commentary
July 17, 2009

 

Suffering under our health care market
by Patrick Dobson

Americans have always been wary of government. But only sort of. We love government when it comes to highways, airports, libraries, public education, parks, public broadcasting, state and municipal services and other socialist programs. We love national, government-sponsored defense and can’t get enough of it of the corporate welfare programs that helps keep 55,000 military contractors in business. We want more.

But in health care matters, we lose faith in our government because somehow we believe that people out to profit from our health care concerns have our best interests in mind. We are only now starting to question the motivations of the people who stand to benefit most from the present system. But we are about to be derailed from that thinking by right-wing scare tactics.

Corporations say they can provide health care more inexpensively and effectively than government. And maybe they can but they haven’t. The rhetoric corporate mouthpieces and conservative politicians throw into the health care debate mucks up the debate, which should center on making us healthier. But, instead of focusing on health care, the people who stand to benefit from the present system steer our conversations toward political motivations for not changing anything. It’s about time we start believing in what’s good for us rather than how much health care giants will suffer from our prosperity.

American Medical Association President J. James Rohack. The AMA is against a government-run health care program.
American Medical Association President J. James Rohack recently announced that he supports an “American Model” of health care — a private/public cooperation that will cover more people. He does not want new government programs but wants to see expansion of the Federal Employees Health Benefits Plan. He tried to make his stance sound new and innovative. In a “smile, act smart and sincere, and they will believe you” ploy, he was simply endorsing the AMA’s existing position on retaining the present sick-care system.

For months (years), the AMA has advocated preserving the present state of affairs as if no one is really having a problem, really. The expanded Fed employees’ plan “coverage” Rohack speaks of won’t cover everyone, and by design. Anyone wanting Fed employee coverage will have to pay full premiums rather than share those premiums with an employer. With employers cutting back on health care coverage for employees, more working Americans are having to carry the burdens themselves. Rohack doesn’t seem to understand that most people without health insurance don’t have it because they can’t afford it. They won’t be able to afford the new plan, either. Since AMA membership only includes less than 15 percent of American physicians, and since most of them are Republican voters, this is a plan that insurance companies can live with even if the rest of us can’t. (http://www.policymed.com/2009/07/health-care-reform-ama-public-option-on-the-table.html)

Newt Gingrich, founder of the Center for Health Care Transformation, wrote in February in The National Journal, “At the Center for Health Transformation, we have long advocated free, fair, and functioning markets as the essential element to expanding coverage. Specific changes like a nationwide marketplace for individuals to purchase insurance and equalizing the tax benefits for those who purchase insurance on their own and those who receive insurance through their employer are key elements to expanding coverage.” (http://healthcare.nationaljournal.com/2009/02/unemployed-and-uninsured-how-h.php#1292236)

Gingrich means this to be confusing. He’s a master of rhetoric in the classic Greek sense — a modern day sophist whose arguments for greater personal freedoms include stricter individual, Christian morality and absolute obedience to an unfeeling marketplace.

Imagine the hundreds of ways that any of Gingrich’s statement, or pieces of it, can be interpreted. For instance, what, exactly, is a free, fair and functioning market? Can such a market exist, given that the government needs to write and enforce laws to create it, and then give tax incentives? What is incentive equalization? Does that mean that everyone pays the same, regardless of income? Or does everyone carry a burden that is the same relative to income?

Like any politician, Gingrich talks of “specific changes” and then offers such ill-defined terms as “national marketplace” and “equalizing tax benefits.” Gingrich’s ideology reveals his intentions. The Contract for America sounded like advocacy for smaller government. But the spend-without-taxing government the Contract created in the mid-1990s farmed larger pieces of larger budgets out to big corporations, whose CEOs and major stockholders espoused free trade and free markets while their profits and returns on investment depended on taxpayer largesse.

Newt Gingrich, founder of the Center for Health Care Transformation and former Speaker of the U.S. House of Representatives, believes in a “market” solution to rising health care costs and declining coverage.
Since shamed out of public office, Gingrich only began to cry foul against what he saw as creeping socialist policies after President Obama had been in office for less than a week. There’s something to getting out in front of an issue. But Gingrich and his ilk seem weren’t even in the same universe, particularly since the “socialism” he so despises quit creeping and began running a short time after “W” entered the White House. In fact, Gingrich loves business and corporate welfare, regardless of the checkbook imbalance it creates. The more the merrier.

While “free, fair, and functioning markets” sound good to people who want as little government as possible in health care, Gingrich essentially argues for the same position we find ourselves in today. Insurance companies control the national health care marketplace. Tax breaks to people with ability to buy health insurance trickles up to those insurance companies, who continue to ply their risk-averse methods of supplying health care. Plus, any tax break smells like another splash into the borrow-and-spend methods of government financing pioneered by Ronald Reagan and perfected by George Bush. The people who pay for such tax breaks don’t get them.

