When I read that the Obama Administration is not really giving serious consideration to single-payer health care, I feel like going off on a crazed left-wing rant. Alas, I don't write those kinds of diaries. There is, however, no issue that I feel more strongly about, with the possible exception of doing something, anything, to reverse global warming.
When we talk about expanding health insurance, we're having the wrong debate and using the wrong terminology. We do not need more health insurance. We need more and better health care. And, we need affordable health care. So long as we focus on tweaking a private system of health insurance, we guarantee that we will have neither more and better health care, nor more affordable health care.
Usually, I strive for balance in my diaries and comments. On health insurance, I really don't see two sides. The health insurance industry is basically a consumer scam. It's worse than a Ponzi scheme. Whereas Ponzi schemes recruit new investors to pay off old-time investors, the insurance industry is aimed at not paying any of its investors. It collects money, but it remains profitable by denying as many claims as possible or reducing benefits.
If buying life insurance is like gambling -- betting the odds -- then health insurance companies are the insurance industry's equivalent of Las Vegas casinos. Their game is rigged so the house always wins.
For a compelling case study of what's wrong with our health care system, I think everyone should read this piece in Time magazine. Reporter Karen Tumulty describes her family's close encounter with the medical system: The Health-Care Crisis Hits Home. To summarize, Tumulty's brother, who suffers from Asperger's, paid thousands of dollars to buy his own health insurance -- because his $9 an hour job didn't offer him benefits. He wanted the insurance to protect him in case of a catastrophe. Surprise! When he had his medical catastrophe, his "insurance" proved to be an illusion.
Tumulty's been making the rounds on the talk shows to discuss this article, and I think it's an important touchstone in the debate. Today, Tumulty was on NPR's Fresh Air, and earlier in the week she was on the Diane Rehm show for a full hour. Her brother's case illustrates everything that's wrong with our private health insurance system -- and why the only reform that can work is to offer a public health system that offers subsidized care for everyone.
Patrick Tumulty bought health insurance that was basically worthless. To begin with, it carried a $2500 deductible. Until he had a health crisis, there wasn't much chance of his reaching the full amount of his deductible. That meant the insurance company would not have to pay anything for his standard medical care. Because of this, he did not seek regular check-ups, Consequently, he did not have a medical diagnosis for his feelings of fatigue and weight-loss.
Most Americans know this state of affairs, because we self-ration our own care. If we don't know that there is something a doctor can do for us, or we don't perceive that we have a serious condition, we don't seek out medical care. Medical care seems too expensive for ailments we think will eventually pass if we can just ride them out.
When Patrick Tumulty had his first physical in 5 years, blood tests revealed a big problem. A follow-up biopsy showed his kidneys were failing. Tumulty had a medical problem -- a crisis -- but, he would soon learn he had a health care coverage problem, too. His insurance company refused to pay any of his bills. Turns out they had a CYA provision -- a Catch-22 -- in the fine print.
Tumulty's payments didn't continue his coverage. According to the insurance contract, he had bought a six-month nonrenewable policy. Each payment simply bought him a new policy, every six months. The real catch, though, was that the contracts didn't cover pre-existing conditions. His kidney problem was deemed pre-existing, because it clearly pre-existed the six-month contract he was under. As for the prior contracts, those no longer existed -- they had expired. Even if the company hadn't already deemed Tumulty's illness to be a pre-existing condition, they would have done so when it came time to "renew" at the end of the six-month period. He could pay to renew his insurance, but his "insurance" company wouldn't pay out a dime.
When I call health insurance a "scam", this is Exhibit 1. There are tens of millions of other cases I could cite. What is it we are paying for when we get health insurance? Are we really spreading the risk? Wouldn't that be accomplished much better by simply paying for our medical care out of our government budget, as all other developed countries do? Why are we giving our money to companies whose profit motive compels them to deny us benefits when we need them most?
It's insanity. We are being fleeced, and what makes it worse is that we are complicit in this crime. We pay for the privilege of being scammed.
Are there more reputable companies and better policies? Sure there are. And, if your employer is able to purchase group insurance, the insurance company has an incentive to offer real, tangible benefits. If they play games with the first subscriber who gets sick, they stand to lose multiple subscribers.
Private insurance companies are also able to negotiate lower prices for medical care because they can bring a big base of patients. Individuals who pay for their care directly pay much more for their care. For his uncovered care, Patrick Tumulty was charged more than 8x what it would have cost his insurance company.
Does this mean that private insurance companies play some positive role in holding down health care costs? Not at all. In fact, if everyone was "covered" by a government plan, the overall cost of our health care would be far less. First off, the government could hold down prices even more effectively. Moreover, there would be no massive bills that go unpaid.
Many patients in Tumulty's position end up declaring bankruptcy and walking away from their enormous medical bills because there is no way they could pay them. As Karen Tumulty notes, a Harvard study found that half of bankruptcies are the by-product of an illness.
"In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance."
We are in an irrational system that serves no one's interests well, except those of the insurance companies (and, maybe pharmaceutical companies). Even those of us who have not been devastated by the market collapse -- we are all one major illness away from economic crisis.
"As Elizabeth Warren, a Harvard Law professor who helped conduct the study, wrote in the Washington Post, "Nobody's safe ... A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck.""
No doubt, Tumulty is correct when she writes:
"just about anyone could be one bad diagnosis away from financial ruin."
