HEALTH CARE/Joan Retsinas

Whining to an Impasse

Washington’s best and brightest, working 24/7 on health reform, are whining. Indeed, the whining is mounting to a crescendo that may well end in impasse. Listen to the plaints: A government program will cost too much. It will stifle private insurers. We’ll end up with magnanimous coverage that will bankrupt us. We’ll end up with rationing that will kill us. We can’t realistically cover everybody. We can’t raise taxes. Reforming this system is too hard. We mustn’t rush in. We need more time.

The team — call them Team A — is debating key policy decisions. Its members are private sector bigwigs from the industries that benefit from the status quo, abetted by the Congressional and Senate solons whose campaigns they have generously supported. If I belonged to this team, I’d be whining too. Reforming the system, while keeping intact Team A’s ultra comfortable way of life, is impossible — like squaring the circle. So the whining will continue, maybe until the “wait for next year” reprieve.

Why not send in Team B? I bet they could succeed.

For a start, recruit a few uninsured people for this team. Ask the people who clean the houses, cut the grass, and take care of the children of Team A honchos. Visit an unemployment office, drawing from those whose employers downsized, or declared bankruptcy. Try employees who can’t afford their companies’ policies. Ask parents who have been dropped from their states’ Children’s Health Insurance rolls. Look closer to home – at the legions of “contract workers,” that government and industry hire to avoid paying for insurance. With 49 million — and mounting — uninsured people, the country could quickly gather a few to decide today’s intractable debate question: cutting costs versus expanding coverage.

Next recruit a few people who have private coverage, but are not singing its praises. Try one or two “medically bankrupt” people — the ones driven to bankruptcy not by predatory mortgages or pink slips, but by medical bills. Go to debtors on hospitals’ “dunning” lists: the ones who get calls from bill collectors (a robust industry). I bet they’d attend a few meetings to discuss the responsibility of government to pay for health care. And I’d bet they could advise on the wisdom of using tax dollars to insure the overall health of the populace.

Team B wouldn’t be complete without some of the people left “on hold” waiting to talk to their private insurers. Since “your call is very important to us and may be monitored for quality reasons,” we should be able to retrieve a few names from those data bases of people who are bureaucratically trapped, trying to get somebody to explain why treatment x or drug x was denied. Ask a woman hustled out after a same-day mastectomy to serve on Team B, or a patient with cancer, forced to switch oncologists when an employer switched insurers, to comment on all the save-money rules that insurers have wielded to save costs. Recruit some people with chronic illnesses who have exceeded their insurers’ caps. Team A fears that government would base rules primarily on health, not costs. In short, sicker people would drive the system to spend more. Team B could advise.

Invite Medicare enrollees to the table. Include some Medicare-complainers. Let them reminisce about the good old days before they turned 65. They may lament the co-payments, the expensive supplemental private insurance, the complicated drug coverage add-on — but I doubt they miss their workplace policies.

Invite a few foreigners onto this team, from those countries in the developed world that cover all their citizenry at a lower per capita cost than we do in the United States. Virtually all the countries in the developed world manage to do so. And those countries end up with a healthier citizenry. (We Americans may get more tests, more drugs, more procedures than foreigners, but we don’t end up healthier.) I concede: their governments play a major role. And we want to do health care our way, relying on private sector initiative (just as we used to make cars our way). But maybe the rest of the world could help with our deliberations.

Team A comprises people with insurance (if Uncle Sam or the insurance industry covers them, they have wonderful insurance), who are healthy (otherwise, they couldn’t work 24/7), who are worried about the larger economy but do not fear imminent layoff or foreclosure. Crucially, many are prospering under the status quo. They recognize the need for reform, if only because the political pressure is on. After all, a majority of the population wants change. But Team A won’t readily let go.

Let’s try Team B.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, August 1, 2009

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