Thursday, November 13, 2008

One More Time

Before I get off my soap box I want to add one more post on universal health care.

A friend who is ambivalent about universal health care said the issues that needed to be addressed before the friend would subscribe to it are:
  • How much will it cost?
  • Where will the money come from?
  • How will it be implemented?
In reality, no one can know how much it will cost and, of course, the cost will change as circumstances change. However, the money we are already spending would probably pay for most, if not all, of the Federal cost. The rest would be made up in a monthly premium from the individual heads of households. We are already spending more per capita than countries that have universal coverage.

Private insurance is now so exorbitant that only the most affluent can afford it. A monthly premium under universal coverage would be far less.

Logically, the ultimate cost would less for both the government and the individual.
Low income people would be subsidized for their premium, but that is not really an issue as the government is already paying for their health care with Medicaid. The profit now enjoyed in the current health care mess would be eliminated and, therefore, the cost would decrease dramatically.

The details of how the single payer would be managed could be solved by studying the successful implementation by other countries and copying their methods.

If we want health care reform we must put pressure on our representatives. Let your Congressman know how important this issue is to you. Elders may be happy with their coverage, but how about your children and grandchildren? And the most compelling argument is that the high cost of health care is part of the reason the big 3 auto makers are in deep doo doo. It is also a drain on our economy. Something must be done to end this nightmare.

The following article by Paul Krugman of the New York Times was written last August, but it is relevant today.

Can It Happen Here?

by: Paul Krugman, The New York Times

A primary care practice in Amherst, Massachusetts, where universal coverage was mandated. Paul Krugman says despite this plans early troubles, public support has grown and reveals that once a system of universal health coverage exists, people want to keep it.

The draft Democratic Party platform that was sent out last week puts health care reform front and center. "If one thing came through in the platform hearings," says the document, "it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care."

Can Democrats deliver on that commitment? In principle, it should be easy. In practice, supporters of health care reform, myself included, will be hanging on by their fingernails until legislation is actually passed.

What's easy about guaranteed health care for all? For one thing, we know that it's economically feasible: every wealthy country except the United States already has some form of guaranteed health care. The hazards Americans treat as facts of life - the risk of losing your insurance, the risk that you won't be able to afford necessary care, the chance that you'll be financially ruined by medical costs - would be considered unthinkable in any other advanced nation.

The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.

I know that's not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won't accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program - you may have heard of it - called Medicare. It's a program that collects money from every worker's paycheck and uses it to pay the medical bills of everyone 65 and older. And it's immensely popular.

There's every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular. Consider the case of Massachusetts, which passed a state-level plan for universal coverage two years ago.

The Massachusetts plan has come in for a lot of criticism. It includes individual mandates - that is, people are required to buy coverage, even if they'd prefer to take their chances. And its costs are running much higher than expected, mainly because it turns out that there were more people without insurance than anyone realized.

Yet recent polls show overwhelming support for the plan - support that has grown stronger since it went into effect, despite the new system's teething troubles. Once a system of universal health coverage exists, it seems, people want to keep it.

So why be nervous about the prospects for reform? Because it's hard to get universal care established in the first place. There are, I'd argue, three big hurdles.

First, the Democrats have to win the election - and win it by enough to face down Republicans, who are still, 42 years after Medicare went into operation, denouncing "socialized medicine." (Darlene says, "Done and did".)

Second, they have to overcome the public's fear of change.

Some health care reformers wanted the Democrats to endorse a single-payer, Medicare-type system for all. On the sheer economic merits, they're right: single-payer would be more efficient than a system that preserves a role for private insurance companies.

But it's better to have an imperfect universal health care plan than none at all - and the only way to get a universal health care plan passed soon is to inoculate it against Harry-and-Louise-type claims that people will be forced into plans "designed by government bureaucrats." So the Democratic platform emphasizes choice, declaring that Americans "should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan." We'll see if that's enough.

The final hurdle facing health care reform is the risk that the next president and Congress will lose focus. There will be many problems crying out for solutions, from a weak economy to foreign policy crises. It will be easy and tempting to put health care on the back burner for a bit - and then forget about it.

So I'm nervous. The history of the pursuit of universal health care in America is one of missed chances, of political opportunities frittered away. Let's hope that this time is different.

Last , but not least. HAPPY BIRTHDAY MARK. My son turns 58 today. My how time flies - wasn't it just yesterday that I held the most beautiful baby ever to enter this earth in my welcoming arms?


Rain said...

Yes, it won't be easy but it can be done and should. People might be surprised how much it frees the economy when someone doesn't have to fear leaving one job for another simply based on health coverage. Costs will have to have some controls which will lead to screaming from pharmaceuticals who have raked in a lot of profits. There will be naysayers and you sure don't want those who don't believe in government in charge. I think it can be done and needs to be but the restrictions on the patients won't be popular either. Anybody with an HMO has some of that already. Doctors will have to have more say on what kind of care is practical. Letting someone have a surgery when there is no hope for their survival long term will be another of those sticky wickets.

You hear about how bad the coverage is in other countries where they have it but my friends in Canada can afford routine surgeries that they would not have in this country as things stand. It can be done and should be.

Sherre said...

I agree that this issue must be addressed. We actually have the start of a universal system in Medicare. Why not just extend that program (with some tweaks obviously) to everyone! In addition to getting rid of health care profits, we'd also save a bundle in administrative costs. Today all providers must have several staff to handle all the billing requirements for all the various health plans.

Unfortunately, CA tried to follow in MA footsteps last year, but our legislature caved to opposition by for-profit Blue Cross and the tobacco industry (part of the proposal was a tobacco tax to fund some of the expansions).

It will be a big undertaking, and we won't get it right the first time. The US didn't get Medicare and Medicaid right the first time either. Those programs have been evolving over time. A universal plan covering everyone could do the same.

Darlene said...

Rain, not only will the pharmaceuticals fight this tooth and toenail, but the insurance industry will muster all those billions they have raked in to fight any legislation.

I am not sure that there will be any more restrictions under a single payer system than there is now under the HMO's. I had to fight to even get an evaluation for my cochlear implant several years ago.

According to the experts the so-called bad experiences in other countries are usually stories planted by the drug and insurance companies. When you talk to the real people in other countries, they love their system. Besides, there are quite a few horror stories in our system, too.

Sharre, you are right, It is daunting, but will eventually happen when the cost of medical attention is finally so bad that the politicians are forced into changing the system. So why not now? The timing is good with Obama in the White House and a Democratic majority in Congress. With the economy so bad, continuing this way is unacceptable.

joared said...

Excellent article, Darlene. I, too, have written in the past on the need for health care for all and specified some specific criteria I believe to be critical in a final plan adopted. We all need to keep up the drum beat to others and our legislators.