Let’s Tell It Like It Is, For A Change!

The evolution of the health care debate has taken us on a wild ride. At first the goal was to have national health care, which sparked fear into conservatives based on the argument that innovation will be stifled by lack of competition. This led to a compromise between Democrats and Republicans which produced the public option. This way, the insurance companies were not directly cut out of the picture with the first stroke of the pen.

At that point Republicans set out to fight the public option. It is all part of their strategy to protect the insurance companies’ involvement in health care. Their argument being that introducing a government run public option into the insurance picture will make it impossible for insurance companies to compete. This is probably correct. In order for insurance companies to be able to compete with a government run, non-profit they would have to turn themselves into non-profit entities.

Given that among the most serious problems with our current health care system are the outrageous cost of health care and the rampant out of control rate of cost escalation—and further given that the health insurance companies’ billions of dollars in annual profits is a major reason for our high cost of health care—It makes perfect sense that this is the point. Because health insurance companies make their profits by denying coverage because of pre-existing conditions (among other reasons) along with restricting the list of reasons why patients need certain procedures and treatments and because by the very nature of corporations they thrive to cut as many costs as possible and increase as much profits as possible in order to show a favorable financial position to their stock holders and boards of directors—insurance companies have become the cancer that infects our health care industry, thereby threatening it with insolvency.

There is a paradox here. To be an efficient corporation health insurance companies must cut people out. They must deny coverage to some in order to insure their profits. This produces more than one problem. One problem is that we will never achieve universal coverage with insurance companies making our health care decisions and therefore. Another problem is that with denial of coverage, the number of people allowed to have expensive tests like an MRI or CAT scan is restricted and because of this fact the cost of these procedures has to increase for the hospitals to be able to continue to offer these services. Without universal coverage, health care is inefficient. With out of control rates of rising costs, health care is inefficient. So we come back to the paradox. There can either be efficient health insurance companies or there can be efficient health care. There cannot be both. By its very nature a health care system controlled by health insurance companies that are mandated to cut expenditures and make profits is producing an inefficient and unacceptable health care system.

T.R. Reid, a former Washington Post journalist and the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” recently wrote an interesting article about how we can compare how other developed countries in the world are providing health care for their people. This article was the result of world travel and research into how health care is done in these countries. The first point he made has been made by many writers so far and that is that the United States is the last of the developed countries in the free world that has not gone to national health care.

Reid compared systems from Germany, France, Switzerland, Britain, Canada, Japan, and Taiwan. He could easily have included other nations but he chose to stick with the industrialized free world. While doing his research he found some interesting facts. While in some countries peoples must deal with long lines for their care, in most countries this is not a problem. As for limited choices, some countries provide multiple choices for care and some provide only one.

He also found that in every country he researched, the costs were less than the cost of care the U.S. “But in fact all other payment systems are more efficient than ours.” Among other things Reid looked at how cost controls stifle innovation and found this to also be a false fear.

“Any American who has had a hip or knee replacement is standing on French innovation.

“Overseas, strict cost controls actually drive innovation. In the U.S., and MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. (And Japanese labs still make a profit.)”

The Republican fear that competition is critical to provide the innovation needed for the U.S. to be on the cutting edge of state of the art medical care is simply not true. This has not been the case in criminal investigating or firefighting technology and it is not, nor will it be the case in medical care.

So let’s tell it like it is. As U.S. Republican Representative from Colorado, Mike Coffman, stated in his Sunday Op-Ed piece in the Denver Post:

“Although it is debatable whether the creation of a government-run insurance entity will inevitably lead to a single-payer system, it is simply naïve to think that it will not lead to the government dominating the health insurance market place…”

This is not only true, it is the whole point. The only reason the public option surfaced in the debate in the first place is because Republicans, being the pro business party they are, embarked upon a strategy to kill the idea of national health care to protect the businesses which are currently involved in the health care industry. The sad thing is that they actually believe that leaving health care to the free enterprise system will produce better health care in a more efficient manner than any other possible alternative. For them it is case closed, end of story. Free market competition is not only the best answer; it is the only answer. They are not interested in looking into how the rest of the world is handling health care. They don’t believe our health care system is broken in such a way that cannot be fixed by simply changing as little as possible so that the free market system will correct our health care problems on its own.

There have been some who have stated that it would be much more refreshing to see Democrats just admit that they want the single provider system in the first place. Again, initially, they did exactly that. The debate on health care reform began with the Democrats stating that they wanted national health care. The Democrats want everyone insured and everyone covered no matter what. They don’t want anyone denied health care for any reason and they don’t care about pre-existing conditions. This is not a bad goal at all.

Because compromise is how things get done in congress and because the parties are so polarized this has become a battle of strategies. Should health care be incorporated into the basic infrastructure of government responsibility along with highway maintenance, national parks, police, fire, and military protection? Or should health care remain in the hands of gigantic middlemen known as insurance companies?

Yes, the Democrats eventually would like to have the government take over the entire health care system. No, they are not hiding their agenda. During the continental congress of 1776, when John Adams vehemently opposed a constitution that did not make slavery illegal, Ben Franklin told him, “First things first, John. Let’s establish a country first. Then we can handle our problems.”

Rather than try to establish national health care immediately, the Democrats realize that this reform is too abrupt to accomplish so quickly, especially in the face of organized Republican opposition. So they are telling themselves, “First things first.” First they will get the public option which will by default make it impossible for insurance companies to compete and still make a profit. Without profits, insurance companies will bow out of the industry. They will not have to, but they will not willingly stay involved as non-profits. Then, with that accomplished, the Democrats can more realistically move toward an all inclusive national health care system.

Is national health care what America needs? When people on the street are asked this question, healthy people always answer differently than those who have had to face any health issues other than simple health maintenance. Anyone who has either been denied a procedure, treatment or medication or who has a relative who has been denied these things by the insurance companies will give a different answer than someone who needs no medicine or care other than an occasional physical or cold remedy. Those people are not among those who are denied coverage and because they haven’t run into that wall they are reluctant to see the need for major change.

This does not mean there is no need for change. When two of your needed prescriptions cost $125 each for a 30 day supply and when you need these prescriptions at a time in your life when you are living on a fixed income, something needs to change. If you own a small business and you cannot provide health insurance for your 15 employees without either you or your employees having to pay prices that are so high that they are simply unaffordable, something needs to change. If you have lost a limb because of an automobile or industrial accident and your insurance company either denies coverage or your co-pay cost is un-affordably high, something needs to change. If you have an accident at work that required expensive medical care and it was covered, but when you returned to work you only managed to keep your job for less than a year before the company you worked for found enough reasons to fire you, something needs to change. (And don’t think this example is un-related or that it doesn’t happen. It is, and it does, but that is a subject for a different article.)

With health insurance so expensive that major employers must compromise the quality of coverage just to be able to provide insurance at triple the cost of the previous year, something needs to change. So the answer to the question as to whether or not national health care is what America needs is a resounding yes. Must it take on a specific shape? Not necessarily. As Reid pointed out, there are many examples in the world to use as models. Some of these examples have more pronounced weaknesses than others. But all of them are more efficient than our current system, and all of them cost less. With our life expectancy and our infant mortality rate not even reaching the top ten on the world’s list, and with America landing at number 39 in the world list in terms of the quality of our over all health care—not making the switch to national health care would be a serious mistake. How else will we achieve universal coverage? How else will we eliminate from the equation entirely the possibility that we may not get the care we need because we cannot afford it?