That’s not a conclusion based on evidence -- US health care in the aggregate is mediocre -- it’s a belief. A belief that is reinforced continuously by almost all politicians, medical professionals, and various citizen groups. A belief that is carried in the brains of almost all Americans regardless of whether or not they personally have access to "the best." A belief that is intertwined with that of American exceptionalism: the best military in the world, the most innovative and industrious, the richest, etc.
Combine that belief with the beliefs that "the best" costs more and more is better, and it becomes clear why it doesn’t distress most Americans that nationally healthcare consumes significantly more of GDP than in other industrialized countries. Or that US governments spend more on a per capita basis for health care than foreign governments spend for universal health care. What does distress Americans is the cost of health insurance and the deductibles and co-pays, insurance denials for care they know they need, and all the "free-riders and immigrants using their emergency rooms and hospitals. Thus, "health insurance reform" and "public option" resonates positively for them.
NOW -- Go listen to "This American Life’s" latest episode Less Is More.
You knew all that didn’t you? US patients are lousy consumers of medical services, physicians have a financial incentive to recommend high profit margin services, and health insurers aren’t completely evil bastards. Disappear the "evil bastards" and the US health care system is still left with those patients and providers. Would nationalized health insurance change the behavior those consumers (70% or more of the population) and the for-profit medical services, supplies, equipment and pharmaceutical providers? (Yeah, and diets work.)
Decades of deferring to employers and health insurers to manage our health care costs has had several unintended consequences. It essentially put us in no-man’s land between "free market" medicine and socialized medicine. Without any of the benefits of either. Essentially ignorant of how various systems are supposed to or do work, we live with this monstrosity and every fifteen years or so, forget to play ostrich, look around, and utter a, "WTF?" Yet, instead of paying a dollar in taxes that provides quality healthcare to everyone, we forgo seventy-five cents in income that our employers pay for health insurance, pay fifty-cents for health insurance premiums, deductibles and co-pays, and somebody, mostly somebody else, pays a dollar in taxes. Some go broke paying their share of their medical bills and some get little care at all. Those that enjoy employer subsidized health insurance may not be happy campers, but better the control of the devil one thinks they know, than the imagined government devil. That could be rational irrationality.
How much imagination does it take to fear government control of healthcare? Not much these days. How well did government perform in regulating, not even running, Wall St? Managing military contractors in Iraq? Protecting the people from predatory lenders? Managing the money it has? The tea-baggers may be ignorant loons, but it’s been a long time since the federal government has demonstrated goo-goo.
The health insurance reform bills wending their way through Congress are all about propping up the status quo. (Read the so-called good one HR 3200 if you doubt my assessment.) Squeezing blood money out of the young and healthy uninsured (because their student loans debts aren’t crushing enough?). Squeezing money out of the uninsured working poor. Reforming Medicare -- all hail the new HHS Medicare czar -- to make it work more like private health insurers. (The 2013 implementation date is more about Medicare than the individual mandate because Granny votes and the young don’t. ) It’s simply untrue that the young, the healthy, and the so-called "free-riders" are responsible for the high cost of health care and its derivative, health insurance. But scapegoats are ever so useful to mask kicking the can down the road for a solution.
The mistake the left made wasn’t so much in not demanding single-payer -- it is a much tougher sell than anyone acknowledges because there are too many stakeholders in the status quo -- but in not demanding UHC. Then figuring out how to get there as quickly and expeditiously as possible. Not selling out the most vulnerable of populations -- undocumented workers and their families. Not asking anything of the tens of millions that do enjoy "the best health care in the world."* Recognize ALL that ails the US healthcare system. Stop holding up Canada or Germany as UHC models to emulate. Those systems weren’t adopted when medical costs were consuming 17% of their GDP and 80% of the population had health insurance. (Canada’s was only 4% and now it’s over 10%.) Finally, cease the railing against evil corporate power and control -- it’s the job of corporations to be amoral, profit maximizers -- because it doesn’t work. No powerful, wealthy, and wily foe has ever been defeated by complaints of the people.
-- Full disclosure before anyone accuses me of being heartless, naïve, or pessimistic. A nation without UHC is economically and socially irresponsible. Such a nation fosters economic stratification. The haves stepping on the backs of the have nots. --
My heart and head is as heavy today as it was in late 2002-2003. This country is once again on the precipice of making a terrible and consequential mistake. A mistake that will likely smash much of the remaining most efficient, lowest cost component of the US healthcare delivery system: the public health clinics and hospitals. The public healthcare safety net that we have always under-funded, and that has guaranteed that those providers aren’t competitive with the private sector. A dollar to public clinics/hospitals buys twice as much healthcare as a dollar funneled through insurance (public or private) to the private healthcare delivery system. Not that we’ve ever given public health a dollar. More like twenty-five to fifty cents.. Then we turn around and hand out two or three dollars to those deemed worthy of government health insurance dollars. (Decades of neglect and who do the people turn to for their free H1N1 vaccines?)
Carl Ginsberg detailed one example of what I’m talking about in Saving New Orleans' Charity Hospital His voice is rare in this so-called healthcare reform debate. (To his credit, Michael Moore acknowledged this shortcoming in the health insurance reform bills.) Why did the MassHealth (that is already beginning to crack and has done nothing to contain health insurance inflation, up 10% last year) get so much attention and Healthy SF got none? We can no more afford our foreign adventures than we can afford 17% of GDP on healthcare. Pretending we’re a middle-class nation doesn’t make it so. And as Barbara Ehrenreich points out, positive thinking is positively disempowering and destructive. How can we not see that US public health facilities, Community Health Clinics and free clinics are the only viable key to expanding access and affordability to the tens of millions of Americans that have been left behind by The Best (and most expensive) Health Care in the World?
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* (The Baucus/WH attack on the contracted benefits of union members – members that gave up more than $0.75 in income for their health insurance benefit – is reprehensible (as are all neo-liberal policies) if not illegal.)