Observing from beyond the solar system, a cultural outsider looks in.

Monday, February 25, 2008

EENR for Progress: Health Care is a Human Right

Health care is a human right. In my own definition of the progressive movement, I count that as a basic progressive principle.

For various reasons, from my own personal perspective, it is simply unacceptable to settle for anything less than true universal health care. Some of those various reasons are my experiences with health care in the United States, as well as those of my friends and family, some of whom have serious or chronic conditions.

In tonight's EENR for Progress, we look at why we need universal health care, proposals for universal health care, and what progressives can do to achieve it.

It's true that I feel very strongly about the need for universal health care, but I am not a health care expert. The research presented here is not comprehensive, but it is the best of my understanding to date.

Why we need universal health care

Why do we even need universal health care? Here's a quick review, just in case anyone remains blissfully unaware.

Before getting into the proposed solution, the written plan proposed by John Edwards this year offers some important statistics with sources cited:

45 Million Uninsured Americans: There are 45 million uninsured American residents, nearly one in five non-elderly residents. For these people, preventive care is expensive and even major illnesses may go untreated until it is too late. An estimated 18,000 uninsured people die every year because they lack access to care, according to the Institute of Medicine. [Census Bureau, 2006; Institute of Medicine, 2002]

Tens of millions more Americans are at risk of losing coverage. One in three non-elderly Americans goes without insurance at some point over a two-year period. Some families see their claims denied or insurance cancelled after they incur large bills. Half of US bankruptcies are caused by medical expenses, even though two-thirds of bankruptcy filers had health insurance. Insured Americans also pay higher premiums – $922 on an average family policy and $341 on an average individual policy – to pay for the cost of treating the uninsured. [Families USA, 2005; LA Times, 9/16/2006; Warren et. al., 2005; Hacker, 2007]

Spiraling Health Care Costs: The U.S. health care system is needlessly expensive. Health care costs have consistently grown faster than wages for almost 50 years. Over the past six years, families have seen premiums grow by nearly 90 percent while benefits have been cut. One in four Americans say that they or a family member have had trouble paying a medical bill in the past year. More than a quarter of low- and middle-income households with credit card debt have charged medical expenses. [Kaiser Family Foundation, 2006; Demos and Access Project, 2007]

Furthermore, inadequate available and affordable health care leads people to ignore health problems, eventually turning into higher costs.

Niko Karvounis has a fascinating analysis of why consumer-driven health care can raise costs.

A 2007 paper from the National Bureau of Economic Research looked at retired California public employees on Medicare, and its findings contradict some of the basic assumption of the consumerist movement.

The study’s authors--from Harvard, MIT, and the University of Oregon-- found that chronically patients who are asked to shoulder more of their health care costs deferred, neglected, or opted-out of doctor’s visits and drugs when the price got too high. This short-term cost reduction led to long-term catastrophe, as their hospitalization rates were significantly higher than other patients suffering from chronic diseases. Immediate savings ultimately led to a greater—and otherwise preventable—use of more expensive care. Oops.

It's even worse for those already in poverty.

In 2003, the Center for Budget and Policy Priorities cited research from the RAND corporation that found “low-income adults and children reduced their use of effective medical care services by as much as 44 percent when they were forced to make co-payments, a much deeper reduction than occurred among those with higher incomes.”

Clearly universal health care that everyone can afford is important if we want to help lift people out of poverty and prevent the middle class from falling into poverty. Having a healthy population is also important to businesses, which would benefit from having a healthy work force, and even to national security.

Our every-man-for-himself attitude toward health care is a security threat on a par with unsecured ports. In Canada, people go see the doctor if they're sick for more than a day or two. It was this easy access to early treatment, along with the much tighter public health matrix that enables doctors to share information quickly, that allowed the country's health care system to detect the 2003 SARS epidemics in Toronto and Vancouver while they were still very localized, act within hours to stop them before the disease spread any further, and track down and treat exposed people before they got too sick to be helped. In both cases, the system worked flawlessly. The epidemic was stopped within days and quashed entirely in under a month, potentially saving of millions of lives.

In the U.S., that same epidemic might easily have gone unnoticed for critical days and weeks. If the first people to get sick were among those 75 million without adequate insurance, they probably would have toughed it out a few extra days before finally dragging their half-dead carcasses into an ER somewhere. Not only would they be much farther along in the course of the disease -- and thus at greater risk of death themselves -- every one of them could have infected dozens or even hundreds of other people in the meantime, accelerating the spread of the epidemic.

