A Health Care Solution, but Dare We Speak Its Name?

The Hour

By Leonard Fein

Published September 02, 2009, issue of September 11, 2009.
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Take away the loonies, the ones shouting comparisons of President Obama to Hitler, the ones talking about “death panels” and all the other stuff. Imagine a reasoned discussion of the pros and cons of the health care reforms now before us.

The health care reforms now before us? Excuse me, but what are they? We have no final bill from the Senate, we have three different bills from the House that await passage, and we have nothing specific from the White House. Here we are, arguing about a 17% slice of the American economy, and we don’t know what we are talking about.

Oh sure, we are talking about a public option, but we don’t know who will be eligible to join, we don’t know whether such an agency will be permitted to charge lower rates than the private insurance companies, we don’t know whether it will be allowed to negotiate lower fees from the drug manufacturers. We talk about Medicare remaining intact, but at the same time we are talking about reducing its cost by some $300 billion, much of this by moving toward a results-based medicine, which would surely mean some adjustments in Medicare, quite possibly very major adjustments.

We want — presumably even the Republicans want — a system that costs less and delivers more. We are — or should be — embarrassed by our low ranking, compared to other industrialized nations on such elemental matters as life expectancy and infant mortality. When all the chest thumping’s done, ours is not, by any measure, the “best” health care system in the world; it is only the costliest. And there’s also that minor issue of nearly 50 million uninsured people and another 25 million underinsured.

I’m afraid we’re having the wrong debate, even without all the absurd charges and the outrageous behaviors that have characterized altogether too many of the town meetings. It’s the wrong debate because it’s trying simultaneously to increase coverage and to reduce costs, and if that has left the public confused, there is good reason for the confusion. It is not possible, within the current structure, to do both at the same time.

Or, more precisely, there is only one way in which both goals can be accomplished. It is the way that has been chosen by Canada, by Great Britain, by France, by Germany, by Spain — indeed, by every other industrialized nation. It is — dare I speak the words? — universal coverage with close government supervision of costs.

That option, endorsed by a significant number of members of Congress (and, presumably, supported privately by many more), has been off the table since the debate’s been joined. President Obama supported it — but only back when he was a state senator in Illinois. Here’s the full quote, from an Obama speech to the Illinois AFL-CIO on June 30, 2003: “I happen to be a proponent of a single payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14% of its Gross National Product [now 17%] on health care cannot provide basic health insurance to everybody…. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Well, guess what? We have the White House; we have the Senate; we have the House. But we not only do not have single-payer, we are not even talking about single-payer. It’s possible that Obama suffers from a failure of nerve, or from a surfeit of bipartisan aspiration. It’s also possible that he and his people are better vote-counters than those of us who wish he’d given single-payer a real test.

Still, it would not be that complicated a test, since the truth is we already have single-payer for all Americans over the age of 65. It’s called Medicare, and it solves both coverage (everyone) and cost at the same time, running very substantially below the private insurance companies in administrative costs.

But the way to “sell” single payer is not to persuade people that it is fiscally sound and medically appropriate. The way to sell it is to insist that there is something fundamentally wrong when the system designed to provide health care is set up as a profit center. There are those who define a mix of public and private insurance systems as “the American way,” but the stark truth is that the insurance companies bring no added value to the health care system, none at all. (Unless you want to count their clerical contribution in processing claims.) What they contribute to the system is, alas, money for lobbyists and for legislative campaigns.

There are more modest potential fixes (savings) of other key components of the health care system — some improved efficiencies in hospitals (most are still nonprofits), drugs (where much better prices could be negotiated), professional compensation of some specialties, tinkering with the costs of malpractice premiums — but none promises nearly the saving that the elimination of private health insurance would provide. Between 2000 and 2007, the net profits of 10 of our largest health insurance companies increased by 428% (that includes WellPoint, up from $226 million to $3.345 billion — a 1,380% increase, and Aetna, up from $127 million to $1.831 billion, a 1,342% rise.) In 2007, the chief executive officers at these 10 companies collected a combined total compensation of $118.6 million — an average of $11.9 million each. That is 468(!) times more than the $25,434 an average American worker made that year. (We may assume that the CEOs all have health insurance; we know that many American workers of average income do not.)

Can government do the job? Look at Medicare, look at the V.A. hospital network. Government is already doing the job — or a significant chunk of it. By going for half a loaf instead, we may end up with a pile of crumbs.

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