Features > March 7, 2007
The Health Care Monster Returns (cont’d)
The Bush YOYO strategy assumes that when health care consumers — otherwise known as patients — confront costs of medical care, they’ll consume less, and overall medical costs will go down. But Americans already spend more out-of-pocket on health care and use doctors and hospitals less than citizens of almost every other industrialized country. Yet, while the overall health cost in the United States is much higher, the outcomes — by virtually every measure of health — are worse. U.S. health care costs more mainly because of private insurance: Overhead at insurance companies runs close to 20 percent of total revenues, compared to less than 4 percent for Medicare. When the extra administrative costs imposed on providers are counted, the overall overhead that private insurance imposes on the system eats up about one-third of what Americans spend on health care. Eliminating those costs, as proposed by Rep. John Conyers (D-Mich.) and supported by Ohio Rep. and Democratic presidential candidate Dennis Kucinich, could finance most of a Medicare expansion to cover all Americans much more comprehensively than the program does now.
MOST PROGRESSIVE REFORMERS acknowledge that Medicare for everyone would best slay the health crisis monster, but many strategists worry that trying to eliminate the private insurers will provoke a withering counterattack. Consequently, many current proposals try, as Hillary Clinton did in 1993, to preserve a more regulated role for the insurance companies and at the same time expand public programs, on the model of Medicare, to provide a competitive alternative to private insurers.
Edwards’ plan would require employers to cover employees or help pay for their insurance (what’s widely known as “pay or play”). Everyone would have to buy insurance, taking advantage of tax credits, expanded programs such as Medicaid and the State Children’s Health Insurance Program, or new regional “health markets” that would provide a choice of competitive private plans and a public plan. Along the same lines, but with a simpler design and more robust public component, Yale political scientist Jacob Hacker proposes that everyone not in Medicare be covered either by insurance at work or a public insurance pool, including both regulated private plans and a Medicare-like plan.
Both these proposals move in the direction of Medicare for all, but strike a compromise with the existing system, losing the potential for better efficiency and more equity in the bargain. Why not push for universal Medicare (aka, a “single payer” plan)? Proponents of compromises say Medicare for all is a political non-starter. Americans, they argue, are suspicious of government, like choices and often like the private insurance they already have. And besides, they say, the insurance industry — along with most business interests and political conservatives — would launch a scorched earth campaign against such a proposal.
“There are a lot of dedicated, smart people who have made the judgment that taking some steps toward a comprehensive system with a public health care plan is better than waiting for the perfect system,” says Hickey, whose organization supports Hacker’s proposal. The labor movement, which was divided over support of a single-payer system in the ’90s, seems even more cautious now. “The political will isn’t there now, but it could get there for single-payer,” says AFL-CIO health care lobbyist JoAnn Volk. A close union ally adds, “Most of the labor movement has already accommodated to the reality that we’re not going to get a pure single-payer system. They have made the judgment that it’s just not within the range of possibility.”
SEIU’s Stern — who has argued that the United States needs an “American” plan, and not a foreign model like Canada’s single-payer system — says, “First we should create [a health care system] in which everyone is covered, then we can figure out how to rationalize it. It will cost more money than if we did it the other way [i.e, pursing the best alternative], but I think we have more chance of getting it done. The perfect cannot be the enemy of the good.”
ALTHOUGH A SMALL but rebounding movement for some form of Medicare-for-all exists, some progressive groups that would be its natural partisans are reluctant to commit themselves to a specific plan. William McNary, president of USAction, a national group of statewide citizen organizations, notes that many of their allies are splintering over proposals. “Things are fracturing,” he says, “it would be best for us to line up behind principles,” and not a plan. Jim Dean, chairman of Democracy for America, a liberal movement within the Democratic Party, thinks the United States is ripe for universal health care, but worries about both infighting over the best plan and the specter of corporate attacks. He wonders, “Can we figure out a way to talk about this so as not to get bogged down, sway, with “Harry and Louise” commercials [that the insurance industry used against President Clinton’s plan]?”
But there’s no guarantee that insurance companies won’t launch a war against these compromises, especially any that curtail insurance industry profits. And corporations that support universal health insurance will almost certainly oppose any plan that doesn’t seriously reduce their financial responsibility, which would threaten to shift costs to individuals. “Everyone says they’re for universal health care,” says Don Bechler, chair of the California Universal Health Care Organizing Project. “But the fundamental question is, ‘Who pays?’ Is [universal health care going to be] a sliding scale health care plan where everyone is entitled to first class health care, or a flat tax to sell junk insurance?”
When Clinton tried to finesse such political opposition by making insurance companies central to his plan, he suffered merciless attacks. No plan worth having will win without a massive grassroots organizing and education campaign. And Medicare for all is the one most likely to do so, while simultaneously strengthening progressives politically.
The American people are at least open to the argument. In a 2003 Washington Post poll, one of the few to pose alternatives fairly, 62 percent of respondents said they would prefer a universal health insurance program like Medicare, run by the government, to the current health insurance program. And support for the Medicare program remained nearly as high even if it limited the choice of doctors or led to waiting lists for non-emergency procedures.
Eventually, Medicare-for-all advocates might have to settle for a compromise. But the opportunity for major change in the health care system doesn’t come around very often. Since any change will require a massive effort, why not fight for the best?
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