Why Obama's Public Option Is Defective, and Why We Need Single-Payer.
By Drs. Steffie Woolhandler and David Himmelstein, July 22, 2009
Once Congress finishes mandating that we all buy private health insurance, it can move on to requiring Americans to purchase other defective products.
A Ford Pinto in every garage?
Lead-painted toys for every child?
Melamine-laced chow for every puppy?
Private health insurance doesn’t work.
Even middle-class families with supposedly good coverage are just one serious illness away from financial ruin.
Illness and medical bills contribute to 62 percent of personal bankruptcies — a 50 percent increase since 2001. And three-quarters of the medically bankrupt had insurance, at least when they first got sick.
Coverage that families bought in good faith failed to protect them. Some were bankrupted by co-payments, deductibles, and loopholes. Others got too sick to work, leaving them unemployed and uninsured.
Now Congress plans to make it a federal offence not to purchase such faulty insurance.
On top of that, it’s threatening to tax workers’ health benefits to meet the costs of simultaneously covering the poor and keeping private insurers in business.
President Obama's plan would finance reform by draining funds from hospitals that serve the neediest patients. His other funding plans aren’t harmful, just illusory. He’s gotten unenforceable pledges from hospitals, insurers and the American Medical Association to rein in costs, a replay of promises they made (and broke) to Presidents Nixon and Carter. And Obama trumpets savings from computerized medical records and better care management, savings the Congressional Budget Office has dismissed as wishful thinking.
The president’s health plan can’t make universal, comprehensive coverage affordable.
Only single-payer health reform — Medicare for All — can achieve that goal.
Single-payer national health care could realize about $400 billion in savings annually — enough to cover the uninsured and to upgrade coverage for all Americans. But the vast majority of these savings aren’t available unless we go all the way to single payer.
A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.
A single-payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget. Physicians’ billing could be similarly simplified.
With a public insurance option, by contrast, hospitals and doctors would still need elaborate billing and cost-tracking systems. And overhead for even the most efficient competitive public option would be far higher than for traditional Medicare, which is efficient precisely because it doesn’t compete. It automatically enrolls seniors at 65 and deducts their premiums through the social security system, contracts with any willing provider, and does no marketing.
Health insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels. To compete successfully, a public plan would have to copy private plans.
Decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. And a government-run clone of private insurers cannot fix these flaws.
Drs. Steffie Woolhandler and David Himmelstein are associate professors at Harvard Medical School. They co-founded Physicians for a National Health Program, a nonprofit research and education organization of 16,000 physicians, medical students, and health professionals who support single-payer national health insurance. For more about the group, go to www.pnhp.org. This piece was distributed by the Progressive Media Project, an affiliate of The Progressive magazine. To subscribe to The Progressive, for only $14.97, click here.
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Comments
Ah, if you consider a 3 trillion dollar debt in 8 years "close to bankruptcy,"...what do you call adding 6 trillion dollars to that debt in 10 weeks under BHO?
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All the problems with the American health care system come from government intervention, so naturally the Democrats' idea for fixing it is more government intervention. This is like trying to sober up by having another drink.
The reason seeing a doctor is already more like going to the DMV, and less like going to the Apple "Genius Bar," is that the government decided health care was too important to be left to the free market. Yes -- the same free market that has produced such a cornucopia of inexpensive goods and services that, today, even poor people have cell phones and flat-screen TVs.
As a result, it's easier to get your computer fixed than your health. Thanks, government!
We already have near-universal health coverage in the form of Medicare, Medicaid, veterans' hospitals, emergency rooms and tax-deductible employer-provided health care -- all government creations.
So now, everyone expects doctors to be free. People who pay $200 for a haircut are indignant if it costs more than a $20 co-pay to see a doctor.
The government also "helped" us by mandating that insurance companies cover all sorts of medical services, both ordinary -- which you ought to pay for yourself -- and exotic, such as shrinks, in vitro fertilization and child-development assessments -- which no normal person would voluntarily pay to insure against.
This would be like requiring all car insurance to cover the cost of gasoline, oil and tire changes -- as well as professional car detailing, iPod docks, leather seats and those neon chaser lights I have all along the underbody of my chopped, lowrider '57 Chevy.
But politicians are more interested in pleasing lobbyists for acupuncturists, midwives and marriage counselors than they are in pleasing recent college graduates who only want to insure against the possibility that they'll be hit by a truck. So politicians at both the state and federal level keep passing boatloads of insurance mandates requiring that all insurance plans cover a raft of non-emergency conditions that are expensive to treat -- but whose practitioners have high-priced lobbyists.
As a result, a young, healthy person has a choice of buying artificially expensive health insurance that, by law, covers a smorgasbord of medical services of no interest to him ... or going uninsured. People who aren't planning on giving birth to a slew of children with restless leg syndrome in the near future forgo insurance -- and then politicians tell us we have a national emergency because some people don't have health insurance.
The whole idea of insurance is to insure against catastrophes: You buy insurance in case your house burns down -- not so you can force other people in your plan to pay for your maid. You buy car insurance in case you're in a major accident, not so everyone in the plan shares the cost of gas.
Just as people use vastly different amounts of gasoline, they also use vastly different amounts of medical care -- especially when an appointment with a highly trained physician costs less than a manicure.
Insurance plans that force everyone in the plan to pay for everyone else's Viagra and anti-anxiety pills are already completely unfair to people who rarely go to the doctor. It's like being forced to share gas bills with a long-haul trucker or a restaurant bill with Michael Moore. On the other hand, it's a great deal for any lonely hypochondriacs in the plan.
Now the Democrats want to force us all into one gigantic national health insurance plan that will cover every real and mythical ailment that has a powerful lobby. But if you have a rare medical condition without a lobbying arm, you'll be out of luck.
Even two decades after the collapse of liberals' beloved Soviet Union, they can't grasp that it's easier and cheaper to obtain any service provided by capitalism than any service provided under socialism.
You don't have to conjure up fantastic visions of how health care would be delivered in this country if we bought it ourselves. Just go to a grocery store or get a manicure. Or think back to when you bought your last muffler, personal trainer, computer and every other product and service available in inexpensive abundance in this capitalist paradise.
Third-party payer schemes are always a disaster -- less service for twice the price! If you want good service at a good price, be sure to be the one holding the credit card. Under "universal health care," no one but government bureaucrats will be allowed to hold the credit card.
Isn't food important? Why not "universal food coverage"? If politicians and employers had guaranteed us "free" food 50 years ago, today Democrats would be wailing about the "food crisis" in America, and you'd be on the phone with your food care provider arguing about whether or not a Reuben sandwich with fries was covered under your plan.
Instead of making health care more like the DMV, how about we make it more like grocery stores? Give the poor and tough cases health stamps and let the rest of us buy health care -- and health insurance -- on the free market.
--Ann Coulter