James P. Gelfand, head of health policy at the U.S. Chamber of Commerce denies the need to act now on health care reform. There is no crisis, he maintains. Everyone wants to make sure the uninsured are insured. The “crisis,” he says, is a fabrication of President Obama and his liberal lackeys in Congress. The use of government to solve the health care coverage “crisis” makes health care another government program, susceptible to graft and corruption. Instead, he seeks to restore market forces in health care even if he can’t tell us where they went. (http://www.politicsdaily.com/2009/06/19/public-health-insurance-practical-fix-or-partisan-warfare/)

All of these guys understand the “market” has made health care inadequate for over a quarter of us. But one thing a good old capitalist can’t stand besides government is actual competition. Afraid of losing their grip on the market, they take some facts out of context, distort others, and omit many more.

For instance, the AMA, Gingrich, and the U.S. Chamber slog the final report of the 2009 Health Confidence Survey, knowing no one at home or in print or broadcast journalism is really going to read it. They quote a single fact in the report sponsored by the nonpartisan Employee Benefit Research Institute (EBRI) and market research firm Mathew Greenwald & Associates. Buried into the report’s conclusions is a single entry that 77 percent of insured Americans say their health care is adequate.

Because of this one conclusion, these champions of free enterprise maintain with all determination that the market is adequate and functioning nearly perfectly. But the EBRI report refutes this. A number of other assertions make up the bulk of the report, and none of them reflect well on the present situation: A majority of insured Americans (51 percent) believe that health care needs improvement in coverage, access, and treatment. Fifty-nine percent believe that the U.S health system is either inadequate or poor. They are afraid that satisfactory coverage will not remain so for very long. Health care has negatively affected retirement savings plans, buying household necessities and family savings. They complain of increasing costs and increasingly limited access to adequate therapies, prescriptions and treatments. They know they cannot afford insurance on their own if their employers drop their coverage. They want the increasing ranks of the uninsured covered.

And, most importantly, between 68 and 88 percent of us favor a national health care plan, employer mandates, and want insurance market reform. (http://www.ebri.org/pdf/briefspdf/EBRI_IB_7-2009_HCS_09.pdf)

Here’s what we know we are dealing with:

• Forty six million Americans, or 18 percent of the population under 65 with no insurance.
• Twenty to twenty five million underinsured Americans — meaning that, because of their insurance deductibles, limitations of care, and existing-conditions exemptions, they will likely be financially responsible for the hospital care, pharmaceutical needs or therapies needed to relieve chronic illness or a catastrophic medical situation.
• Americans just one catastrophic illness away from financial ruin. Worse, lots of on-the-edge working people use credit cards to pay for their health care. When they go bust, they can never start with a clean slate. Bankruptcy “reform” that a largely Republican Congress enacted during the Bush Administration has made sure of that.
• Incredible waste. A dollar in Medicare/Medicaid spending results in upwards of 95-97 percent health care delivery. While there is waste that is newsworthy, according to the Congressional Budget Office, this waste is only 1-3 percent of all Medicare/Medicaid spending — a damn sight less than the 15-30 percent administrative costs of private insurers before counting their waste. (http://www.cbo.gov/publications/collections/collections.cfm?collect=6; http://www.politico.com/news/stories/0609/23853.html)

What’s interesting about these numbers is that those who favor the present system or champion some free-market solution to health care:
• Say that single-payer or universal health care will hinder and deteriorate American health care.
• Tell Americans that they will not have a choice of doctors.
• Assert that “faceless” and uncaring government bureaucrats will make health care decisions.
• Insist that government-administered health care will limit access to certain health care procedures, technologies and therapies.
• Decry national health care systems in Britain, France and Canada for long waits, denial of treatment and waste. That’s funny. Ridiculous, as a matter of fact.
Over the last few years, on average, health insurers have covered less for greater cost. Medical procedures and therapies once covered are not any longer.

The insurer determines what patients the doctors and health professionals can see. If patients choose to see a doc not on the list, they can pay extra. The result is that many can’t afford to choose, despite the rhetoric of “choice.”

Faceless corporate bureaucrats — administrators and actuaries in distant cities and even other countries — make health care decisions. Again, we can choose to pay more for greater access. Everyone has that choice. But like many people, most wage earners don’t have the money to pay for above-and-beyond procedures and technologies for themselves and their children. That, ultimately, removes the range of choices available to me in a “free, fair and functioning market.”

The criticism of other national health care systems rests upon anecdotal and out-of-context horror stories. Most Brits, Canadians and French are happy with their health care. They want “health care” to mean “public health” and the health of their fellow citizens (and non-citizens). And these socialists are healthier in general than Americans who believe they have the best, most technologically advanced health care in the world. (http://content.healthaffairs.org/cgi/content/full/21/3/182)

The fact is that most of us don’t own huge amounts of stock in health care companies. We know we are in a big, fat, expensive mess. We know what’s good for us, and we know corporate health care has mucked up things so badly that only a third-party or government administration can resolve with a sane health care system. Unfortunately, for the alleged free-marketers, that will involve a single-payer or nationalized health care system that lets insurers compete for our business and gets us all in to see the doctor.

Patrick Dobson is a freelance writer, author and working member of Ironworkers Local Union #10 in Kansas City, MO. His first book, Seldom Seen: A Journey into the Great Plains will be published September 2009.