Unifying Our Nation and Resolving Our Crisis in Health Care

THE DASCHLE-LAMBREW POSITION, as expressed by Barack
Obama during the campaign, contends that single-payer
(SP, approximately Canadian-style) health care makes the
most sense for its efficiency and ability to stabilize health
care financing. But that SP is “not politically feasible now
in the USA.” This is exactly what middle-road reformers
have been arguing for decades. But what if we choose to
sidestep the argument over what is “politically feasible”
and whether any significant step forward has ever been
achieved without challenging the mainstream’s (corporate)
concept of what is “politically feasible”?
OUR GOAL AND COMMITMENT
What our nation needs now is a commitment that we are
going to begin evolving, as quickly as possible, to a system
that will accomplish this one goal: allow everyone access
to all medically appropriate care-regular, preventive, critical
and chronic. Let’s act as if we no longer want to be the
one industrialized country which fails to do this. No
American shall be excluded from the system of quality care
due to being unable to pay. Let’s agree on this principle
FIRST!! Pres. Obama, is this a shared principle or not?
Let’s say we do agree that our goal is NOT getting just
80% or 95% of Americans into some insurance program
that picks and chooses who is eligible for some restricted
quality of coverage. (Who is volunteering themselves or
their family to be in the left out 5%?) And let’s make it a
real commitment, let’s push forward a legal commitment
to the Right to Health Care for every American, just as
solid as the Right to Education (K–12) which was enacted
in 49 State Constitutions. Let’s make the Right to Health
Care in 2009 a demonstration of how this nation will unite
and stand up for the least fortunate, for those whose
health is failing, for those whose loved ones are terribly
stressed not only by the illness, but who are also burdened
with approaching family financial ruin with our cruel system.
Let’s unify as a single caring society.
We know that achieving this goal is possible. Other
industrialized nations are spending about half what we
spend per capita and all their people enjoy full access to
needed care. After we make this commitment to the Right
to Health Care, if then the insurance companies cannot be
affordably and usefully employed in achieving the goal,
we’ll leave that up to them and the Obama Department of
Health and Human Services. If the insurers can and wish
to be honestly and energetically involved in a system delivering
care to all who need it and it’s financially stable, then
fine (as long as we watch them and regulate for good quality
care). If they do not wish to be involved anymore, then
we might have no choice butgo single-payer, eliminating
private insurance and saving the wasted administrative
portion (25–30% of current health care expenditure).
Recently, in fact, conservatives have voiced concern that
the Obama health care intentions (March 2009) might be to
set up a public Medicare-like option and that this would
certainly out compete and eventually put all private health
care insurers out of business. Perhaps, but it seems like a
strange thing to be worrying about, even for a conservative
Republican. After all, it would seem that currently our primary
concern might be doing what’s fiscally responsible and
at the same time providing our whole population with the
benefits of modern industrialized society, especially given
the tremendous stress of our severe recession.
But it’s all a fraud if we don’t agree on the goal and we
don’t make this commitment. The private companies will
always be happy to insure the healthier Americans, and get
generously subsidized to temporarily take in a token few
of the riskier cases. And pharmaceutical companies will of
course always be willing to give away a few drugs here and
there, when they can sell everything else at prices they set
without negotiation. Maybe I’m too naïve to think that
insurance and pharmaceutical corporations might be willing
to shoulder their share and cover the needs of a crosssection
of Americans, not just the younger and healthier?
And to do so at stable affordable costs? We’ll never know
unless we agree on what we are trying to achieve.
WHAT’S WRONG WITH “GUARANTEED
AFFORDABLE” HEALTH CARE?
Okay, so let’s say we can agree, or have agreed on, what kind
of health care system would we then go about setting up, let’s
say in the first year or two? What we hear most about, of
course, are the corporate-friendly “solutions” arranged in
Massachusetts and in Maine during the last several years,
often referred to as “Guaranteed Affordable Health Care”
plans. And it’s likely we will hear something like that proposed,
even if a shared and clear commitment is made. There
is nothing wrong, of course, with health care being guaranteed
and affordable. And nothing is wrong with health care
being universal. Problems arise, however when organizations,
politicians and the media use the terms so loosely, as to render
them meaningless. “Universal Health Care” cannot honestly
be used to refer to the MA and ME reforms which might
cut the state uninsured rates in half. Similarly, “guaranteed
affordable health care” has been much abused of late.
The growing clamor under the banner “Guaranteed
Affordable” health care, much of it emanating from major
liberal reform organizations on the national and state levels,
has been a dishonest PR campaign. What most of these
plans have in common is an increased role of for-profit
insurance corporations—with their high overhead and their
primary commitment to shareholders. Patient care is not the
goal or the driving principle of these plans, just as it never
was in the evolution of our current system. In fact, to the
insurance corporations the official term is “profit loss ratio”
(money lost from profit, having been spent on patients).
Now, of course, sometimes some of the uninsured do get
included in new tax-subsidized for-profit programs, but
that’s always temporary and no more than a by-product of
creating a program which looks good on paper and delivers
more profits to insurance corporations. Such improvements
are temporary because costs have to increase overall when
new programs are designed for the private insurers and
involve both direct and indirect additional taxpayer subsidies.
There is no way to get the insurers to offer high quality
health insurance to higher risk patients or those who are
likely to actually need health care services. In other words,
these are all expensive plans and thus financially unstable.
Maybe the incremental reforms that are proposed within
these “Guaranteed Affordable Plans” or “Nearly Universal
Health Care Plans” could be legitimately considered
improvements over current lapses in coverage, even if they
are expensive. And maybe I would not vote against them,
if I were sitting in Congress. But what we cannot allow is
for them to be touted as the real thing. They are not universal
plans for health care. They are not guaranteed care
to all Americans. They are not serious proposals for keeping
health care affordable. It’s not just a matter of “better
than thou” semantics. It’s a matter of keeping in mind
what our country should be (all-inclusive, with abundant,
broad opportunities) and what we should provide for each
other as a civilized people. It’s a matter of putting the commitment
first and foremost and then beginning the discussion
anew about how we are going to realize this agreed
upon principle.
AGAIN, BEWARE OF THE HUCKSTERS
In closing, remain aware that these plans for incremental
reforms like to insert a final step after several others
(benefiting private insurers)—a final step in which “finally
the other programs we have proposed will be further
expanded so that everyone in our nation (or state) will be
included.” That’s just shrewd marketing for the incremental
reforms, otherwise the commitment would be
primary not an afterthought. Organizations and politicians
making such proposals are just trying to “dress up”
their corporate-friendly incremental reforms with a final
“hypothetical” step, which they honestly know will never
ever come to be.