Worse: America's underfunded public health system might have taken several days to piece together the whole picture of an epidemic; and perhaps another week or two might have passed before the E. Coli conservatives in charge (having thrown out the science-based management plans thoughtfully developed by the bureaucracy) cooked up some kind of half-assed ideology-driven decision about how to proceed. (It would, of course, involve spectacular amounts of lying to the public.) By that point, tens of millions could have been infected, leading to a death toll that would make 9/11 and Katrina look like minor statistical blips.

Proposals for universal health care

All of the health care plans proposed this year by the major Democratic presidential campaigns were based on the "Health Care for America" plan proposed by Yale University political science professor Jacob S. Hacker, including the plan by John Edwards, which was the first and best of the plans proposed. Of course, any of the Democratic plans is better than the Republican plan.

The Health Care for America plan is an insurance-based system that seeks to leverage what we already have, create efficiencies, and close gaps in coverage. It's not a terrible plan. It could work to cover everyone, and there are indications that it would reduce costs.

WASHINGTON – A health care plan that combines the best elements of the current employer-based system and the Medicare model would create big savings, offer more choices and guarantee affordable coverage to all U.S. residents, according to a new cost and coverage analysis of the plan by the Lewin Group, a nationally respected nonpartisan consulting firm.

Health Care for America, developed for the Economic Policy Institute (EPI) by Yale political scientist Jacob S. Hacker, would achieve these goals and maximize consumers’ health care choices without unraveling existing health security, forcing individual to obtain coverage on their own, pressuring patients into health savings accounts or using inadequate vouchers.

Lewin estimates the proposal would cover 99.6 percent of all Americans without raising total national health spending. It would also save hundreds of billions over time – more than $1 trillion over the next 10 years – in national health spending, according to Lewin.

The argument can certainly be made that it is much more politically feasible to fix what we have already than it is to put health care for profit out of business and start from scratch. The problem with that is, what we have is really broken, and if we improve upon a shaky system, we are likely to cause that shaky system to become more entrenched.

Virtually all the gradual reforms being touted would reinforce a multi-tiered health care system with as many standards of care as there are dollars to purchase them, and further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

The public is ahead of the politicians and policy wonks. A recent New York Times/CBS poll found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

Back when I had a dog in the hunt in this presidential election, I was willing to make my best case for the health care plan proposed by John Edwards, knowing that it was better than what we have now, would actually cover everyone, and could evolve into a single-payer system. When my goal is to get my candidate elected, I know better than to publicly quibble with their ideas, especially when those ideas are basically solid.

Now that I no longer have a dog in the hunt, however, I admit that I have always favored a single-payer (Medicare for All) system, and I believe that is what we should really be striving for.

Excerpt from Michael Moore's Sicko

What Sicko taught America is that health insurance is not health care. Coverage is not care, because the holes in the coverage are large enough to slip through and die. So when Senator Obama says that he would support a Medicare for All system if we were starting from scratch, the nurses, patients, and Michael Moore can attest that we are all starting from scratch. As a nation, there is no health care system.

-Rose Ann DeMoro, executive director, California Nurses Association, 2/22/08

That's right, folks. We don't HAVE a health care system. What we have is a hodge podge of services that cover some of the people, some of the time, in some circumstances, maybe, but only if you can cut through the red tape. That's not a system. That's chaos.

Could we fill some of the gaps between services, legislate against the worst abuses, pull some of the pieces together, and make sure everyone has some kind of coverage using parts of what little we've got? Sure. We could do that. That's what all of the plans based on "Health Care for America" are saying we should do. Perhaps they're even right that it woul be easier and more likely to succeed than starting from scratch, but again, we'd be building on something that's broken.

It seems to me (and 65% of the American people) that we ought to instead admit that we don't have a system and we ARE starting from scratch. (Senator Obama and Senator Clinton apparently do not see it that way, however, since their health care plans are also based on the "Health Care for America" model.)

Sixty-five percent of those polled said the United States should adopt universal health insurance that covers everyone under a program such as Medicare that is run by the government and financed by taxpayers.
- Recent AP/Yahoo poll

Medicare for All. That, my friends, is single-payer health care. But isn't this the dreaded evil socialized medicine? Personally, as long as everyone has adequate health care, I couldn't care less what you call it. But the answer is no, according to a very illuminating analysis of the Canadian health care system by Sara Robinson.

1. Canada's health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.

The proper term for this is "single-payer insurance." In talking to Americans about it, the better phrase is "Medicare for all."

By that definition, none of the proposals mentioned in this article qualify as "socialized medicine," including Medicare for All.

