Go for Gold in Health

The top Democratic presidential candidates have embraced the concept of health care for all, which is a good thing in an era when the Republican preference is health care only for those who can pay for it.

Hillary Clinton's plan, announced to much fanfare on Sept. 17, would require everybody in the US to have insurance. Individuals whose employers didn't provide insurance would have to buy their own insurance for themselves and their families.

Clinton's plan, which has many of the same features as the one John Edwards proposed in February, has some good points: She would require private insurance companies to offer plans that meet the standards of the Federal Employee Health Benefits Program -- the plan that covers members of Congress and other federal workers. She also would offer a public health plan similar to Medicare. Coverage would be portable in case of job loss or change. Employers would be required to provide health insurance or pay into a fund to defray the cost of covering those employees. Small businesses would get tax breaks to encourage them to offer coverage. A graduated system of tax credits would make sure that no one paid more than a "reasonable" percentage of their income on health premiums.

The health care reforms proposed by Clinton, Edwards and Barack Obama satisfy the main points of Health Care for America, which the progressive Campaign for America's Future drew up with the assistance of Yale Professor Jacob Hacker as part of the Agenda for Shared Prosperity (sharedprosperity.org). It called for a Medicare-style system for all Americans under 65, where the uninsured and underinsured could buy into the plan, with federal or state government assistance if necessary. Medicare and Health Care for America would then join forces and wield enormous bargaining power, driving down costs and raising the bar on quality. Private employers could provide insurance coverage for their workers or enroll their workers in Health Care for America at a modest cost. One way or the other, affordable, quality health coverage would be guaranteed for all Americans.

Top Republicans scoffed at the need for universal health coverage. President George W. Bush says everybody who doesn't have insurance can just show up at the emergency room. Former New York mayor Rudy Giuliani said health care doesn't need "government command and control." Mitt Romney criticized Clinton's plan as "a European-style socialized medicine plan."

Actually Clinton's plan reminds us of the bill Romney signed when he was governor of Massachusetts. In that case, many of the good parts were compromised out to satisfy the insurance racketeers. Uninsured residents were left with a state mandate to buy health coverage, with some assistance from the state by redirecting federal dollars, fees on hospitals, and other money that had been subsidizing care for the uninsured.

But Steffi Woolhandler and David Himmelstein of Physicians for a National Health Program (pnhp.org) wrote in the Boston Globe Sept. 17 that only 28% of Massachusetts uninsured have incomes low enough to qualify for free coverage under the state's new health plan, while 34% qualify for partial subsidies. That leaves 240,000 Massachusetts uninsured with no assistance -- only a stiff fine if they don't buy skimpy coverage that can run $8,638 annually for a couple in their 50s.

Considering that the GOP Congress did not lift a finger to address the growing crisis of the uninsured, -- even as Republicans refused to cut any slack for families driven into bankruptcy by ruinous hospital bills -- they can be expected to continue to oppose any meaningful health care reform.

Democrats will need a supermajority of 60 votes in the Senate and a Democrat in the White House to pass health care reform. But if Democrats find themselves with 60 votes in the Senate and a Democrat in the White House, they might as well go for single-payer health care, such as that proposed by Democratic presidential candidate Dennis Kucinich, the progressive congressman from Ohio. Kucinich supports HR 676, the US National Health Insurance Act, sponsored by John Conyers (D-Mich.), which would expand Medicare to cover all Americans.

The Clinton, Edwards and Obama plans appear to be as much interested in helping insurance companies stay in business as in helping working people get quality health care. And a proposal to make health insurance mandatory is not likely to excite uninsured voters to get to the polls for Democrats next year.

Congressional Democrats might not want to lose the $10.7 million they got from the insurance industry in 2006; if so, they're selling themselves short: Republicans got $20 million in insurance money in the last election cycle. (Hillary ranked third among senators in 2006 with $367,800 in insurance contributions. She has received $357,200 from the insurance industry for her presidential campaign, according to opensecrets.org. Obama got $269,750 from insurance sources and Edwards got $81,7500. Christopher Dodd, D-Conn., was tops in insurance money with $605,950, while Romney got $459,625 and Giuliani got $370,100. Kucinich got $500.)

Democrats would earn millions of dollars worth of good will from voters if they told insurance companies to go to hell.

Insurance companies increase their profits by denying claims. Michael Moore's movie, SiCKO, documented the cases of middle-class folks who thought they had good health insurance until they got sick and found out the limits to their coverage.

Insurance companies waste health dollars on things that have nothing to do with care, such as overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals also must maintain costly staffs to deal with the insurance bureaucracy. PNHP estimates that bureaucracy consumes 31% of Americans' health dollars. Single-payer financing would save $350 billion a year on paperwork alone, enough to provide comprehensive coverage to everyone without paying any more than we already do.

PNHP estimates that a comprehensive national health program that includes all medical, hospital, eye care, dental care, long-term and mental health services as well as prescription drugs and medical supplies -- and preserves a choice of health care providers -- could be financed by a 7% payroll tax on employers and a 2% income tax on individuals. Both businesses and families would spend less than they do now on private insurance coverage. Employers now pay upwards of 8.5% of their payroll for health coverage -- and many small businesses have to pay 25% or more of their payroll on health insurance, if they offer it at all.

As for the fear that Medicare expansion would result in health care rationing -- that's what we have now. If insurance doesn't approve the medical procedure, you don't get it, unless you pay cash. The Institute of Medicine found that 18,000 Americans die every year because they don't have health insurance.

The United Auto Workers went on strike with General Motors on Sept. 24 over the carmaker's refusal or inability to guarantee US jobs in part because of the high cost of health insurance. We agree with Digby of digbysblog.blogspot.com, who noted Sept. 24, "GM says it needs to cut costs. Perhaps it would like to work with the Democrats and the Unions to get universal health insurance. It would be good for their workers, good for the country and good for the bottom line."

Congressional Democrats shouldn't wait until next year. They should pass Conyers' Medicare expansion bill out of the House. Let Republicans filibuster it in the Senate, so that working people will know who is responsible for keeping them from getting the same quality medical care as the rest of the industrialized world. Then they'll do the sensible thing next year and give Democrats the long-sought supermajority for national health care reform. and other progressive initiatives -- JMC

From The Progressive Populist, October 15, 2007

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