Features » March 7, 2007

The Health Care Monster Returns (cont’d)

Most progressive reformers acknowledge that Medicare for everyone would best slay the crisis monsters, but many strategists worry that trying to eliminate the private insurers will provoke a withering counterattack.

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?

• Help In These Times publish more articles like this. Donate today!
• Subscribe today and save 40% off the newsstand price!

• subscribe to print magazine

• stay in touch with our email newsletter

  Subscribe to our regular weekly e-mail newsletter. It's packed with updates on recent and upcoming stories, events, campaigns and things every progressive should be informed about.

   

• email this article to a friend

  Your Name Your Email Recipient Email

  Personal message Thought you might be interested in this article from In These Times.

   

  Please help us prevent spam by verifying the word you see in the image above

  Send to multiple recipients. Just separate each email address with a comma.

• Reader Comments

  “Stern argues that “the most essential change is to get everyone in a system where they have health care,” then work to improve it.”

  Terrible argument! In order to be politically possible, any changes to the health care system must not lead to worse coverage for those who are covered already (the vast majority). If we attempt to screw the middle class to help the lower class, it will be a non-starter.

  In any case, medical care in the US is expensive here due to very good reasons (e.g., MRI machines cost big bucks as do their operators). We can no more afford to provide the poor with excellent medical care than we can provide them with gourmet food. The trick will be to provide adequate care for the poor, while continuing to provide excellent care for the middle class and upper classes. We need to remember that resources are limited and to robustly support those of us who are paying for the services (or those of us who already have, via Medicare).

  Posted by wolf on Mar 7, 2007 at 4:56 PM

  I’ve got mine, Jack, the hell with you…........nice philosophy, wolf. But are MRI’s the main reason for the high medical costs ? I’ve had a few myself
  over the years but they are not exactly standard procedure. How many
  tests and procedures are necessary ? And should insurance companies be making those medical judgments ? The HMO system
  itself is socialist, a joint brainscheme of Nixon and Ted Kennedy.
  It may be that we need laissez faire here instead of socialism, abolish licensing and the medical guild monopoly over medicine since all monopoly raises prices. While the poor and many middle class people can’t afford gourmet foods it is still possible to get good food on the market, not just adequate. Medicine is a highly government controlled and regulated field and all the braindead libs can do is cry for more government intervention. We can’t be more creative than this ?

  Posted by blondemike on Mar 7, 2007 at 7:50 PM

  pretty much every other industrialized nation provides ALL it’s people quality healthcare for less money than we do, probably the best thing to do is increase resources. in France they spend about 60% what we do as a percentage of GDP and have about twice as many doctors. a for profit healthcare system DOES NOT WORK. just look at the numbers.

  Posted by konformer20 on Mar 8, 2007 at 3:30 AM

  A very basic principle in insurance is having a pool of clients large enough in order to spread the risk over a broad area. Having a lot of people paying for insurance with the risk spread out as vast as possible is very efficient and profitable. A system that has EVERYBODY covered (i.e. the largest pool possible) would be the best way to spread that risk. Single-payer is the only real way to get out of our present situation. In addition to eliminating the “middle-man” of private insurers with their smaller risk pools, other savings can be had with a greater focus on preventative care and a reduction in useless (from a societal point of view) coslty cosmetic/elective surgeries that skew valuable resources away from better uses.

  Posted by lams712 on Mar 8, 2007 at 5:53 PM

  The trouble with the system now is that is too socialized with medicare,
  HMO’s, etc. The state will decide who can and can’t get surgery because of “society’s” (read: government) resources. People who need serious surgery in Canada come here. We should turn over medicine to
  the folks who run the postal service ? And what you consider “cosmetic”
  otheres consider necessary and if they can afford it they should get it. Not have some shitass bureaucrat decide for them.

  Posted by blondemike on Mar 8, 2007 at 6:05 PM

• extended discussion >>>Continued...

  Discussions with more than 5 comments are continued on our special discussion page to encourage continuity and ease of use. There are currently 113 posts.

Also featured Counterinsurgency 101
Elders of the New Left
Colombia’s Third Way

Full contents
Previous issues
Subscribe and save!

Also by David Moberg

• Labor’s New Leader
  The AFL-CIO stakes its future on Richard Trumka. Posted on October 16, 2009
• The Retail Devolution
  Two new books explore corporate evil.Posted on September 25, 2009
• Who’s Got the Power?
  Progressives find themselves outmaneuvered on healthcare reform. Posted on August 17, 2009
• Not Your Parents’ Labor Movement
  Why the Republic sit-in failed to inspire other worker actions.Posted on August 3, 2009
• Solidarity Reunited?
  Unions rally around shrunken UNITE HERE as it takes on its former ally.Posted on July 4, 2009