Last Friday, thanks to your warm reception, your recommendations and our mutual concern, my debut as a diarist,
Retired M.D. & HMO administrator speaks out, made a splash. In it, I asked you to imagine an America in which people didn't live in fear of illness and bankruptcy or have to beg for health care. I laid down the three mandates of my health care reform plan,
Health Security America, and I talked a little about my background as a family practitioner and HMO/clinic administrator. I finished by promising to talk more about why participant-paid premiums in a single payer plan are necessary, and how the Democrats' so-called plan is a roadmap to nowhere, and what you can do.
In homage to Kos' Crashing the Gates ad, I'd like to dub this series "Kicking the Donkey," because that is absolutely how we have to start. Please make the jump with me for more.
Crossposted at
My Left Wing
First of all, let me recap Health security America's three key mandates:
A Health-Secure America has:
- Birth to death affordable, single-payer health insurance for everyone, without restrictions
- Free health insurance for those under 19 years
- A health care plan paid for and governed by the participants themselves
That is the core of my plan. For the details on how to get there, I have written a book, Health Security America: Fixing the health care crisis. All profits from book sales are plowed right back into my coalition's push for health care reform, and by the way, I thank those Kossians who made purchases and volunteered with the coalition. We even gained another physician willing to speak on our behalf.
In future diaries I'll lay key aspects of our plan out here for your discussion.
Who will tell the people?
In an ideal world, the Republicans would be eager to plump for Health Security America and do what is right by their constituents. In fact, the plan's various acknowledgments of personal responsibility should really light their collective fire. Yet they have just essentially dismissed America's uninsured by saying "Let them eat doughnut holes." So let's forget about Republicans for a moment and focus on the Democrats. The ones who put people first--or so they say.
An evergreen topic here at Daily Kos is why Democrats claim to be champions of the vulnerable, yet vote against their constituents' interests time and again, whether it be in favor of usury, the Iraq occupation, or against real health care reform. It is probably safe to sum up the reason in one word: money. Are you surprised? No, I'm not, either. In his landmark work, Who Will Tell the People?, William Greider pushed aside electoral politics as the proper focus of reformers and accurately described the real problem with our Washington representatives as an inability to govern fairly, thanks to special interest money.
We need to talk louder than the money.
Why govern and pay for our own insurance?
And out-shouting the money is why we ask citizens to govern and pay for their own insurance in our third mandate, above. Without some element of fiscal responsibility and public accountability, Congress and our leadership would never be able to come together to give us the first two mandates. We really have no choice but to circumvent the "iron polygon" of Congress and various special interests. Nor can we run up much more debt.
Consider today's situation:
- At least thirty years have passed since the advent of managed care plans (HMOs, etc.) and the large clinic paradigm. For much of this time, Democrats have also controlled Congress, and they could have straightened out the health care system if they had had the will and the incentive.
- Our leaders are wedded to special interest lobbyists, whether they are from physician groups, large clinics, insurance companies or large HMOs and other managed care plans. These groups have strong money ties to both parties and they aren't about to get off the gravy train without a fight. Nor are the congressional representatives willing to give up their own diet of special interest gravy. One sure way to break the cycle is to short-circuit it with citizen-based governance of the health plan. People-powered health care, if you will. It won't be a cinch, and I can already see many people from administrative positions, a very lucrative side of medicine, testifying very convincingly against citizen governance , discussing citizens' inability to deal with complicated issues of medicine. You can bet that citizens will understand and will make common sense decisions after weighing the options given them in The Health Security America plan.
Citizens, don't ever let anyone in a suit tell you that you aren't smart enough to make your own health-care decisions--and that most certainly includes your ability to best spend your health care dollars.
- After Medicare Part D, do you want the congressional/special interest junta penning and running your health care reform? Imagine getting cancer and falling through that "doughnut hole." What kind of credibility does the government have right now? Can anyone's confidence go unshaken when we are prohibited from buying drugs from registered Canadian pharmacies? Our government tells us that Canadian pharmacies are not trustworthy. What do you think?
- Americans spent twice what the Japanese spent in 2001 per person for health care and for all that money still have a life expectancy of five years less than that of the Japanese. Considering this massive spending that imperils what little social safety net we do have, would it not have been reasonable for Congress to have dealt with this before now?
- These explanations could stretch out indefinitely but allow me one last reason. Congress and our government will not correct this health care crisis and know they are incapable of doing so. Read the House Democratic Caucus platform on health care. It hurts to say it, but the Democrats have a health care roadmap to nowhere.
Roadmap to Nowhere
For instance, take the Dems' tax credit idea:
Small business tax credit. Because small businesses have an especially difficult time providing health insurance to their workers, the Democratic plan provides a tax credit to help small businesses offer health coverage to their employees. Over 60 percent of uninsured workers are employed by a small business.
Tax credits, admirable devices in many instances, won't help the health care crisis. A tax credit won't help the Wisconsin manufacturer whose premiums went up 34.1% in 2005. It would be better for Democrats to delve into why insurance is so expensive and correct it. The
Health Security America plan does that.
