So most of my recent posts have been about health care, but I promise after this I will branch back out and write on some different topics. I just want to conclude my health care binge with an article I wrote for The Indicator, a campus magazine. It was originally published in the September 24 issue of The Indicator.Michael Moore’s SiCKO begins with stories about a woman whose post-car accident ambulance ride was denied by her insurer because it wasn’t preapproved, and about a young girl in need of cochlear implants, but who only received one because apparently a cochlear implant for the right ear was OK, but for the left ear it was an “experimental procedure.” We are all familiar with the health care horror stories, the tragic bankruptcies and preventable deaths that have befallen both the insured and the uninsured alike. There are few serious people who will dispute that the health care system in the United States is in need of urgent attention. The more serious among us know that this predicament calls for more than just reform; we need a health care transplant, if you will.
As Barack Obama finally stated in his address to Congress on September 9, the United States remains the only industrialized democracy that does not provide access to medical care to all of its citizens. Even without providing every citizen with care, an enormous amount of money is infused into the healthcare system. We spend far more per person ($6096 in 2007 dollars) and as a percentage of GDP (16%) on health care than any other country in the world. Yet the United States currently ranks 33rd in infant mortality rates, and came in at 37 in the last WHO ranking of world health care systems. Spending twice as much per capita as the next closest nation (Germany) without better results to show for it demands an explanation. Allocating such funds without even managing to cover all of our citizens is completely inexcusable—a kind of inefficiency I would think most fiscal conservatives would also reject.
A likely explanation lies in the fact that whereas German insurers are non-profits that don’t compete, American insurers advertise, pay stock dividends, rack up corporate profits and generously compensate their executives. Indeed, a good 30% of US health care expenditure is insurer overhead costs. This makes sense logically: If health care is treated as a commodity in a market based system, then the goal is profit. If there were no profit from health care, no private insurers would exist. And that is exactly the point of the European systems in question. These systems treat health care as more than a commodity to be enjoyed by the wealthy—they recognize that health care is a basic human right to be afforded to all peoples regardless of economic means.
Health care is different from, say, the computer market. In that market, companies make money by building the best computers they can in order to attract consumers to buy their product. In the health care market, where it is difficult to switch providers, or even to buy insurance in the first place, profit is not made by providing the best care possible, it is made by denying expensive, but often necessary, claims and procedures. Let me repeat myself: Neither you nor your doctor is currently in charge of your health care. A corporate bureaucrat with a mandate to keep costs low by denying your health care claims is in charge of your health care. It astonishes me that anyone could look at the system we have now and claim to be afraid of government rationing of care. We already have health care rationing, and the government is not doing it. We have rationing by economic means, and then by the profit motive. I am far more worried about Blue Cross/Blue Shield being unwilling to pay for an “experimental procedure” should I ever need one than I would be about enrolling in a public insurance option.
Health care reforms alone will be a welcome, necessary measure, but they are bound only to increase health care costs in the absence of a public option. Insurance companies will not take a hit to their profits by having to cover those with preexisting conditions and eliminating lifetime and annual coverage caps. They will just increase premiums to make up for these added costs. We need a competitive insurer, one motivated by providing patients with the care they need, not denying as much of it as they can to generate the largest profit possible. By fulfilling this criterion, the public option can keep the got-profit industry in check.
So why has President Obama strayed from his campaign stance that if he were designing a system from scratch, he would choose a single-payer system? There is an undercurrent in American politics of reticence to admit when the United States is not the world’s best, and to search for “uniquely American” solutions to American problems. I believe that such sentiment is ultimately destructive, because it prevents us from finding the best solutions to our problems, when such solutions may come from the example of another country’s example. Thus far, nobody in the administration or the Congress has been willing to look to Europe for the solution to the health care conundrum. It is no sign of weakness to admit to America’s faults and to admit to others’ successes. Were I leading the push for health care reform, I would make it a priority to attempt to combine the best parts of our peer nations health care systems into a bill. We often boast of being the world’s cultural melting pot, so why is it not also acceptable to be the melting pot for ideas?
