Guaranteed Healthcare

Now that we have a new president espousing health care reform and a Democratic majority in both houses of Congress, isn’t this a time to be excited and optimistic for long-overdue reform?  Much as we would like to say “Of course!”, we cannot.  The “reform” effort is already way off the track, despite the hype of “progress” in the uncritical mainstream media.

It is now widely recognized that we are in a global recession of historic proportions, raising comparisons with the Great Depression of the 1930s. The failures of deregulated markets, whether in housing, banking or other industries, has become obvious to all. So far the private health insurance industry has not been called to account, but its day is coming soon.

In a Letter to the Editor of the Wall Street Journal just days ago, John Goodman, president of the conservative Dallas-based National Center for Policy Analysis, repeats this classic premise of Milton Friedman's economic views:  "capitalism confers its greatest benefits on people at the bottom of the income ladder.  People at the top would have done well under any system. It is people at the bottom who are most liberated by markets." This view of the world has dominated U. S. politics for several decades.  As we saw in our last post, however, free markets in health care are driving up costs at three and four times the rate of cost of living and family incomes.  It is long overdue to hold this theory to account for its actual track record and its impact on people needing health care.

Market theorists have been telling us for years that the competitive marketplace will keep prices under control, as well as fix problems of access and quality of health care.  This statement by senior fellows of the Hoover Institution in 2006 reflects market ideology which has framed health care policy for three decades:

“Greater reliance on individual choice and free markets are the solutions to what ails our health care system . . . A handful of policy changes that harness the power of markets for health services have the potential to give patients and their physicians more control over health-care choices, create more health insurance options, lower health costs, reduce the number of uninsured persons— and give workers a pay increase to boot.”

As our health care “system” continues to fall apart in its crisis of access and affordability, new coalitions are popping up all around us, each espousing the urgent need for “ health care reform”.  These are some of the bigger, more recent coalitions:

    •  Divided We Fail (includes AARP, the Business Roundtable, and the Service
Employees International Union (SEIU); committed to a “search for solutions to  
health care” - - -  by building on private insurance.
    •  The National Coalition on Benefits (includes more than 50 of the largest
corporations and most powerful lobbying organizations, including private health
insurers, the Business Roundtable, and the U. S. Chamber of Commerce; they
lobby to keep large employers’ insurance plans exempt from regulation)
    •  Health Care for America Now (HCAN), a coalition of many national
organizations, including the American Nurses Association, MoveOn.org, and the
    Progressive  Action Network; their common purpose is to promote “an American
solution” which assures universal health coverage “through the largest possible
risk pools” for affordable health care in an inclusive and accessible system leaving nobody out; it retains choice of a private health plan.
•  Five other organizations --- the American Cancer Society’s  Cancer Action Network, the American Hospital Association, the Catholic Health Association, Families USA, and the National Federation of Independent Business (NFIB, which represents small business); this group is co-sponsoring the latest Harry and Louise advertising campaign, which expresses concern about cost and access problems, urging that “health care should be at the top of the next president’s  agenda.  Bring everyone to the table, and make it happen”.

Starbucks has been a model among U. S. employers for its social and
moral responsibility to its work force since its founding in 1982.
Howard Schultz, who founded the company, grew up in Brooklyn, New York
in a hard-working family without health insurance, and never forgot the
plight of working class people struggling every day to make ends meet.
He was determined to build a different kind of company—one that makes a
profit, builds shareholder value, but also has a social conscience
integrated back into the company. As he has said in his excellent book
Pour Your Heart Into It,

“From the beginning of my management of Starbucks, I wanted it to be
the employer of choice, the company everybody wanted to work for. By
paying more than the going wage in restaurants and retail stores, and
by offering benefits that weren’t available elsewhere, I hoped that
Starbucks would attract people who were well educated and eager to
communicate our passion for coffee. To my thinking, a generous benefits
package was a key competitive advantage.”

Last week’s action by Congress to override President Bush’s veto of the Medicare Improvements for Patients and Providers Act (HR 6331) was a landmark step toward reversing the tide of privatization of Medicare over the last three decades. The votes in Congress were a resounding defeat for conservative policies and the lobbying efforts of the insurance industry. There was no ambiguity in the override votes — 383 to 41 in the House and 70 to 26 in the Senate, with 153 Republicans in the House and 21 Republicans in the Senate defying the president. The courageous leadership of Senator Edward Kennedy, long a champion of better access to health care, helped to head off a disastrous veto of this legislation despite his current medical problems.

Although we pay more and more each year for health insurance (average premium for a family of four now over $12,000), we get less and less for it. Insurers continue to take high profits first, leaving enrollees more vulnerable to high out-of-pocket costs for health care.

Conservatives in government, free market stakeholders, and their
lobbyists won a big one last week. Even after the House gave
overwhelming bipartisan support to the Medicare Improvements for
Patients and Providers Act (HR. 6331) by a vote of 355-59 (including
129 Republican votes), the Senate fell two votes short of the 60 votes
needed to overcome a presidential veto. Presidential candidate Obama
voted in favor of the bill; McCain was a no-show. The bill would have
cancelled a physician pay cut of 10.6 percent, reduced overpayments to
private Medicare plans, improved coverage of mental health and
preventive services under Medicare, and added consumer protections for
enrollees in private plans. President Bush planned to veto the
legislation because of payment reductions to private plans and the
improved benefits, claiming that they would “reduce access, benefits
and choices for many of the 2.25 million enrollees in Private Fee for
Service (PFFS) plans. Robert Hayes, President of the Medicare Rights
Center, called this “a craven submission to the insurance industry”.

Access to health care is a complex matter, ranging from availability of health professionals in one’s community to many barriers to care, such as racial/ethnic, geographic, and literacy factors. But as the costs of health care surge ever higher, the financial barrier to care has clearly become the biggest impediment of all. Having insurance used to offer some protection against this barrier, but does so less all the time as the numbers of uninsured and underinsured grow.

The American Association of Health Plans (AHIP) is the national trade
group for some 1,300 private health insurers, which collectively
provide some kind of coverage for more than 200 million Americans. As
the voice of industry, AHIP’s web site boldly describes its goals “to
provide a unified voice for the health care financing industry, to
expand access to high quality, cost effective health care to all
Americans, and to ensure Americans’ financial security through robust
insurance markets, product flexibility and innovation, and an abundance
of consumer choice.” This post examines how successful the industry has
been in one of these goals --- the cost and affordability of coverage.

Most of us have by now heard many indictments of private health
insurance, from its inefficiencies and unaffordable costs to its
profiteering, cherry picking, and avoiding coverage of those who most
need insurance. What’s new and may be surprising to many people is
this: despite its size and political power, it is a dying industry.