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Monday, January 01, 2007

My #1 Domestic Issue for 2008
Posted by Jill | 9:03 AM
You might think it's outsourcing, but you'd be wrong. Yes, the continued outsourcing of just about every sector of highly-paid American jobs is a huge problem, but an even bigger problem is the disastrous state of heath care in this country.

I'm lucky. I have good insurance, and while my share of the premium is increasing by 42% as a result of my employer going to a "sliding fee" scale of assigning the employee share of the premium, it's a cost I can absorb. I have both in-network and out-of-network benefits, and when I recently had a colonoscopy, the out-of-network surgical center wrote off the difference because the physician is in-network.

So right now I'm lucky....but if I were to lose my job, I would not be so lucky. Mr. Brilliant's plan is one of those plans where a primary care physician has to approve any visit to a specialist, and as we all know, these physicians have incentives to NOT provide such referrals. Yes, COBRA allows me to keep my coverage for eighteen months, but if I were unemployed, the total premium of over $13,000/year would simply be out of the question.

The problem with the current model is that health care simply cannot be run on a for-profit model. The more a corporation can cut costs, the more it can increase profit. And given corporate America's tendency to shovel a good chunk of its profits into executive pockets, management has a strong incentive to deny you care.

This chart gives you an idea of how executives at managed health care companies are compensated. Given that healthcare is hardly discretionary -- if you need it, you need it -- it's hard to justify a model in which total compansation that approaches eight figures can also provide benefits to policyholders.

Conservative arguments that single-payer heath care (which is not "government health care", but rather a single insurance pool that spreads the risk around) would "give government control over your health care" are disingenuous and false, especially in a world in which clerks at computers in call centers at insurance companies control your access to health care now. Physicians for a National Health Program shoots holes in most of the Republican arguments against single payer here.

To start off the new year, Paul Krugman agrees that health care should be one of our highest priorities:

In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.

Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”

And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”

Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.

Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?

Part of the answer is that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”

In addition, insurers often refuse to pay for preventive care, even though such care saves a lot of money in the long run, because those long-run savings won’t necessarily redound to their benefit. And the fragmentation of the American system explains why we lag far behind other nations in the use of electronic medical records, which both reduce costs and save lives by preventing many medical errors.

The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.

If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.

Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to H.M.O.’s run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.

Can we get there from here? Health care reform is in the air. Democrats in Congress are talking about providing health insurance to all children. John Edwards began his presidential campaign with a call for universal health care.

And there’s real action at the state level. Inspired by the Massachusetts plan to cover all its uninsured residents, politicians in other states are talking about adopting similar plans. Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the nation as a whole.

But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.

Now we have another chance for fundamental health care reform. Let’s not blow that chance with a pre-emptive surrender to the special interests.


The L.A. Times article he cites is here.

One of the first clues we'll have of whether the new Democratic Congress believes it answers to the people or to its corporate contributors is how it handles the issue of health care. If insurance companies that shovel cash into their executives' pockets play a leading role in whatever proposals are produced, we'll know soon enough that the new boss is the same as the old boss.
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