I am not naïve enough to believe that we would ever achieve single-payer health care in this country, but anyone who has ever bargained for anything knows that you never open a negotiation with a compromise—and that’s what the public option was supposed to be: the compromise. Had the President at least made it look like he were capable of generating significant support for a single-payer push, the backlash of lies, hate-speech and paranoia would have been burned out against it, and the public option would look like a magnanimous compromise deal.
However, before the opening shots were fired on the health care debate, there was already a casualty: bipartisanship. Bipartisanship was dead, but the Democrats failed to realize it, and that has been the main problem. Republicans like Kent Conrad publicly proclaimed that they wanted to “break” Obama on health care, but the Democratic Party has mostly willfully ignored such claims. It should be obvious that the Republican Party does not want a strong, successful public option. Such a new government program would be more than just a partisan political victory—it would be an ideological victory, proving that government is not always the problem, and can even be the solution when the private market fails. Yet the Democrats have seemed willing to risk the success of health care reform by watering down potential bills in an attempt to garner one or two unnecessary Republican votes. In fact, Minority Leader Mitch McConnell announced on September 16 that the Republican Party would not support the bill authored by Senator Max Baucus (D-MT), a bill that was purposely watered down and dispensed with the public option in hopes of engendering Republican support. Clearly the Republican Party is not interested in meaningful health care reform, and it’s not too difficult to figure out why.
A successfully implemented public option would push the ailing Republican Party even further into obscurity for the next two decades. In fact, the best thing that could happen for the Republicans politically is for Obama to fail and fail big. Why else would the far right be so dead-set against a public option? Either government is inept and inefficient as they claim, in which case no one would have an incentive to join the public plan because it would be neither cheaper nor provide better care, or the public option is something that will actually work to insure the uninsured and drive down costs and regulate moral hazard in the insurance industry by competing against the profit motive. It’s the second scenario that provides the right wing with the incentive to vigorously oppose it.
The polling data supports my hypothesis: Obama’s approval ratings have dropped, but the Republicans’ approval ratings have not risen. They have stayed relatively stable, hovering near 24% throughout the summer. If Americans truly did not want a public option, and did not want the Democrats to pass a bill on their own or through reconciliation, then the Republicans approval ratings should have risen with their increased opposition to health care reform. Furthermore, nearly every poll shows large majority support for a public option. Even in red Arkansas, 55% support a public option, and national support among doctors is at 73%. Thus the fall in Obama’s approval ratings is most likely to be attributed to disaffected progressives and liberals who want the president to take a stronger, more inspiring stand for the real change he promised in his campaign.
Unfortunately, Obama has failed to make health care a moral crusade. It should be a moral issue for the right-to-life camp; it should be a moral issue for humanitarians; and it should be a moral issue for anyone who cares about their fellow Americans. He has thus far failed to inspire and to mobilize his millions of followers in support of a clear, coherent plan. That’s partly because he has not expressed such a specific plan but only a set of vague goals. Every few weeks Americans hear Obama waffling back and forth in support of the public option. That is not what America needs. Obama’s support is waiting to rise up, whenever he finally decides to stand up for himself. He has let the extreme right wing take control of the debate for far too long; it’s pathetic that the death panel rumors are so pervasive that he had to denounce them to the joint session of Congress.
The message that needs to come forcefully from the administration is that health care is a matter of human decency, and it America has been remiss in its moral duty for far too long. They should also make clear that the public option is non-negotiable, and they should make it the centerpiece of the “Edward Kennedy Memorial Heal America Act.” Then, by reconciliation if need be, the Democrats should pass that bill and challenge opponents to go ahead and vote against it. When universal health care is as successful and beloved as Medicare and Social Security, the naysayers will be held accountable, and the Democrats will enjoy the secondary political benefits of success. But both conservative and liberal Americans will enjoy the primary benefits of better, more efficient and more equitable health care accessible by all.
