Change We Need – And Can Afford

Because of the current financial crisis many observers see no point in discussing an expansion of health care coverage this year – either federal or state. Indeed, it is true that the current crisis is adding greatly to our public debt. And it is true that total health costs in the US are already twice as high per person per year as those of any other nation and rising faster. If we were to start paying to insure our 50 million uninsured – plus an estimated 40 million Americans who are under insured – costs would escalate hugely. This would be true with any of the recent proposals for insuring the population – except one.

Believe it or not, there is one proposal, which could cover all Americans for all needed services and save money. And it is now – with funds getting shorter every day – that we must explore that proposal. In truth, we cannot afford not to. Careful studies have shown that national savings would amount to $350 billion per year.

At the national level, this proposal is called Medicare for All, and it is embodied in Congress as Bill HR676. In New York State it is called Single Payer New York and it is one of the options now being studied by the Governor in Albany.

The propagandists call it “socialized medicine.” But it is not – because most doctors and hospitals would be private and working in their own facilities.

How could covering more people decrease total expenditures? The difference is in “administrative costs.” Private insurance companies have such costs totaling 15 - 30%. Blue Cross 11%. Medicaid 5%, and Medicare 1-2%. “Administrative costs” include advertising and shareholders’ profits, as well as the billing and collecting costs of hospitals, doctors’ offices, labs and x-ray facilities. These become a nightmare as patients change among a variety of insurers, or when they lose insurance by changing or losing their jobs.

HR676 is an expanded Medicare for All, and it is brief, simple, uncluttered: Everyone in the country is covered. Everyone has one card. Present costs disappear completely. The patient may go to any doctor or hospital. The entire health system is paid for by taxes on corporations and a progressive income tax. A public or quasi-public body could administer it. Health providers do their jobs and receive a fee for service with the fee scales negotiated annually.

Would private insurance companies suffer? Yes, their roles would be limited. That part is controversial, and that’s where the fight begins. Many feel that it’s impossible to beat the insurance industry, but if this is truly a democracy, who should decide such a basic public policy as this, the people or the corporations?

My own opinion, after 40 years of organizing to change the health care system, is that the private insurers have had decades in control. They have had their chance, and they have left us in a mess: Ranked 37th in the world by the World Health Organization for health care delivery; 1/3 of our population is un- or under-insured; costs higher than any other nation; many parts of our population with poor care; higher morbidity and mortality rates than any other developed nation. It’s time to fight!

President-elect Obama’s health proposal is not close to Medicare for All. But he is a good listener who encourages the grassroots to speak up.