NYTs & Health Terror: “No Clear Alternatives”

…So, are we in the final days of the company health plan? Probably not.

Frustrations with the status quo notwithstanding, the current system of providing insurance to most working Americans through their employers is not likely to disappear… none of the other possibilities, like a government-run [single-payer] plan or some new private-sector solution, have enough support to serve as a replacement.

…Only 60 percent of employers now offer coverage,….

…The debate over the fairness of the current tax system, which benefits employees with rich coverage more than people who must buy health insurance on their own, is not a new one. Neither is the heated argument over how best to deliver health care in this country.

… Employers increasingly worry about their ability, and the ability of their employees, to pay for care. But they also recognize that the growing numbers of people without insurance only add to their own health care bills, by expanding the numbers of people without coverage who show up in emergency rooms and contribute to the overall rise in health care costs.

…there are no clear alternatives. Corporate executives and many others are leery of a government solution, but no one has come up with a private-sector option that has gained significant support [since the single-payer plan cannot possibly be an alternative]. Because individuals who buy private insurance on their own pay much higher prices than the group rates employers get [and that the American population would get, a “group” of nearly 300 million] many people could probably not afford health insurance if their employers were not buying it for them. …And while change may be inevitable at some point, no one is willing to predict how soon a sufficient consensus might emerge to allow something significantly different than the current system.

Reed Abelson, “Employer-Backed Health Care Is Here To Stay, for Lack of a Better Choice,” NYTs, December 5, 2005. [emphasis added]

Health care costs should be the first priority for our next Senator, as they are for so many middle-class Minnesota families. Too many are being forced to choose between medicine, food or heat, or are faced with losing all they have worked a lifetime for because a family member becomes ill. The time is now for Mark Kennedy, Amy Klobuchar and Patty Wetterling to join me in taking a stand, or to explain to Minnesotans why they won’t.

We spend more on health care per person than any other country, twice as much as Canada, but we trail most of the developed world in life expectancy and infant mortality. “

…the problem is not that we don’t spend enough, it is that too much of what we spend is either wasted or goes into the pockets of people like Bill Frist. The for-profit health care system is broken, and it is hurting American business and the American people.

… [The Physicians' Working Group for Single-Payer National Health Insurance] proposal shows clearly that single-payer national health insurance would save over $200 billion annually, enough to cover all uninsured Americans. National health insurance will make American business more profitable and competitive and the American people healthier and more secure. It is the only affordable option for universal care.

Our politicians need to start making choices that benefit our citizens. Universal health care is such a choice, and I call again on Mark, Amy and Patty to join me.

Ford Bell, Minnesota senatorial candidate, fmr. head of the Minneapolis Heart Institute Foundation.

“Ford Bell Renews Challenge to Senate Candidates on Health Care: ‘Time to Take a Stand of Explain Why Not,’” U.S. Newswire, November 21, 2005.

This screening process is the main reason private health insurers spend a much higher share of their revenue on administrative costs than do government insurance programs like Medicare, which doesn't try to screen anyone out. That is, private insurance companies spend large sums not on providing medical care, but on denying insurance to those who need it most.

What happens to those denied coverage? Citizens of advanced countries - the United States included - don't believe that their fellow citizens should be denied essential health care because they can't afford it. And this belief in social justice gets translated into action, however imperfectly. Some of those unable to get private health insurance are covered by Medicaid. Others receive "uncompensated" treatment, which ends up being paid for either by the government or by higher medical bills for the insured. So we have a huge private health care bureaucracy whose main purpose is, in effect, to pass the buck to taxpayers.

…Private health insurance in America comes almost entirely in the form of employment-based coverage: insurance provided by corporations as part of their pay packages. The key to this coverage is the fact that compensation in the form of health benefits, as opposed to wages, isn't taxed. One recent study suggests that this tax subsidy may be as large as $190 billion per year. And even with this subsidy, employment-based coverage is in rapid decline.

Paul Krugman, “Health Economics 101,” NYTs, 11/14/05.

…The funny thing is that the solution - national health insurance, available to everyone - is obvious. … The economic and moral case for health care reform in America, reform that would make us less different from other advanced countries, is overwhelming. One of these days we'll realize that our semiprivatized system isn't just unfair, it's far less efficient than a straightforward system of guaranteed health insurance.

Paul Krugman, “Pride, Prejudice, Insurance,” NYTs, 11/07/05.

Solid majorities of every group, with the sole exception of Enterprisers, favor a government guarantee of health insurance for all Americans, even if it means raising taxes. Across the electorate, support for guaranteed health insurance ranges from 55% among Upbeats and 59% among Social Conservatives to 90% among Liberals. By contrast, Enterprisers strongly oppose guaranteed health insurance for all, if it means higher taxes (76% oppose, 23% favor).

“Beyond Red vs. Blue: Republicans Divided About Role of Government – Democrats by Social and Personal Values.” Report Prepared by the Pew Research Center for the People and the Press, May 10, 2005, p.40.

…What it means is that when people really have very serious medical problems, you put them through an excruciating -- I mean the rule is, you know, again back to the Elizabethan Poor Law, it has to be so unpleasant and undesirable to get public assistance that only people who are truly desperate will seek it. That's the guiding principle. It's pretty horrible in this day and age, but that's still the basis on which our eligibility, ah, decisions are made.

…This is as good as the labor market gets in the United States. What is scary about the current phenomenon is that this is really the first time since people have been keeping the numbers on this since the end of the second world war when the number of uninsured people has increased when unemployment is low. That is what is really scary about the present situation.

...the fact is that we are already paying a large part of the bill for the most expensive parts of the system and the most expensive people in the system. And we're a very rich society and getting substantially more affluent all the time. When people ask, how can we afford it in a nation that bought seven million sports utility vehicles last year, I don't understand quite how to comprehend that question [of How can we afford it?].

…we pay a significant premium for decentralization and pluralism and for, multiple arrangements and lots of different private organizations of one sort of another. The administrative cost component of the American health care system is substantially higher than it is anywhere else, precisely because we have so fragmented and decentralized a system.

…, Medicare and Medicaid, as far as anybody can tell, do relatively well. Given the people they cover and the range of benefits they cover, they're not terribly expensive. In fact, from an administrative point of view, they're much more efficient than most private health insurance.

…I think we've got our political system in a kind of vicious spiral as well. I think as the role of media and money and campaigning becomes more and more important, people, political candidates are more and more locked into a certain kind of insider, inside the beltway mentality in which the realm of what is politically acceptable to talk about keeps shrinking all the time.

Bruce C. Vladek, Senior Vice President for Policy, Mount Sinai Medical Center, New York.

“Health Care Crisis: Who’s At Risk?” PBS. 1999.