John Geyman, emeritus professor at the University of Washington medical school, has just published a book that should be essential reading for anyone interested in real health care reform.
Book Review
Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It
by John Geyman, M.D.
Common Courage Press
2008
Table of Contents
Preface: Got Insurance? Maybe, But How Much and For How Long?
- In Sickness and in Wealth: Growth of a Monolithic Industry
- The Big Three and the Big M's: Mergers, Market Share and Medical Loss Ratios
- From "Cherry Picking" to "Denial Management": How the Industry Really Works
- Myths and Mirrors: How the Industry Perpetuates Itself
- Terminally Ill: An Imploding Industry on a Death March
- Saving Lives or Saving the Industry? Why Incremental System "Reforms" Continue to Fail
- Drawing the Battle Lines: The Industry's Rear-Guard Action
- Beyond Denial of an Obsolete Industry to a New Day
Appendices
If I could choose one book to make Barack Obama read, this would be it. Physician John Geyman lays out a detailed and compelling case for a single-payer Medicare-type system for the United States.
Geyman begins by reviewing the evolution of health insurance, from a non-profit public-private partnership through the rise of employer-sponsored insurance during World War II, to the profit-driven, risk-avoiding behemoth of today. He then dissects industry practices, including denial of coverage, bait and switch, policy cancellation, limited benefit policies, inadequate disclosure, deceptive marketing, and outright fraud. Here's one telling example:
Many marketing seminars for private Medicare plans have been held on second floors of buildings without elevators or access by wheelchair, effectively creating a barrier to enrollees who, by virtue of mobility problems, would be higher-risk enrollees. [p. 43]
Geyman spends an entire chapter debunking eight common myths about health and health care. My own favorite is "5. The U.S. has the best health care system in the world." Geyman quotes Ezekiel Emanuel of the National Institutes of Health:
The U.S. health care system is considered a dysfunctional mess... If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative. [p. 77]
Here's George Bush as quoted by Think Progress, December 12, 2007:
I’m going to tell you something — we have fabulous health care in America, just so you know. I think it’s very important — before people start griping about the health care system here — and of course there’s always grounds for complaint — just to compare it with other systems around the world.
(If anyone locates a similar quote by McCain, I'll update to add it.) When we do that comparison, we find that the U.S spends twice as much per capita on health care and has the worst outcomes of any developed country.
Geyman then discusses how the industry is coming under increasing stress as employer-sponsored insurance declines and individual policies cannot fill the gap because of their exorbitant expense and stingy benefits. So if the industry cannot survive in a private market, what's their solution? You guessed it: government subsidies, particularly those from Medicare Advantage and Part D.
By 2007, average overpayments to these plans was running about 112 of traditional FFS [fee-for-service] Medicare payments; private FFS plans were receiving 119 percent overpayments. [p. 102]
And what's the conservatives' justification for channeling these overpayments to private insurers? The private sector is "more efficient" than government, of course! Can you say "cognitive dissonance," boys and girls?
Chapter Six should be read by every politician in this country, as Geyman eviscerates the failed incremental "reform" plans of the last 30 years, including individual mandate plans like the "Massachusetts Miracle." Some miracle.
[Massachusetts] has already found that it has had to exempt many more people from the mandate after finding that the lowest cost private plans were unaffordable. [p. 131]
Once Geyman lays out the evidence, the conclusion is inescapable: any "reform" that retains the private insurance industry is destined to fail, both in reducing costs and expanding coverage.
In Chapter Seven, Geyman examines insurance industry spin, the current battle over SCHIP, and the array of forces against fundamental reform. These include not only the obvious suspects like corporate interests and the tobacco industry, but the AARP, which is riddled with conflicts of interest through its branded Medicare Advantage and Part D plans. The main culprit in the spin is of course the industry group America's Health Insurance Plans (AHIP), which recently launched a new PR blitz dubbed the "Campaign for an American Solution." Apparently any plan which doesn't preserve the industry's economic position must be "un-American." Instead of talking about American solutions, liberal solutions, etc., shouldn't we be talking about solutions that will work?
Geyman concludes by outlining a national health insurance (NHI) program, which would incorporate all existing federal programs including Medicare, Medicaid, and SCHIP. Remaining funds would come from a payroll tax on employers and a progressive individual income tax, which would largely replace private insurance premiums. About $350 billion per year would be saved by administrative simplification and bulk purchasing (about one-third of health care costs are useless private bureaucratic overhead). Such a system would be established under H.R. 676, which has more than 90 co-sponsors in the current House. He notes that a single payer program would comprise one component of overall health care reform; others include evidence-based coverage processes and strengthening of primary care. Despite the pundits and the consultants who write off single payer as politically unsaleable, Geyman predicts that political support for single-payer will increase as the insurance affordability crisis creeps up the income ladder.
If you're at all interested in this issue, this book is a must read. Do Not Resuscitate is available from Amazon (although it's currently listed as out of stock) or directly from CCP's website for about $19 with postal shipping. Be sure to check out the rest of the CCP catalog, which includes books by Noam Chomsky, Laura Flanders, Howard Zinn, and several previous books by Geyman on health care issues.