Friday, October 16, 2009

A Reader's Question on Health Care

Pam, a long-time reader of this blog, asks:

Just out of curiosity, Alg, what is the health care reform you endorse and how do you think we get to it from here? Also, how do we pay for it?

Herewith, a sketch of systemic health care and insurance reform I would whole-heartedly endorse, because I believe it is what we need to do.

Universal single-payer coverage similar to Medicare, with small co-pays at rates commensurate to income. Working people would contribute to its funding through payroll deductions (which most of us who have health care through work are paying anyway, to private insurance companies). Employers would also contribute, as they do now, but at tiered rates so as not to burden smaller businesses excessively or subsidize larger businesses excessively.

Funding from the general budget can also be made available, but only if there is extensive budget and tax reform to accommodate this new priority. A reallocation of public money from subsidizing the private sector through bloated private military contracts, bailouts, and judicious cuts in bloated military spending (and anticipating an objection: significant savings can be achieved without jeopardizing national security). These are areas through which our republic bleeds many billions of dollars per year, and should be reformed for the sake our country's economic system if not for its soul. As for tax reform, it is time for a progressive tax policy where people pay a share for public service that is commensurate with their means.

The challenges we face demand systemic changes.

What I am suggesting would largely kill off the health insurance industry as we know it, although there would likely still be niche markets for private enterprise. Aflac , for instance, has health-related policies that do not provide insurance coverage per se, but promise you payouts of cash in the event of cancer diagnosis, hospitalization, and other medical events. I haven't thought about it much, but I'm guessing these could thrive in a United States that provides its citizens with public health coverage.

Now, a question of my own:

Have you never asked how we pay for our present system?

We do, in fact, currently spend more on health care than any country in the world. Trillions of dollars, we spend. As of 2004, we were spending 16% of our GDP on health care. Many billions of dollars are spent just on executive salaries and bonuses for the insurance company cartel -- that is billions of dollars spent without applying a single bandaid, not one spoonful of hyperoxide, not even a magazine in the waiting room of your community's understaffed health clinic.

The money we spend on our present system, which literally kills people and drives them into bankruptcy, is more than enough to fund a decent single-payer system that covers every citizen.

And it is the right thing to do. Just as an aside.

There is already a bill languishing in the United States Senate. The House has a bill, too.

Other countries have achieved this in various ways. None of them has a perfect system; but they all have decent systems. To borrow a phrase from the current President, it can be a tragic mistake to make the perfect the enemy of the good. Ironically, President Obama frequently makes this mistake himself.

The flaws of these other health care systems are highlighted in order to scare U.S. citizens away from thinking about single-payer health care, but what they do not highlight is that these other health systems, while imperfect, are still cheaper and better than what we're stuck with.

Unfortunately, the best hope we have for health reform in a generation is this weird monstrosity of a public marketplace for private insurance companies to continue selling their premiums, force people by law to buy their premiums (thus giving them a bonanza of new customers), and it seems we aren't even going to get the option of a non-profit entity to compete with the privateers even though polls consistently show the public wants that option.

But it is not about what you or I want. It's not about what's best for you or your grandsons. We aren't what matters. We are expendable, Pam. That is the economic order in which we really live. You have been subsidizing, for quite some time, the luxuries of people who exert influence over your life yet care not one tiny whit about your welfare. And they work very hard at getting you to believe that this is the only way it can ever be. It's a lie.

And things will never be any different until a greater number of us are willing to treat it as a call to their country's defense, to be a pain in the ass, to write and call and sit-in and teach-in (or be taught-in) and organize and campaign and go to jail and maybe even get roughed up, but never give up.

These events always precede important social progress. It does not come from electing someone President and hoping the work will get done. It comes when people take over the streets and say NO in a voice that can no longer be ignored without embarrassment or insomnia.

"You have the bills! Reconcile them and get them to the President! Dare him to veto it!"

It always comes from the bottom up. And actually, that's probably how it should be, don't you think?


Pam said...

It's interesting, Alg. What you're proposing would be a total over-haul of the system. I had another snafu today with my Medicare, trying to get a prescription refill for a medicine I have that helps me when I have bronchitis. Didn't get the medicine. Can't jump through all the hoops when I'm struggling to breathe.

It would take decades to work what you propose out, to completely revamp the system in place. Putting all the insurance companies out of business presents a problem, also.

What would or wouldn't be covered? What would the REAL costs entail on down the line, or even to begin with?

I'm not convinced this is the way to go. Not sure. I can see that this won't get off the ground for some time to come, however.

You say we are expendable. Perhaps, but, I'm afraid that right now I have to be more concerned with the medical needs of my family that of the country in general. Not everyone thinks your way is the way to go.

Personally, I think we need to start with something we can do in my lifetime. We can begin to reform the system and possibly reach a concensus as to how to do it.

What you propose is a radical reform that the country is not willing to endorse at this time.

Social progress, as you put it, is a process, not something that happens overnight.

I applaud those who want this kind of change or any kind of change. I have no problems with people doing what they can to make change happen.

Personally, I have to deal with the day-to-day reality of my personal situation which is unstable and doesn't leave time for protests or whatever. Also, that's not my way of dealing with things.

And, to be honest, I disagree with the single payer proposal that you've outlined. I just don't think that's the way to go for the majority of Americans.

Algernon said...

First of all, I am sorry to hear you had trouble getting your medicine and I hope you are feeling better.

You say an overhaul would take decades. Can you explain why?

You say you struggling with your kids' medical coverage. Too busy, in fact, to deal with "the rest of the country." My suggestion is: don't think about the rest of the country. Think about how the system is failing your kids (and failing you). That's the same system everyone else has got. You don't have to fight this fight for your fellow Americans if you don't want to; fight it for your kids and yourself. You all deserve it. That's why other people are fighting for you.

You say single-payer is not "the way to go for the majority of Americans" but don't share your thought process any further. That's your choice and your right, but I don't understand what your objection is. All I know is, you object.

Okay, so take single-payer off the table. What is your vision? You have some experience of the health care system we've got; you have some experience with Medicare, good and bad. You are an informed and concerned citizen. Participate. Envision. Don't worry about how long it will take -- what are some steps you would like to see happen?

Let's start thinking positively instead of always saying "We can't do that," and "that won't happen." There's no time.

This is a call to participation. Not just punditry, not just voting in the next election. Direct, positive, participation. Can you make some suggestions?

Nathan said...

I think it's important to keep having these conversations. It's so easy to forget that energy builds up from the people, minds are shifted, and eventually we hit a tipping point where the critical mass is creating a new reality. None of us knows how close we are to having a radically new health system. It's happened before, and can happen again.

In 1911, the Flexor Report was issued by the Federal Government, with the backing of the AMA and affiliate organizations. Less that 20 years later, all the medical programs with philosophies that differed from AMA endorsed philosophies disappeared. The main "opposition" group, the Ecclectics, were driven out of business. Herbal medicine was driven underground. And what we know of as "modern" medicine today became the only accepted model. All of this happened within a 20-25 year period.

During a single generation radical change happened, and it can happen again.