And here is the House Democratic provision for 70% of uninsured children:
Enrolling every eligible child in health insurance coverage. About 70 percent of the uninsured children in the United States are eligible for, but not enrolled in, a public health insurance program. Democrats want to ensure that every child who is eligible for coverage is enrolled.
Every eligible child? What about the other 30%? Democrats need to wipe the gravy off their faces and insure all children--now. As a group, children are very inexpensive to insure. Where are our Democratic values when it comes to the 10 million kids still going without adequate coverage?
And here is the Democrats' plan for the ones whose insurance doesn't cover special needs:
Family Opportunity Act. Many children with significant disabilities do not have access to comprehensive health services because their insurance does not cover the care they need and their parents earn too much to qualify for Medicaid. Their parents often forgo jobs in order to remain eligible for coverage of these services under Medicaid. The Democratic plan gives states the option to allow middle class families of children with disabilities to purchase Medicaid coverage, helping parents care for their children while continuing to work.
The Family Opportunity Act is an admirable idea, but shouldn't we really be asking why can't families afford a decent health insurance policy? Where is an investigation to root out the inequity of high cost, poor distribution, and as some claim poor care for those who can't afford it?
It hurts to think that when Democrats come to power next November this is all there is. (Which is not to say that I, like most of you, won't work my heart out for the Dems in 2006.) But Democrats have once again dropped the ball on health care reform. Where is that complete single payer, affordable health care plan available to all? After thirty years, this is all they can suggest? This is all they can come together on? Come on Democrats--I am with you, but let's really dig into this problem of cost of health insurance rather than just glossing it over.
I once conducted a study on administrative waste that I presented at our county medical society in 2003. In the book Health Security America: Fixing the health care crisis I have explained this in lay terms. My colleague, Dr.Thalacker, by using the current Medicare fee schedule, would receive 28% less in actual fees, but could increase his income, not lower it, if he were to free himself of his clinic's considerable administrative overhead. That's a win-win situation, and entirely feasible for a physician to work like that without a whole raft of administrative personnel. By pruning administrative costs in the physician and clinical services part of our health care expense, as Health Security Americawill, we can save an annual $142 billion. No Democrat or Republican has been willing to take on these entrenched interest groups, including the clinic and hospital administrators, who enjoy disproportionately large salaries and perquisites. The government has let themselves be the "sugar daddy" for the current health care industry. But by its independent, self-funded nature, Health Security America will accomplish such administrative streamlining outside of Congress. All we need is the authorization to do so.
Just think what good those freed-up funds would do for our economic vitality and the quality of our lives. Cutting administrative overhead and thereby saving 142 billion health care dollars is just one aspect of the Health Security America plan.
What can the ordinary citizen do?
How do you suppose we get our members of Congress to do their duty for the greater good? As FDR once told a constituent who asked why he did not enact a certain bill, he said, "First you must make me." We the people have to make them do what is right.
This is where I should insert the old Margaret Mead homily:
"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. "
And here is what the ordinary citizen can do:
- Swear off Band-Aid solutions and unite behind one plan for single payer plan available to everyone without restrictions. Health Security America is that plan, and its self-funding is the hammer to drive it through Congress. (Our Coalition for a Health-Secure America feels that no taxpayer-funded single payer plan will survive the congressional gantlet. We are not going to reform the way democracy works [or doesn't work] in the U.S. government. We need to accept it and move forward.) Whether you become a coalition member or not, bear in mind that our coalition is constantly searching for speaking engagements and other venues. Let us know.
- Get the book Health Security America: Fixing the health care crisis; it is the bible for the plan and gives explicit instructions how it will work. Read it, and after you understand it, show it to a neighbor. The first diary of this plan was read by a throng, but we have to circulate this plan to another world of people. This book is concise and should bring the concept of single payer, universal coverage and the attendant necessary health care reform into sharp relief.
- Political processes and listening sessions: My peerless senator, Russ Feingold has them, and almost all good representatives at least appear to have an open door. We've received favorable comments from Senator Feingold and Kohl's offices and a great deal of positive advice from Congressman Dave Obey's office. Badger your elected representatives mercilessly through phoning, FAXing and face-to-face meetings. We might have to get this done ultimately at the polls. Folks, the electorate is on our side not the drug companies, insurance companies or special interest professional groups.
- Foster dialogue about health care where you can. We have passed and probably will pass another "Health Security America" health care reform resolution at our congressional district convention next Saturday, and at the state convention this summer. And you can help create the expectation of of health security. Participants in my last diary suggested expanding the Dkosopedia section on health care reform into a true clearinghouse on the topic. AmberJane has good ideas and so do many others. Together we can scrutinize this issue, using our many fine brains in concert to find the optimal solution to this current mess.
"Never doubt" that we can do it.
What's next?
In the next diary, I'll talk about the governance structure of Health Security America, and the first of two steps that we need to take to getting real health care reform enacted.
Fred Bannister, M.D.
p.s. Oh, and Buckeye Blue, as a small business owner, you mentioned a volatile insurance plan. I saw it from the other end, because our HMO did not have a broad enough risk pool. Revenues were totally unpredictable. This doesn't have to be, and a national risk pool would definitely make things predictable and affordable. And yes, Mike Perry is one of our own, a nurse turned scribe. And I'm pretty sure my kids played with him back in the day. A fine writer.