Guaranteed Healthcare

We saw in our last post how the intensifying class war in America over the last 30 years has hollowed out the middle class and led to the widest gap between the haves and have nots in our country’s history. In this Second Gilded Age, the right has been winning the war by its promotion of deregulated markets and its attacks on government, thereby sacrificing the public interest to the benefit of the politically elite and the few at the top. In this new landscape, Social Darwinism increasingly prevails—sink or swim, take care of yourself, don’t expect any ‘handouts’.

Under the theory of moral hazard, it is postulated that insured people overuse health care services and that patients themselves are a leading cause of health care inflation. If they would just have more “skin in the game” through enough cost-sharing (co-payments, deductibles and other restrictions), it is assumed that costs could be reined in.

Up to the middle of the last century, most Americans could count on good access to generalist primary care physicians with the training and commitment to evaluate and treat their medical problems, whatever they might be. Those days are long gone. The ratio of generalist physicians to specialists in this country reversed from about 80:20 percent in 1930 to 20:80 percent in 1970. Since then we have seen the generalist tradition being carried on by family physicians, general internists, general pediatricians, and osteopathic physicians, but their aggregate numbers today are no more than 30 percent. And that number is falling fast as more medical graduates seek out the higher pay and more attractive life styles of the non-primary care specialties.

Yesterday’s blog post by John Goodman and Thomas Saving of the National Center for Policy Analysis (NCPA) is the latest in an avalanche of unfounded assertions and distortions that have characterized the writings from this center for many years. The Dallas-based NCPA, established in 1983, describes itself as a “nonpartisan public policy research organization, with the goal to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector” (its website). This latest post puts forward, without context and with cherry-picked references, carefully selected statements that might seem to some to support their case—that deregulated markets will solve all of our health care problems. It would take a very long paper, or a number of papers, to respond to the many unfounded claims in their latest post.

Amidst all the crises confronting our country today—ranging from the deficit, rising unemployment and underemployment, mistrust of legislators and the government—there is another major crisis: the continued deterioration of primary care that threatens to break up the very foundation of U.S. health care. Underreported and widely misunderstood, the continued decline of primary care results in uncontrollable inflation of health care costs, decreased access to necessary care, increasing fragmentation and depersonalization of care, and unacceptable quality and outcomes of care. As health care costs spiral out of sight and consume an ever-increasing part of the country’s GDP, this trend, unless reversed, can destabilize and eventually bankrupt our health care system, and perhaps even our country.

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.

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.