Our current system is deeply flawed. For decades, this country has operated a health-care system that is predicated on employer-provided health care plans. Tying health insurance to jobs is a perverse system. When we most need insurance -- when we've lost our jobs -- it is no longer available for us. So, we're left to fend for ourselves and to try and purchase insurance on our own. Except, that's proven unworkable.
"A 2006 Commonwealth Fund study found that only 1 in 10 people who shopped for insurance in the individual market ended up buying a policy. Most of the others couldn't find the coverage they needed at a price they could afford."
This is a deeply personal issue for me, because I have a "pre-existing condition". As a consequence of a detached retina, I ended up with glaucoma in one eye. Not only did I lose any usable eyesight in that eye, I've acquired a lifetime of bills -- regular check-ups and monthly trips to fill ever-more expensive prescriptions. Over the course of my life, I can expect to spend a year's wages just on the amounts I have to pay over and above my insurance. And, I'm lucky to have that -- I could have some insurance that refused to cover any of it. What if I lost my current insurance -- could I get one that would cover my ongoing treatment?
The other problem with employer-based coverage is that it negatively impacts the competitiveness of our biggest businesses. GM cannot compete with foreign companies that do not pay the full freight of inuring their employees.
We are at a crisis point in so many ways. So many of our problems require an integrated, complex approach. If we invest in renewables and new transportation and energy infrastructure, we can address global warming, dependence on foreign oil, joblessness and international competitiveness. Health care is another piece in that puzzle.
Our current system is holding this country back. Our international competitiveness is adversely impacted by multiple ways. Health care costs for US employers are costs that other countries' businesses do not have to face. Moreover, we pay too much for the health care we do provide. The pandemic of bankruptcies and the crisis of the uninsured is actually driving up the costs of our health care, because too many people come in without insurance, or adequate insurance and cannot pay their bills.
Even doctors do not want this system any more. My brother, who is a psychiatrist, is a strong proponent of switching to a single-payer system. He's seen too many patients drop needed care because they could no longer afford it. The private insurance system doesn't serve him or his patients well. The only reliable patient base he had were those in the service, because the government gave them decent mental health care coverage benefits. And, he's losing them because of base closings. There was a time when doctors were the fiercest opponents of single-payer proposals, because they thought it would really impact their ability to earn good livings. Even that dynamic no longer holds true.
During the campaign, candidate Obama said if he were to devise a system from scratch, it would be a single-payer system. However, he said, we are not starting from scratch, so he proposed something other than single-payer. It's no longer time for half-assed compromises. The best system we can have is a single-payer system. There is only one constituency that opposes single-payer, and that is the private health insurance industry.
There was a time when government paid heed to what private industries wanted. We didn't regulate the financial sector, because they argued such regulation would hurt the industry and the country. The reality, as we know now, is that the country is much poorer because we did not ignore their arguments.
We need to do the same with respect to the health insurance industry. In large measure, this is an industry with which we can do without. We would be far better off without it. Even if you do not agree that health insurance is a scam being perpetrated on American health consumers, you have to agree that we would be better off if everyone had health care coverage -- under a public system. Plain and simple.
We don't need to legislate the industry out of existence. There may be a role for health insurance companies to supplement -- perhaps provide catastrophic coverage that exceeds what the government can afford -- or, to cover those traveling abroad. Or, simply to cater to an elite that is willing to pay more for exclusive care. However, we don't need to be held hostage to the economic interests of this industry.
The country will be better off if we move to a public health care system for all Americans. It will be cheaper than what we have now. Americans will get the care they need, and will be healthier. And, our industry will be more viable.
I even believe it would be good politics. Will Republicans run against a single-payer system? Will they seriously try to beat Democrats in the next election by promising to roll back a system that provided health care to the 45 million uninsured, and the ever-growing ranks of the unemployed? If the Democrats pass such a program, they will be rewarded by those who finally see government -- politicians of one party -- doing something that really benefits them. And, if it helps boost the position of American industries, contributing to economic and job growth, that will not hurt Democrats at the polls, either.
So, tell me again, President Obama -- why aren't we talking about a single-payer system?
***Update*** There's another diary just above mine on the diary roll on the topic -- Baucus & Obama: Single Payer is "Off the Table". The diarist, fflambeau, argues that Pres. Obama is
"against single payer not because "a lot of people work for insurance companies and...for HMO's" but because insurance companies and HMO's gave lots of bucks to him and his campaign and the last thing in the world they want to see is a single payer system".
I think that is probably a correct statement. On this point, I keep returning to the 2006 campaign, by Andy Hurst, for the eat in VA-11. I volunteered on the campaign and did a lot of blogging for it, but Hurst lost to Tom Davis. Hurst is a big-firm lawyer who works on health law. He knows first-hand the pernicious influence the industry lobbyists have. In his campaign, he argued we would never get the health-care reform we need until we cut out the lobbyists' money and influence. Perhaps, he's right.
Maybe, we'll need lobbying and election law reform, before we can get real health-care reform. The thing is that Obama doesn't want too much change there, since he did so well raising money. So, I think we need to go straight to the meat of the issue. As kaliope says in a comment below, Obama said ""Make Me Do It". We need to force Obama to put Single Payer on the table. Flood the rec list and the diary roll with demands for single payer. Make the phone calls. Let them know how badly we want this. They can't ignore us, if we don't let them!!
We should all ask: So, tell me again, President Obama -- why aren't we talking about a single-payer system?