Rudy Giuliani has described Senator Clinton’s health care proposals as Socialized Medicine. Mitt Romney went one step further with “European Socialized Medicine” -- apparently to distinguish it from the American (Canadian) version, or the Asian (Japanese) edition. To listen to them, you would think that Socialized Medicine is a bad thing. When you think about it, they might just be right, but only if we’re foolish enough to elect a bunch of Republicans next year.
It has been repeatedly noted that the people who don’t believe in government have it easy. First, get elected by claiming “Government is not a solution to our problem, government is the problem.” It’s the nature of life that sometimes that aphorism will be true, and while you can only fool all of the people some of the time, if you can do it once, it lasts for four years. Step two is to appoint a bunch of sycophants who have no objection to selling their souls for short term gain. Step three: when things go wrong, explain that that’s the nature of government. When President Bush pushed millions of children down the stairs by vetoing the SCHIP bill that would have expanded health insurance subsidies for children, he said, among other things, that it is “an incremental step toward the Democrats’ goal of a government-run health system.” This was followed with warnings that when government pays the bills, government makes the decisions about the nature and quality of health care.
Three things should be obvious, but for some reason aren’t: Whoever pays the bills, government or not, makes the decisions; single payer systems have greater efficiency than the cacophony that passes for a health care system today; and government is a uniquely non-profit enterprise.
The claim that things should be left alone because medical decisions should be made by physicians and patients is nonsense that’s already obvious to anybody who has had a claim rejected, whether because a procedure isn’t covered, isn’t medically necessary, or because a drug isn’t on formulary. Insurance companies are deciding what diagnostic tests should be performed and what treatments are appropriate -- not physicians. What’s more, in many cases, the insurance companies are right, and the physicians are wrong. Insurance companies have a strong interest in providing the most efficient medical care. While drug companies and device manufacturers hire smart people to find reasons why the newest, most expensive treatments are the best choice, insurance companies hire smart people to find out what methods are the most cost-efficient.
Leaving decisions to insurance companies might be okay, if they knew when to stop, but nobody’s perfect. The insurers, and their top level executives, have a strong interest in going beyond efficiency and into miserliness. They don’t stop at efficiency, but try to avoid payments altogether. That’s part of the reason we have so many people without insurance. There used to be a joke, before the current mortgage meltdown, that banks would only lend you money if you could prove you didn’t need it. Health insurers only want to insure people who are healthy, and are very good at finding reasons why they shouldn’t have to pay the bills for anybody who is sick. That’s the disadvantage of relying on a health system based on profit. A government-based system doesn’t have to pay absurd salaries to CEOs, and can’t turn anybody down.
In spite of the experience of anybody who has tried to fill out a 1040 EZ, government-based universal healthcare systems require far less administrative effort than private systems. This, in large part, is where the money savings comes in. There’s no need to waste time and effort asking if the patient is covered because everybody is, no need to argue over who should pay the bill because there’s only one payer, no need to spend hours on the phone discussing alternative therapies, because there’s only one set of rules that everybody already knows.
Right-wing commentators have been complaining about how expensive the Democratic proposals for health care reform would be -- implying that we can’t afford universal health care. There’s a simple solution -- just let everybody send whatever they’re already paying, whether for private insurance or Medicare and SCHIP premiums, to a central fund. That should provide enough money to fund universal coverage, and almost everybody will get a partial refund.
No system, neither government nor private enterprise, has a monopoly on incompetence and inefficiency. We can see that today, when we have inept government and a dysfunctional private health-care system. What we should keep in mind is that it’s the people who brought us the tragedy of Walter Reed Hospital and vetoed expansion of children’s health care, that are warning us against a government-run single-payer system. That’s as strong an endorsement as you can get.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
From The Progressive Populist, November 15, 2007
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