Incremental reform will be the best we can hope for when it comes to health careunless Americans make it clear that the current system must be scrapped and a new one created in its place.
Congress and the White House are working on what is being called an overhaul of the system that is expected to include universal coverage and a public health insurance plan designed to compete with for-profit insurance.
Chairman of the five Congressional committees that will oversee the reform efforts achieved consensus on the main ingredients of legislation, while the insurance industry, considered a major impediment to reform, has made several major concessions, the New York Times reported in April.
The chairmen, all Democrats, agree that everyone must carry insurance and that employers should be required to help pay for it, the paper said. They also agree that the government should offer a public health insurance plan as an alternative to private insurance.
Questions of overall costexpected to be more than $10 trillion over and exactly how to pay for coverage of the uninsured remained unanswered in early April. According to the Times, Congress hopes to vote in July.
While the outline appears to be an improvement over the current state of affairs, it falls short of the kind of major reconstruction necessary to address the chief issues contributing to the systems dysfunction: the patchwork nature of healthcare provision in the US.
As Physicians for a National Health Program point out on their Web site (www.pnhp.org), we spend about twice what other industrialized nations spend but our system performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates, while also leaving 47 million completely uninsured and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers, the organization says. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay.
Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31%) of Americans health dollars.
The solution, PNHP says, is a single-payer system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. It could be financed by cutting administrative waste and taxes that would replace insurance premiums.
The benefits, according to the organization, include: potential savings on paperwork (of) more than $350 billion per year, which would be enough to provide comprehensive coverage to everyone without paying any more than we already do and universal coverage for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs.
Just as importantly, the interference of insurance-company bureaucrats would become a thing of the past because the relationship would change to a fee-for-service or salary model with hospitals receiv(ing) a global budget for operating expenses and facilities and equipment purchases being managed by regional health planning boards.
Patients, the organization says, would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
That is not the case with the reforms placed on the table by Congress, which leave the insurance industry whole and assumes that a competing government plan and universal coverage will address the cost issue. It is the same logic that resulted in the changes in the systemexpansion of HMOs, in particularthat have helped drive up costs over the last two decades without any improvement in access or quality of care.
The willingness of Congress and the new president to discuss reform, however, may offer a way to get past the incrementalism of the political classes. After all, health care is on the agenda because the public wants it there, as poll after poll shows. It is an indication that our elected officials can be moved by public opinion.
Thats where Healthcare-Nows rallies come in. The organization, which advocates national, single-payer healthcare legislation and has endorsed US Rep. John Conyers healthcare bill, protested at the regional health forums held by the Obama administration. The forums were designed to solicit public input.
The Conyers bill, HR 676, would create a publicly financed, privately delivered healthcare system that uses the already existing Medicare program by expanding and improving it to all US residents, and all residents living in US territories.
Hundreds attended the rallies, which were designed to demonstrate the publics commitment and to educate and encourage others to get involved. They were useful building blocks in developing the kind of grassroots energy that is going to be needed to force Washington to expand its limited view of the issue.
Healthcare-Now will hold a National Day of Action for Single-Payer on May 30. For more information, contact the organization at 800-453-1305 or see its Web site, www.healthcare-now.org.
Hank Kalet is a poet and the online editor for The Princeton Packet newspaper chain. E-mail email@example.com; see his blog, www.kaletblog.com; Twitter, www.twitter.com/newspoet41.
From The Progressive Populist, May 1, 2009
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