I highly recommend reading all of Sara Robinson's Mythbusting article on Canadian Health Care, Part 1 and Part 2. If that doesn't make you want to move to Canada, I don't know what will. If it does make you want to move to Canada, the U.S. will have to pay to cover one less person whenever we finally get around to providing universal health care, and please, send us a postcard! But seriously, folks, her article includes all sorts of reasons why we should not fear single-payer health care, including less stressed and less overworked doctors, healthier patients, and wait times that actually aren't noticeably longer than in the U.S.

But don't doctors suffer under single payer systems? This guy doesn't seem to think so:

Interview with a British doctor from Michael Moore's Sicko

There is currently a Medicare for All bill in Congress, H.R. 676, proposed by Congressman John Conyers and supported by 88 cosponsors, including former presidential candidate Dennis Kucinich.

In 2003, Representative Conyers first introduced HR 676, the United States National Health Insurance Act (USNHI). This bill would establish a unique American universal health insurance program with single payer financing. As a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program, it would be available to all U.S. residents, and all residents living in U.S. territories.

Getting this bill passed would require a lot more support in Congress, but if it were passed under a Democratic administration, Michael Moore believes the Democratic president would sign it.

“It’s equally, perhaps even more, important on this issue that people across the country elect members of Congress who support” Conyers’s bill, Moore said. “The Democratic president is not going to veto that bill,” he said. “At that point, they’re going to have to ride the wave.”

To sum up, there seem to be 2 main types of plans being discussed on the national scene in a big way. One is some variation on the "Health Care for America" plan, which is a combination of employer based health care, insurance, and Medicare and builds on whatever it is we've already got. The second is single payer or Medicare for All.

The "Health Care for America" type of plan may be much easier to enact, primarily because it throws insurance companies and drug companies a bone that maybe they shouldn't be thrown and builds on our existing broken system, patching it up. It would be MUCH better than no improvement at all, however, and is the only type of system being currently proposed by the major presidential candidates.

The Medicare for All or single-payer type of system is a better system in many ways, but the opposition to it by entrenched insurance and drug company interests would be even more fierce than the opposition they would raise against the "Health Care for America" system, which is going to be fierce enough as it is. A recent survey shows that 65% of the American people favor this kind of system, but even so, mustering strong enough political will to pass it would be very difficult. There's a lot to be said for doing things right the first time, though, especially if you consider that with the mess we already have, we essentially ARE starting from scratch. There is a bill for this type of system currently in Congress, H.R. 676.

In any case, there's no excuse for not providing everyone with health care. The "universal" in universal health care means everyone is covered. To remind us of that, I give you one of the most poignant videos released during the Edwards campaign.

A Survivor's Question

I'm somewhat agnostic about the difference between "Health Care for America" and Medicare for All. My bottom line is that I want to see some form of Universal Health Care in America within the next president's first term. I prefer Medicare for All, but if "Health Care for America" is what gets passed, I'll be ecstatic for a while, at least until it becomes painfully obvious that it was nothing more than a patch to a broken system and we still need to work toward single payer.

I'm not a purist, and I think that the perfect should not be the enemy of the good here.

The truth is, the families and individuals who are suffering from lack of health care or inadequate health care, or inability to afford health care can't wait. We need to do something, and soon.

What Progressives Can Do

So, what can we do?

Write your Congress critters and tell them to pass H.R. 676, Medicare for All. Here's a sample letter you can use:

Dear (decision maker):

I am writing to ask you to cosponsor H.R. 676, Medicare for All. It's time for Universal Health Care, and recent AP/Yahoo poll indicates that 65% of Americans favor a single payer system.


Sign the California Nurses petition for CheneyCare! You don't have to live in California to sign.

Write to the presidential candidates and tell them you insist on Universal Health Care. If you want Medicare for All, tell them so.

Contact Obama
Contact Clinton

In Obama's case, he has said that he would support a Medicare for All system if we were starting from scratch, so convince him that we ARE starting from scratch. In truth the "starting from scratch" argument is a little bit of a straw man since no health care system ever started from scratch since the time the first healer picked the first medicinal herb. There was always an existing way of doing things that needed to be supplanted by a new way. We need a new way.

Keep in mind also that it will take a strong Democratic Congress to pass Universal Health Care, so work for the progressive congressional candidates of your choice.

Stay tuned for the first EENR candidates endorsement diary coming on Monday from Sarahlane!

Best wishes to Michael Moore and Sicko at the Oscars tonight and the best of health and health care to the American people!

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