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Proposed health care plans miss mark
Robert Reich
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TEXT OF COMMENTARY
Kai Ryssdal: Behind the closed doors of the Senate Finance Committee today... beer. Actually, raising beer taxes. Another 15 cents a six-pack, if that's of particular interest to you. Congress is trying to find ways to pay for health care reform. Exactly what kind of reform we're going to get is still in the works. There's been a lot of talk about some kind of public-private partnership. But commentator Robert Reich wonders whether there's been too much talk.
ROBERT REICH: I understand politics is the art of compromise, but at the rate we're going with health care, politicians may be giving away the store.
Right now, private insurers spend big bucks marketing policies to healthier and younger people while avoiding sicker and older people, rejecting those with pre-existing conditions, and contesting many claims.
That's why many experts have long advocated a so-called "single-payer" system that would instead focus on helping sick people and preventing others from becoming sick. And use its vast bargaining power to negotiate lower prices from drug companies and hospitals.
On the campaign trail, Barack Obama pushed a reasonable compromise -- a universal health system that included a public insurance plan resembling Medicare, which members of the public could choose if they wanted. This optional public plan could at least negotiate low prices and pressure private insurers to better serve the public.
But the Senate is taking this Medicare-like option off the table, courtesy of heavy lobbying by insurance and drug companies. And the White House is signaling it's open to other approaches.
Yet other approaches being considered by the Senate would essentially gut the public plan. One would break it into pieces run by regional third-party administrators, thereby guaranteeing that none would have much bargaining leverage to get low prices.
Another would put the public plan under state governments, further eroding it. Big pharma and big insurance already get just about whatever they want from state officials.
A third would require that a public plan adhere to private-insurance rules. But if they're rules private insurers have wangled, the public plan can't possibly push insurers to do better, or get good deals from drug companies and medical providers.
Maybe the House will come up with a real Medicare-like public option and Senate democrats will pass it under a reconciliation bill needing just 51 votes. But this won't happen unless there's huge pressure from the White House and the public.
Right now we're on the way to a universal health-care bill that politicians will claim is a big step forward when it's really, at most, a step sideways.
RYSSDAL: Robert Reich is a professor of public policy at the University of California, Berkeley.
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Dear Fellow Americans:
There are only two possible events that would lead us to a for a national single payer system in my country:
1) Total economic collapse of our country
2) A grass root effort to pass a constitution amendment for such a system.
Short of either of the above events, legalized corruption will prevent any REAL health care solutions.
Because of White house waffling, I sincerely think Obama do not have the guts or the moral conviction to take on the health care system. It is just all talk.
Good Luck.
I'm a community college student. Most of my classmates are either still under their parents' benefits (if they have any) or uninsured. I have several friends with compounding medical conditions that could be prevented or minimized if they could afford basic health care, but some of them already have enough issues that, unless something changes in the health care world, make them uninsurable. I don't know if a "single payer" program would be the answer, but I do know that things need to change.
As a clinical nurse at a major university teaching hospital I see daily the results of an inefficient and broken health care delivery system; the needless suffering in a population that is too poor afford insurance; chronic untreated illness that leads to spiraling costs and further disability. Even the state and county programs are difficult for the people at the bottom to access; most of the time they only enter by being so ill they require emergency treatment. At the same time I see money, research, and resources being thrown at expensive new treatments that involve drugs, procedures, or products; all designed with profit in mind.
I am a member of CNA (California Nurses Association) and I am proud to say that we have become political players on the national scene. We are primary advocates of a single-payor system and we will not back down and support anything less. Though we supported Obama during his election, the lives of 47 million are now at stake, as well as the future of our economy because health care costs most certainly will derail any economic recovery unless the system is reformed and wrested from the sphere of big pharma and the insurance giants.
Thank you for the story Mr. Reich. I enjoy your style of writing that mixes clear-headed pragmatism with a touch of irony. I was dissapointed that Obama foolishly forgot to pick you for a policy post.
Sincerely,
Linda Vasconcellos RN
San Diego CA
I want to thank you and NPR for giving single payer attention. I hope you will continue to do so.
I am a physician who left practice to work fulltime for a national health system based on single payer financing.
Like many of my colleagues, I became fed up with private insurers telling me how to practice and refusing to pay for care.
A national health system will allow patients to choose their doctor without restrictions. It will allow patients and doctors to make medical decisions. It will allow transparency and public accountability. And it will save money.
A national health system will reduce health disparities and preventable deaths,remove financial barriers to health care, improve health outcomes and end bankruptcy due to medical debt.
I dream of the day we have a national health system. Then I will return to practice. Until then I will continue educating about and advocating for a national health system and will even risk arrest.
I hope my colleagues will recognize our professional responsiblity to advocate for our patients' best interests: a national health system based on single payer. Everybody in and nobody out.
Japan and the European Union, the economic entities most like the U.S. have single payer health care. Europe has a number of variations on the basic single payer scheme.
Americans presently pay more than anyone else per capita for health care. Health insurance is not cost effective because insurance companies are incentivized to raise benefits to healthy payers while raising barriers to unhealthy ones. This maximizes insurance company profits while leaving 50 million uninsured Americans the option of getting health care at the emergency room.
Single payer would cut costs by eliminating unnecessary middle men. Insurance companies typically take over 30% overhead on every health care dollar.
Insurance companies could still process claims as government contractors like they do for Medicare and Medicaid.
Reich is right. Insurance companies are trying desperately to divert attention from a single payer system and toward a system that forces all of us to continue spending 24%+ percent of our health care dollars on them and their profits rather than our health. As a former Fortune 50 company executive, and now a two-time entrepreneur, and mom in a family of four, I am convinced America's global competitiveness depends on us getting health care reform done right and done now. The lowest cost/most business, family and health favorable approaches in the industrialized world are Single Payer. We need to get on with picking from the best examples around the world and implementing our own appropriate American approach. In order to do this, we need to send strong and frequent messages to our elected representatives when we see them being bought off by the insurance companies with campaign contributions and lobbying efforts. Please send a message to your Representatives and to Max Baucus and demand that strong Single Payer advocates be given a seat at the table.
Thank you for being one of few media outlets that has talked about the "single payer plan." For those of you who don't know much about this plan I suggest you visit the Physicians for a National Healthcare Plan site (pnhp.org) to get more of the details. I think it would make life better for everyone and we would save the money that is now spent on profit and on huge amounts of book keeping.
Dr. Reich makes a couple intesesting points, but he doesn't supply certain information that is totally unheard in the discussion.
1) Do "single payer"supporters understand that such a program would be bigger, by far, than the WW II mobilization?
2) Someone please explain how "universal" coverage is handled in countries of populations closest to that of the United States. That would be China, India, Indonesia and Brazil.
3) Do people really believe that claims would, or even should, be paid without first being checked over by claims examiners?
Finally, if Reich thinks that single-payer automatically means no arguments over coverage for services, I'd be happy to send him copies of some of my Medicare EOB (Expalnation of Benefits) forms.
I wholeheartedly agree. I was appalled when the health care companies were applauded for promising to cut costs by what sounds like a lot, but really amounts to one less gold back scrubber, and which will most likely come from denying claims. We need to decide if what we want is health insurance or health care - these are two different things.
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