(10 am. – promoted by ek hornbeck)
As the health care reform issue continues it’s way through the legislative process, it’s becoming increasingly clear to me that there will be a moment in time where many progressives will face the difficult choice of whether or not to support a health care reform bill that looks nothing like what we wanted.
At the end of the day, however, the question will inevitably be: given that people are desperate and dying unnecessarily right now, and given the political realities impeding a better solution, how can we not support whatever incremental improvements survive this legislative process, while still pushing for better things down the road?
I’d like to argue that there is a better way, a politically-realistic way of providing health care for all, without getting into bed with the insurance companies and big Pharma . . .
Whether or not there’s a Public Option, we already have evidence that the entire effort to reduce costs will be hamstrung by a backroom deal that has already been worked out to prevent the government from negotiating for reductions in drug prices. The health insurance companies are going to get, at the very least, mandated health insurance, i.e. 47 million captive new customers, as well as however many millions more through the new small business requirements.
Now, I’m sure that nearly all of us agree that ideally, we’d have Medicare-for-all, i.e. Single Payer. Short of that, we all support the “Public Option” as the next best thing, maybe even a catalyst on the way to single payer. But what if we don’t even get that. Then what?
Correct me if I’m wrong here, but what’s left after the Public Option is taken off the table seems to this diarist to be a bunch of new requirements on various parties, i.e.:
1. The uninsured will be required to buy health insurance.
2. Small businesses will be required to provide health insurance to their employees, or pay a fine.
3. Insurance companies will be required to cover anyone who applies.
4. The taxpayer will be required to provide subsidies to all of the above.
This is what I’m supposed to be calling my Senator, my Congressperson, showing up at town hall meetings, to support?
Maybe so, but I’ll confess that it really doesn’t sound all that great to me. If I think that the insurance companies are ripping me off, I’d like to reserve the right not to do business with them. And I might think the same thing with respect to employee health care if I owned a small business. And I don’t know that the government should be in the business of forcing private insurance companies to take all comers. And I don’t like the idea that some of my tax dollars will inevitably end up in the pockets of insurance executives and shareholders who will profit from the government subsidies.
But I do believe that universal health care is a basic human right and I’m not so dogmatically idealistic that I don’t agree with taking incremental steps to get there, if need be.
For me, then, the question becomes, are there other politically realistic options that get us closer to our goal of universal health care without having to subsidize the health insurance industry and impose new government requirements on essentially everyone in America?
I do believe that there’s another way . . .
My alternative would start with a basic premise that while undoubtedly true, seems to have been lost in the discussion:
Health insurance and health care are not the same thing. Many people have paid for health insurance and still not received quality health care, while many other people have received quality health care even though they did not have health insurance.
I think it might be instructive at this point to consider the background of Obama’s pick for Surgeon General, Dr. Regina Benjamin. Benjamin spent twenty years running a rural medical clinic in the backwoods of Alabama. According to a Reader’s Digest profile of her:
Dr. Regina Benjamin, 49, had laid out $800 to open her family-practice clinic in this impoverished community in 1990, and many thousands more to keep it going. If people couldn’t pay — and many couldn’t — she treated them for free. Clearly, she wasn’t in it for the money.
Our Surgeon General’s take on universal health care in rural Alabama then, did not require hundreds of pages of legislation, and mandates, and massive subsidies to massive insurance corporations. No, it just involved a very simple principle: health care for all, whether they can pay for it or not.
This is not a radical, “pie-in-the-sky” type of idea. There are thousands of nonprofit health clinics in urban and rural areas, Indian reservations, etc. There are hundreds of county hospitals that are funded by the government to take all comers. All emergency rooms across the country accept patients whether they have insurance or not. This is not utopia; this is the current state of our health care system. However weak it is in relative terms, this is the existing safety net for those who fall through the cracks of the for-profit health care system.
Why not work to make it better?
We might also take a look at the Veteran’s Administration. From the VA website:
VA health benefits are open to all Veterans. Family members may also be eligible to receive benefits. There is no monthly premium for VA care, but there may be a co-pay.
Again, health care for all, whether they can pay for it or not — this time guaranteed to millions of military veterans. You don’t need to buy health insurance to get health care from the VA as a veteran. You just sign up — it’s free. No need to pay a monthly premium. They’ll work the details about any co-pays at the appropriate time.
I’d also like to digress for a moment from health care to talk about legal services. We guarantee it in the criminal context. You don’t need to have “legal insurance” to get a lawyer to defend you in a court of law if you are accused of a crime and your public defender is not going to send you a bill after the case has been resolved.
I happen to work in civil legal services. If you are eligible for our services and we have the capacity, then you get a lawyer for the case. You don’t need insurance, and you won’t get a bill. How do we get paid? Through grants, donations, etc. and most importantly, an annual appropriation from the federal government.
So what am I really getting at?
We don’t need no stinkin’ health insurance!
We need health care.
The proposal?
Formalize the existing network of government-funded and nonprofit health care providers into a first-rate health care delivery system modeled on the VA that would accept and care for all patients regardless of whether they have insurance or not.
The difference between this proposal and “Medicare-for-all” or the “Public Option” is that I’m not talking about health insurance, I’m talking about health care delivery. This system would be separate and distinct from the for-profit medical system. Medicare-for-all and the Public Option contemplate the government paying for you to go to private doctors and private hospitals. The other health care reform proposals on the table contemplate paying private insurance companies to pay for you to go to private doctors and private hospitals. This system would be a network of public hospitals and nonprofit health clinics that would be funded by the government to treat people regardless of whether they have health insurance, and would only charge people what they can truly afford to pay, which quite often will be nothing. The catch is that as a member of this public health care system, you would not be able to go to any doctor that you want, or any hospital. It’s like the VA, or an HMO, there’s a coherent system and for the most part you have to stay within it.
