The possibility of fundamental healthcare reform in America was smothered by the thick glacier of Bush-Gingrich-DeLay policies for 13 long years at the federal level, and similar deep-freezes in most states.
But on last Nov. 7, public mounting distaste for the hardline GOP agenda, from Iraq to job outsourcing to stem-cell research, burned a huge hole in the glacier. Finally, the prospect of healthcare reform is once more blooming, with proposals bursting up through the ice at both the state and federal levels. Perhaps we again have an opportunity to end the US's isolation as the only wealthy nation without a universal, quality healthcare plan.
Following the 1994 defeat of the needlessly complex "HillaryCare" effort to appease and reward the big insurance companies and HMOs, the Republicans seized control of Congress in part because of that failure. Incessantly-repeated conventional wisdom contends that Hillary and Bill Clinton were "too ambitious" in their plan.
In fact, the Clintons' plan left the most unappetizing features of the current system in place, namely the power of the big insurers and HMOs to intrude into medical decisions and jack up premiums to increasingly unaffordable levels. Despite this reality, the HillaryCare plan served to discredit far-reaching health reform in the minds of mainstream politicians and pundits for more than a decade.
But now, after the long winter where health reform was pushed off the public agenda, the potential for fundamental reform has now grown much stronger than any time since the 1994 debacle. In 2006 polling, healthcare was named as the number one economic issue by Americans. The connection between slumping wages and soaring health premiums has become crystal-clear.
Meanwhile, more and more Americans worry about falling out of the ranks of the insured as employers entirely cut out health benefits or make them unaffordable. For the 47 million uninsured, a severe illness or accident can push the family deeper into poverty or into bankruptcy.
Moreover, the advantages of a single-payer system are increasingly clear. Canada has maintained a privately-run health system with per-person costs scarcely half of those in the US (for 2003, $3,003 in Canada per person compared with $5,635 in the US). Canada provides care to every citizen as well as far better health outcomes, from infant mortality to longevity. These gains have been achieved largely by simply eliminating the costly middle-man role of the insurance companies, a point easily grasped by most citizens.
As the health crisis intensifies, the US public's concept of a solution far out-strips that of their elected officials, many of whom got elected with generous contributions from the insurance-drug-medical-industrial complex. Polling by Business Week shows "67% of all Americans think it's a good idea to guarantee healthcare for all US citizens, as Canada and Britain do, with just 27% dissenting."
Remarkably, the incursions of insurers into health decisions and intensifying commercial pressures have also galvanized doctors. The result has been an increasing openness to a universal single-payer healthcare plan along the lines of Canada's, where doctors and hospitals remain private but the insurance function is "socialized." Polls of Massachusetts and Minnesota both showed a stunning 64% of doctors favoring a single-payer approach.
But before fundamental reform can flower, it must overcome several major challenges:
MORE PROFITS, MORE RESOURCES FOR ANTI-REFORM FORCES. While public dollars account for a substantial of our $2.1 trillion in healthcare spending, control over the system now rests decisively in the private hands of major insurance corporations, drug companies, hospital chains, and medical-equipment firms. Since much of US spending on health is wasted on bureaucratic overhead, exorbitant CEO pay, marketing costs, and profit, fundamental health reform is a dagger at the hearts of these powerful interests.
Given the self-interest of powerful corporate interests in protecting their share of excessive spending, the battle over healthcare reform will call forth every weapon in corporations' political arsenal, which has been multiplied by the enormous profits of recent years. Thus, there will be ample dollars for non-stop aerial bombing via TV and radio ads, sponsored by phony "astro-turf" front groups.
DIVIDING REFORM APPEAL -- AND CONSTITUENCIES. One of several wedges that the Corporate-Right coalition subtly used in the early 1990's battle to defeat any healthcare reform was the implication that healthcare reform's chief impact would be to establish a second-class kind of program serving the poor. The anti-reformers were trying to establish a parallel to the incessantly-attacked welfare system that allegedly abused taxpayers' hard-earned dollars to benefit undeserving, lazy people of color.
The problems of those already covered with insurance -- soaring premiums and more costs shifted to workers, the denial of needed treatment, and the oppressive weight of red tape and multiple billings by parasitic insurance corporations -- was carefully separated in the public debate from the need for universal coverage. The potential appeal of the single-payer's plan to both the uninsured and the already-insured -- security about coverage, effective cost controls, establishing free choice of doctors, and the elimination of bureaucracy -- went out the window with the HillaryCare plan.
The Clintons had imperiously dismissed the single-payer option despite 69% public support (Wall Street Journal poll in 1993).
By the time the eye-glazing HillaryCare plan was released, the only major selling point left was its (relative) universality. The notion of universal care was distorted into a welfare-style program and the sheer complexity of HillaryCare made it easy prey for the Right's media machine's anti-government message and the "Harry and Louise" ads launched by medium-sized insurance firms.
So how do we integrate the issues of universal, quality care with cost control in a more inclusive and compelling way and keep potential reform constituencies unified? In critiquing state-level plans in Massachusetts and California, Dr. Marcia Angell concisely expressed the inseparability of the two concerns: "They {the plans}offer no workable mechanism to control costs, mainly because they leave the private insurance industry in place. Yet, soaring costs are the fundamental problem; lack of coverage follows from that."
NO POINT TO PREMATURELY COMPROMISE. Controlling costs effectively, based on global experience from Germany to Taiwan, requires installing a single-payer system that replaces for-profit insurance at the heart of the healthcare system. Yet, discouraged by past reform efforts and the urgency of unmet health needs in the US, some reformers have already begun "negotiating against themselves," by accepting the dominant role of health insurers as a given.
With the best of intentions, they are acting as if reform can be enacted with a voracious tiger still roving inside the tent. This approach ignores a central reality: the costs imposed by retaining for-profit insurers will continue to rise and make universal care an unreachable goal, along with endangering Medicare.
CORPORATE SUICIDE WISH? Yes, the Business Roundtable, US Chamber of Commerce and even Wal-Mart now acknowledge the need for reform of some sort. But what will it take for them to toss overboard antiquated "free-market" ideology along with their fellow CEOs in the insurance and HMO industries?
Despite soaring health premiums that render US products and services uncompetitive -- with iconic US firms GM and Ford in deep trouble partly because of health costs -- many CEOs remain cemented to free-market principles or afraid to cut out insurers. While GM and Ford would save $4 an hour per worker with a single-payer plan like Canada's, they are barely audible on healthcare reform. It's as if much of Corporate America has a deeply-held suicide wish, and it will be difficult to dissuade them from their present course despite imminent disasters ahead.
Even with these challenges, healthcare reformers must recognize that we have been given another chance to promote quality, affordable care to all Americans. We must approach this opportunity recognizing that only the single-payer model is comprehensible to the broad public, can deliver dramatic, tangible improvements, and represents the best policy for healthcare.
Roger Bybee is a Milwaukee-based writer and activist. Email winterbybee@aol.com
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