen of the health care industry, especially insurance companies, by prohibiting “an institution from participating in the program unless it is a public or nonprofit institution.”
Conyers’ bill also would prohibit the sale of insurance that duplicates benefits provided by the legislation.
Finally, Conyers would finance the benefits mostly by adding 3.3 percent each for employees and employers to the 1.45 percent payroll tax each is now paying, thus relieving the heavy burden businesses now bear in paying expensive premiums for employee/retiree health insurance. It also would end the need for health insurance premiums for working families and provide coverage for the estimated 75 million who are uninsured or underinsured.
While Conyers’ bill has broad liberal and union support, “Medicare for All” is not the only proposal for universal health care, and we intend to look at others as well your ideas.
WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at saulfriedman@comcast.net.