It would be kind of like . . . the VA, or the health care clinic run by Obama’s pick for Surgeon General, or your local county hospital, or a public HMO.
But let’s be clear here: the eventual goal will be to develop this health care delivery system to a standard unsurpassed in the private sector. At first, the care will be “surprisingly good”, despite the prejudices of most people against “government-run” health care. That’s fine, because at the beginning the focus will be on taking care of those people who have fallen through the cracks of the for-profit health care system. But eventually, we will build respect and admiration from those “in the know”, i.e. medical professionals, and the system will begin to attract the “best and the brightest” from nursing and medical schools, not only because of rising quality, but because these professionals will be able to do what they love most, without worrying about billing, generating a profit, balancing the books, etc., which could be taken care of by medical billing companies like Precision Medical Billing or similar firms.
But the public health care system will never fund the kind of medical excesses that currently plague the for-profit system. If you want “Cadillac” health care, you will still have to pay for it yourself. The public health system will be organized to make good, hard choices about where to allocate resources to maximize the health and well-being of everyone involved. Prevention and healthy living will be the priority; you won’t get the most expensive, most cutting-edge treatments here. Sometimes that’s going to be harsh, but there’s no other way.
How do we pay for it? Well, to start, we just do what we’re doing now, except formalize it. We already fund public hospitals and nonprofit health clinics and emergency room visits for the indigent to the tune of many billions per year. Anybody who wants one should be provided a membership card in this system for free (it would really just be a way of consolidating their medical records), and it need not entitle them to anything more than they can obtain right now for free in our medical system, i.e. preventive care at nonprofit health clinics, health care at public hospitals, and emergency room visits anywhere.
But we do want to do better and for that we’d need more money. My proposal:
A 50% tax on all unnecessary, detrimental and/or purely elective medical procedures in the for-profit medical system.
According to an article last year in the AARP magazine, “of our total $2.3 trillion health care bill last year, a whopping $500 billion to $700 billion was spent on treatments, tests, and hospitalizations that did nothing to improve our health.”
How about we take a look-see at setting a means of identifying these procedures, and then slap a 50% tax on all it? That would be $200-300 billion per year.
By way of comparison, the VA’s budget is currently around $87.6 billion per year. For that amount they were able to provide health care for 5.6 million Veterans.
I don’t want to get too lost in the numbers. The main point, however, is that we already spend billions of dollars on providing free medical care through our publicly-funded medical facilities. We just need to formalize that system and then start to build on it, hopefully by taxing the excesses of the for-profit medical system.
The essential point that I’d made in support of this proposal is:
Why are we proposing to pay health insurance companies billions of dollars in subsidies to provide heath care at their discretion after they take out their cuts for profits and administrative costs when we could use that money to provide health care directly to those who need it?
I am not saying that health insurance is not a valuable thing. If you can afford it, or you work at a job where it’s provided, great. This proposal would also help put downward pressure on the cost of private health insurance by: (1) providing a real “Public Option” that would deliver health care at lower costs; and (2) taking care of people who the for-profit health insurance system deems too costly for whatever reason.
But fundamentally it’s about leaving health insurance to private market, and using government funds to provide health care. The role of government, IMHO, is to take care of those who fall through the cracks in the private market. For free, or for however much they can afford, depending on the situation. This is the model that we use in public schools, in the police and fire department, in most areas of our society. Usually when someone on the right suggests that government fund private for-profit corporations to provide a public service, liberals and progressives fight against that. It’s called privatization, and whether it’s school vouchers, military contractors, etc., we don’t see it as a positive.
But somehow in the health care debate, we are being told that the progressive response is to pay private insurance companies to pay private medical service providers to provide health care to the public. I’m willing to be “talked down” because I do want to see people get the care that they need, but I don’t see how this is “progressive”.
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We can kind of back into a public health care system in the way you propose–no dramatic changes just use the clinic model that I’ve been a part of in the inner city. Professionals donate some time set up a clinic at a church or high school and give people basic care with respect.
Your comments on the current legislation are right on. Current health reform exists for two reasons: 1) appear to be doing “something” to mollify the “left”; and 2) enrich the medical industry. One thing the right has right is hatred for government.
I wish the people on the left would get it through their heads that government is increasingly a tool for corporate power. Increasingly smaller parts of the gov’t actually are interested in the public good–I speak from experience as a long-time gov’t consultant.
I really appreciate you thinking outside the box–we need more of that here.
That the “fix” for health care is going to be just like the “fix” for the economy. Deep inside all of the media induced propaganda I truely and sincerly believe the story about swine flu vaccinations coming this fall are a binary type bio-weapon. Really how can we possibly fix health care with zero jobs,industry,resources on top of enviornmental damage.
from VA care, I would not hold up the Veterans Administration health care system as a model to be replicated.
Yes, the care you get is free, the QUALITY of that care, however, leaves a lot to be desired.
My good friend, a veteran who works for the US government, used the VA for his health care. He went to two different VA cardiologists, who told him he had some small heart problems that could be treated with medication, here’s the pills come back in six months. He went to a private cardiologist, who looked at the records, who right away said where are the rest of the tests? He ordered an angiogram, which turned up an aortic aneurism, which required immediate open-heart surgery. In six months, my friend would have been dead.
The basic problem with the VA system is that it DOESN’T attract the best and the brightest. On the contrary, it tends to bottom feed on the dregs of the medical profession. The best and the brightest go for the bucks; as long as the private medical industry pays the bucks, the B&Bs ain’t gonna work for the VA.