You'd think that when the country is in economic crisis, and when there's a national consensus that the health care crisis threatens the nation's fiscal survival, there'd be very little room for smoke.
Not so, according to Allen S. Brett, author of the recent article "'American Values' — A Smoke Screen in the Debate on Health Care Reform" (New England Journal of Medicine, July 29, 2009). He makes the convincing case that a simple rhetorical sleight of hand has prevented honest discussion of the benefits of a single-payer plan, and even arguably threatens efforts to include a public option in the current health care bills.
This smokescreen arises from the baseline assumption that the "claim that single-payer health care — a Canadian-style Medicare-for-all system — is antithetical to 'American values."
The underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry. Remarkably, this premise has received very little scrutiny.
Brett convincingly takes apart the three pillars of anti-single-payer rhetoric in a very lean and effective article that centers around the coveted American need for "choice" (Not to mention its corollary claim that people in government-run systems have none).
1. Single-payer somehow limits "choice of physician, hospital, or clinic."
In fact, Brett says, the opposite is true: a single-payer system removes obstacles to such choices. And the current system gives us all the evidence we need for the many ways in which the private insurance industry limits these choices. He says:
For such choice, a single-payer system beats the competition hands down. Incremental reforms preserving the private insurance industry and employer-based insurance would probably perpetuate the restricted choice of health care providers that many Americans already encounter: private plans typically limit access to certain physicians or hospitals, and physicians often refuse to accept certain plans. In contrast, single-payer proposals eliminate those restrictions.
2. Single-payer would eliminate the choices of insurance providers
Well, yeah. That's the concept of choice that the industry most fears to lose, because right now a few companies enjoy powerful control over what consumers get for their money. Currently they behave like a trust in fixing prices and options, and they work very hard to limit care. And they behave as if the insurance industry, rather than medical care, is the end goal. As Brett says,
Here it is important to acknowledge that insurance is only a means for collecting and disbursing health care funds — not an end in itself. The key question is therefore whether private insurance is superior to single-payer insurance in achieving the desired end of efficient, cost-effective health care.
The lower administrative costs of a single-payer system (as low as 3 % for Medicare, for example) mean that money can be spent on medical procedures rather than advertising campaigns. That's a choice I can live with.
3. A single-payer system will limit choice of treatments
As is widely known by anyone who has private insurance, the industry already devotes a lot of time and personnel hours to getting in the way of patients' treatment, or shedding clients altogether. The goal of cutting costs already means painful discussions of necessary versus unnecessary treatment. As Brett says,
This choice is system-neutral, pointing to neither single-payer nor alternative systems. Any reform initiative must control spending; unproven or unnecessary medical interventions should not be available in any system.
It's worth repeating that the private insurance industry does this every day.
Equal Opportunity and Fairness are American Values.
Brett concludes by challenging critics who say that the very idea of single-payer is antithetical to a unique American value system, that it violates the rugged individualism that defines the American character. Citing the book Benchmarks for Fairness in Health Care Reform, (Daniels, Light and Kaplan, 1996), he reminds us that individualism is just one of many American values.
I took a look at Benchmarks, which I'd never seen before. Daniels et al point out that a commitment to equal opportunity, fairness and justice are also important American values with a long history.
The existance of Medicare and Medicaid show that Americans are not so uncommitted to social justice or fairness or support of others in need as the ungenerous [individualistic] view suggests. Although we fall well short of living up to the values we claim to have, the ungenerous attack on American values overreaches and oversimplifies. It fails to explain our support for Medicare and Medicaid, but more than that it fails to explain why the majority of working people do not act in their own interest by improving their own security and extending universal coverage to each other. We should seek better explanations for why we do not have a universal health insurance scheme, after several close encounters, than merely blaming people for being too selfish and claiming that universal coverage is alien and un-American."
Brett concludes his article by telling us to look beyond the smoke screen, and that we ask the important questions based on what exactly we want a health insurance plan to accomplish.
Will the system care for us when we’re sick and help prevent illness when we’re well? Will we have access to medical care throughout our lives without risking financial ruin? Will we be able to navigate the system easily, without jumping through unnecessary hoops or encountering excessive red tape? Will health care spending be managed wisely? Health care reformers owe Americans a system that best addresses these questions — not one that merely pays lip service to ill-defined "American values."
This is just a summary of his excellent article--I hope you'll have a look. I missed it last week when it came out, though searching today revealed that there was one diary, briefly, that reported his article.
I can't help feeling that this debate is more than anything a war of words. People want health reform, and don't seem that concerned about how it's delivered as long as it covers everyone and cuts costs.
But with a fortune in advertising money backing it up, the insurance industry is going to make the rhetorical war a very hot one indeed. We'll need to fight the smokescreen, and take apart their claims word by word, or they'll succeed in fooling people yet again.