| Number 5 | October 6th, 1998 |
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This Week: |
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Greetings, This week I am sending your way a commentary I wrote for ACCESS PRESS in August. It's still timely. S. 2529., A bill entitled the `Patients' Bill of Rights Act of 1998.' was placed on the Senate calendar on October 2nd. [Ed note: In July of 1999 there are several similar bills, but who cares what the numbers are? It’s STILL timely!] I think it is worth contacting your legislators at any time with the basic message "We want universal health care paid for with progressive income and wealth taxes." I personally prefer a fully socialized system, but a Canadian-style single payer system would be a reasonable compromise. A fully socialized system (does everyone - anyone - really understand what that would be?) would go a long way toward transforming the health care system from a business into a public service. A single payer system would leave the system too competitive and commodified, but at least it would remove the insurance industry from the equation, which could only be good. A more pure example of social parasitism cannot be found, methinks. In the current political climate, of course, both of those ideas sound like the ravings of a space alien, but I think it's important to say what we want regardless. Any good negotiator goes in with a clear statement of what she/he wants, and compromises from there. Then you at least have a chance. Besides, what's the worst that can happen if we state clearly what we want in a health care system? Rod Grams will laugh at us? Here's the piece; I think it's informative. ‘Til next week, Nygaard |
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What happens when an irresistible force meets an immovable object? Something has to give. In the fight to reform health care in the United States, in which the irresistible force of profit has met the immovable object of fairness, we haven't been able to stop profit. The latest attempt to support the idea of fairness is something called a "Patients' Bill of Rights," now being debated in Congress. The Republicans have their version, the Democrats have theirs, and each is quick to point out why the other party's proposal is a disaster. They're both right! With 44 million people uninsured, and with the United States ranking near the bottom among industrial countries in infant mortality and life expectancy, our health care system is already a disaster. And any "Bill of Rights" that Congress might pass is likely to make things worse instead of better. In the days before managed care, profits came from treating sick people. Every office visit, every prescription, every surgery, meant that someone was making money. Who made the money? Doctors, clinics, hospitals, medical equipment makers, pharmaceutical companies and insurance companies, who charged whatever the market would bear for their product. Many people wondered: Who wants a system where the main financial incentive is to have more sick people? Then, overall medical costs began to go through the roof in the 1980s, with millions uninsured. Enter managed care. Under managed care, the profits come largely from cutting costs. If an HMO takes in $10 million per year in premiums from its members and can somehow figure out how to pay out only $9 million for their care, that's a $1 million profit. So, under managed care, the incentive became exactly the opposite of what it was under fee-for-service care: now less treatment means more profit. Is this a good thing? The HMOs say they have a new incentive to promote "wellness," which will lead them to invest in preventive care and public health programs. This sounds good to everyone, and some HMOs do indeed seem to be following this course. The problem is that it takes quite a long time (in corporate terms) to improve the overall health of a population. It's much more profitable in the short term for HMOs to cut costs by denying or limiting the amount of care that they give to their members. Horror stories abound of patients getting sicker or even dying after being denied care by their HMO. In addition, not everyone needs the same amount of health care. In America, one percent of the people are so sick that they consume about 30 percent of medical expenditures., and the sickest 5 percent take up 58% of the cost. HMOs know this, and they know they can cut their costs by attempting to enroll only the healthiest (read: least costly) among us. Insurance companies have been doing this forever. Many of our readers have no doubt been denied insurance coverage because they had a "pre-existing condition." This is part of the reason why 44 million Americans are currently uninsured. Private Profit, Public Cost So, would legislation mandating a "Patients' Bill of Rights" change the focus in our health system away from profit and toward health? Hardly. It is possible to see the Patients' Bill of Rights as an attempt to slow down profit and give fairness a chance to assert itself. This hopefully well-intended legislation attempts to eliminate some of the more outrageous cost-cutting practices that have been used by HMOs, such as "drive-through" childbirth and denial of payment for emergency room visits. The Democrats say we need to limit profit to improve care. Republicans say all this regulation will simply raise costs, resulting in more uninsured people. They're both right. Nevertheless, the largest HMOs support some sort of bill, so it looks like we'll get one. What can we expect? It looks like we'll continue with our system of "private profit, public cost." Private health care companies will continue to pursue profit by denying our sickest and/or poorest people access to their system through unfettered "issuance or pricing of policies" (regulation of which the Bill of Rights expressly forbids). At the same time, the American values of fairness and compassion will dictate that the government make at least some attempt, probably very costly, to serve the health care needs of those who are unprofitable. And, in this era of budget-balancing and cost-cutting, the minimal programs we have are bound to be cut still further. The Solution Almost every other industrial country (and many poor ones) has a universal, nationwide system of health care. These take many forms, from a socialized system such as the National Health Service in the United Kingdom, to a single-payer, province-run insurance system in Canada. The least extreme solution would be one along the lines of a Canadian system. The Canadian system is cheaper than the U.S., both per capita and as a percentage of Gross Domestic Product. Everyone is covered. Complete choice of doctors, high-quality treatment. Taxes in Canada, despite what you may have heard, are similar to the United States (about 3% higher). When Canadians were recently asked which system they would prefer, their own or that of the United States, 95% said they would not switch. Perhaps most importantly, in a universal system, we would all share the costs and risks, and we would all share the benefits. No one would gain by depriving another of health care. The main incentive in such a health care system would be to reduce human suffering and to preserve human life. The Patients' Bill of Rights is the "hot new issue" in health care, and it's easy to get distracted by the high-volume arguments about which one is best. But the majority of Americans think that our health system needs fundamental change, so let's not get distracted. Let's keep working for universal health care, where people come before profits. That is truly our right. [This Commentary was published in the August 10, 1998 ACCESS PRESS] |