John Buell

Freedom and Health Care

I am angered when I hear the health insurance lobby proclaim their interest in preserving our freedom of choice. This line is on a par with the corporate anti-labor lobby’s claim that their opposition to the Employee Free Choice Act grows from concern for a democratic workplace. As with EFCA opponents, one should scrutinize carefully that elusive concept of freedom. What are the real freedoms our health care oligopoly preserves? These include the freedom to choose the doctors and procedures your insurance company allows, the right to go bankrupt, the right of the healthy, wealthy, and lucky to continuing coverage, and the right to choose between medical insurance giants as many and varied as Coke versus Pepsi.

We have heard a slew of ads about how publicly funded health care systems limit patients options. Here in my home state of Maine, Canada has been a frequent target of abuse. Yet as Rhonda Hackett, a Canadian born clinical psychologist now living in the US points out, it is a myth to suggest that the Canadian government dictates health care options. She goes on to point out. “While HMOs and other private medical insurers in the US do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.”

Here in the US many private insurance conglomerates allow us our own medical choices — as long as we are willing to shoulder the very risks for which we buy insurance. Under the current system corporate insurers can suddenly jack up the rates — and effectively purge — a longstanding business client whose medical bills have suddenly increased. In addition, the industry routinely rescinds payment for claims of those it deems to have made misstatements of previous medical history — even when the misstatement was minor or even non-existent and the insurer had collected premiums for years.

Our freedom is the right to play Russian roulette with a profit-hungry industry. And as with the real game, it takes a fatal toll on some. Some studies show that as many as 20,000 a year die needlessly. Economic analysis of personal bankruptcy indicates that just in 2001 to 2007 period, the percentage of bankruptcies attributed to health expenses has gone from about 50% to over 60%.

Inadequate as this insurance is, most of us prefer the game to nothing at all. Yet even for our limited protection, we pay a price that goes beyond dollars and cents. Sara Anderson of the Campaign for America’s Future points out: “Americans routinely stay chained to jobs they hate because they can’t afford to lose coverage. Canada has an exuberant entrepreneurial culture … Canadians may bet the house and the kids’ college funds on a new venture; but they never think twice about whether or not they can afford to leave BigCo because they’ll lose their insurance,”

Even for those who don’t aspire to their own business, publicly financed universal health care is a social as well as economic blessing. Anderson comments: “Take this job and shove it” is a lot easier — and sweeter — when your boss isn’t holding an almighty health care card over your head. Bosses know this, too, and working conditions are often better as a result.”

Perhaps because they identify with the wealthy corporate CEO’s or because they enjoy the workplace power afforded them the health insurance lure, too few small business lobbies have endorsed universal health insurance. With health costs regularly outpacing inflation, they face substantial limits on future expansion.

Market rhetoric teaches us that if insurance company A offers unfair rates and conditions, just choose B. But here in Maine, and in many other states, the market is dominated by as few as two or three players and choices offer no significant differences. Profits and prices far exceed competitive market returns. Competition among many players, however, would create its own diseconomies. Perhaps strong regulation of the giants would minimize these problems, but at best we gain no more than a wholly public plan would achieve. In any case, truly effective regulation is as politically difficult as a public system, which remains the best alternative.

John Buell lives in Southwest Harbor, Maine, and writes regularly on labor and environmental issues. Email

From The Progressive Populist, August 1, 2009

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