The Amazing Maze of US Health Care

Retired Steelworkers and single payer advocates rest after a long day rallying and lobbying for health care on June 25, 2009.

The Senate and House are preparing to reconcile two modestly different approaches to health care reform.  Charges and counter charges continue to swirl around like New Year’s Eve confetti.  Are we on the verge of an historic breakthrough on health care reform?

What lessons have we learned about ourselves and our government?  Let me suggest six.

1.            America matters more to some than Americans.

The target of health care reform is Americans who are in the margins of our workforce.  They earn too much money to qualify for health care programs for the poor – state Medicaid and Children’s Health Insurance Programs (CHIP).  They work for small businesses who cannot or do not provide health insurance coverage.

As a society we have already agreed to provide health care to the poor, the old and those who work full time for profitable companies.  Why is it so difficult to fill the remaining cracks in the system?

Yet opponents of reform frame their arguments as a classic American struggle against big government.  The stories of very real Americans facing death by neglect or medical bankruptcy don’t seem to resonate as much as the conjured images of America challenged by fictional tyrannical death panels and giant government databases.

2.            I got mine – go get your own.

Very few people with health insurance pay anywhere close to the full cost of health insurance.  Less than 10% of adults under 65 obtain their health insurance in the individual market where they have to pay the full price.  73% of those who tried to buy individual insurance gave up either because it was not available to them or it was too expensive, according to a study by the Commonwealth Fund.  For the rest of us, our employer pays the majority share, or the government for those on Medicare and those on Medicaid.

Yet extending the same helping hand to those who may need health insurance to continue to participate in the workforce is tantamount to terrorism or tyranny, according to certain news commentators.  That may be an extreme view, but the noise it generates is dead weight that drags the center of political discourse away from constructive and meaningful reform.

3.            Money talks

Despite the clamor from the right, polls consistently show strong support for health care reform and even for the “controversial” public option.  Recently, I described how opinion pools show strong support for a single payer system.

So why are Democratic politicians having such a hard time getting “on board” with health care reform.  Countless stories have documented the amount of money the health care industry has spent on lobbying members of Congress.  One is reminded of my home town’s favorite son, Simon Cameron, Lincoln’s first Secretary of War, who once said, “An honest politician is one who when bought, stays bought.”  Only when some politicians began to realize that actual voters are behind those poll numbers did the public option begin to show renewed life.

Sadly, the Senate result reinforces the impression that money talks.

4.            Symbols matter

There is not a whole lot of evidence that the public option by itself will make a meaningful dent in the number of uninsured or in medical cost inflation.  But it is a powerful symbol reflecting one’s viewpoint about who should be the intermediary between the patient and the health care system – a government or quasi-governmental organization, or a private health insurance company.  There is clearly little appetite or political will to take on the insurance companies directly with the kind of strong and consistent regulation found in other countries.  The best that Democrats can offer is the threat of weak-kneed competition.

5.            Why do simple when complex is so – complex?

There is much ado about the nearly 2,000 pages of the health care bill.  When Congress tries to fix 1/6 of the American economy, it can’t be easy.  An analogy can be made to taking your tired old clunker to the repair shop.  It is too expensive.  It can’t haul nearly as many people as it was supposed to.  But you love it to death.  Your favorite repairman could hand you a ten-page estimate and tell you it will still be expensive and still won’t carry the all the passengers you would like.  Or he could hand you a one-page invoice for a new car.  HR 676, the “Medicare for All” legislation and beloved of single payer advocates, is 27 pages long.

6.            Who does Congress love most?  Not you and me.

Do you doubt the devotion of Congress to the insurance industry?  If so, the provision in both the House and Senate proposals to require an 85% medical loss ratio should say it all.  The law requires that at least 85% of premium income be used to pay for medical claims of covered participants.  Even the most conservative estimates put Medicare’s loss ration in excess of 90%, some argue in excess of 95%.  If the government can spend premium income more efficiently why let the private insurers in?

What next?

It’s no longer a safe bet that health insurance legislation will succeed (It does not deserve to be called health care legislation).  It is criticized from the right and from the left.

As feeble as it is, it will be a significant achievement given the long record of historical (and hysterical) opposition. Calling it reform will be the challenge of the spin-doctors.  Already there are estimates that it will leave a significant number of people still uninsured.  It doesn’t do enough to manage costs.  And there will undoubtedly be a backlash for a variety of reasons, some of them legitimate.  The question will be, how soon before Congress will have to revisit this issue?

Photo by JL McGee

Art by donna K mcgee

How many health plans have you belonged to?

If you are old enough to read this, you are the exception if you can count them.

Because you weren’t paying attention before adulthood, we will ignore the number of times you changed health plans as a child.

Maybe you are one of those very few employees who has stayed in the same job your entire working career.  Even then, your employer has most likely changed health plans several times during your career.

And then you will retire.

How many health plans may you encounter during your life time? Read the rest of this entry »

There is a group of people that has not been engaged in this debate about health care reform.

Yet the debate is about this very group of people – the uninsured.

But when the dust settles, the shouting is over, the ink is dry, and the regulations are in translation, those disengaged uninsured will emerge from their shells.  Like Punxsatawney Phil their heads will rise above their immediate struggles and they will check out the new climate for health care.

Will the sun shine and point the way for a brighter future for so many who have hidden in the burrows of our society?

Or will they see no discernible change and crawl back into an indefinite health insurance winter?

A recent report by the Robert Wood Johnson Foundation and the Urban Institute attempts to answer the question, how will the current reform proposals affect the number of uninsured.

It is full of impressive numbers, but offers insufficient concrete evidence that a “reformed” maze will be any easier to navigate than the current one.

One number is instructive.  Almost 30% of the currently uninsured are eligible for some form of public health insurance programs?  Half of those are children.  Why aren’t they enrolled? Read the rest of this entry »

Insurance reform is OK but we don’t need health care reform.

Conservative opponents of health care reform repeat this refrain in the blogosphere and the news.

Single payer advocates, on the other hand, insist they want  health care reform, not insurance reform.

What is the difference?  Are they mutually exclusive? Read the rest of this entry »

I am upset with President Obama’s handling of health care.

If I was responding to the recent Washington Post –ABC news poll I would respond “strongly disapprove” to the question:

Do you approve or disapprove of the way Obama is handling health care? Do you approve/disapprove strongly or somewhat?

But I am not sure the media analysis of the poll captures my sentiments.  To listen to them you might think Americans don’t want health care reform.  That’s not my view and that does not appear to be supported by the poll results.

The last president barely squeaked into office without a majority of the popular vote and the slimmest of margins in both the House and Senate.  And yet within two years he led the country into a war that almost no one wanted, and that has killed and maimed thousands of American service men and women.  That very same poll shows that 62% of Americans consider the war in Iraq not worth fighting. Read the rest of this entry »