The Policy That Dare Not Speak It's Name
By Robert Kuttner
Huffington Post: June 21, 2009
I'm sure I'm not the only reader who noticed the juxtaposition of two front
page stories in Sunday's New York Times dealing with health care. The first
article cited a new Times-CBS poll showing that 72 percent of Americans
favored a government run health plan comparable to Medicare, which would be
available to everyone.
The second reported on a rogue radiologist at a Philadelphia VA hospital who
botched 92 prostate procedures.
The right will doubtless go to town on that one, as what we can expect of
government-sponsored medicine. I'll have more to say about the VA in a
moment, but first let's consider the poll findings.
The poll is relevant because Congress will soon decide whether to include
the so-called "public option" in the Obama health reform bill. As drafted by
three House leaders and unveiled last Wednesday, the 852-page bill would
include a government-sponsored, Medicare-like public plan.
Republicans and the health industry have been kicking and screaming that
this is socialistic. But the poll suggests that defenders of the public plan
have nothing to fear politically, and that Republicans are in danger of
getting on the wrong side of a popular issue.
However, that's only the beginning of the story. The reform package, as
drafted by the Obama administration and the House leadership, is dubious
legislation even with the inclusion of a public option. Basically, it leaves
the two worst aspects of the system intact. First, private insurers will
continue to dominate. Second, most people will continue to get their
insurance through their employers. Given these two bedrock realities, there
is no way that the bill can make serious inroads on cost without cutting
back on care. The high cost of the approach is already causing key
legislators to back off. The current system wastes huge sums, but because it
is so fragmented the money flows to profit opportunities and not to the most
cost-effective forms of health care.
Also, as my American Prospect colleague Paul Starr warns, a mixed system
with a public option effectively invites the most expensive and
hard-to-treat people to opt for the public plan, while private insurers will
seek to insure the young and the healthy. This is a familiar problem known
as adverse selection. The private insurers will then smugly point out that
the public plan is less "efficient," when in fact it simply will have a more
costly population. The only way to avoid this problem is to have everyone in
the same universal plan--what's otherwise known as a single-payer plan.
The public option is a not-very-good second best--because our leading
liberal politicians lack the nerve to embrace the one reform that
simultaneously solves the problem of cost, quality, and universal inclusion.
The policy that dare not speak its name is of course comprehensive national
health insurance, or Medicare-for-All. I try to avoid using the term "single
payer," because a technical, policy-wonk phrase not understood by most
civilians has become insider shorthand for national health insurance. Let's
call the thing by its rightful name. Medicare-for-All is something regular
people understand.
The Times-CBS poll is evidence that this is what more than two Americans in
three really want. Most voters have not followed the nuances of how the
public option in the Obama plan would compete with private insurance. The
poll simply indicates that voters want access to a straight-up,
Medicare-style plan to be available to one and all. In past polls, when
Times-CBS pollsters ask whether people favor national health insurance,
responses generally favor Medicare-for-All by margins of about two-to-one.
In the current debate, liberals find themselves fighting to keep the public
option alive, so that some form of efficient, publicly-run health insurance
will stay in the mix--but knowing that it is embedded in a reform package
that is far more costly and inefficient than it should have been. Instead of
validating the common sense and reformist demands of ordinary Americans and
identifying the insurance, drug, and corporate elites as the obstacles to
real reform, too many of our liberal leaders from President Obama on down
hope to co-opt business elites with a convoluted scheme that undermines the
efficiencies of a comprehensive and universal system. And just wait until it
gets watered down further in order to retain the support of these same
elites. A plan that all of these groups would endorse would not be worth
having.
So what's the matter with our politicians? Why are the people so far ahead
of their elected leaders on this one? One reason, as usual, is money. The
combination of the insurance industry, the drug industry, the American
Medical Association, the hospital lobby--all of whom oppose
Medicare-for-All--represents a huge amount of political spending. It takes a
brave politician to face down all of these industries, even though the
people are on the side of real reform. The AMA's position is especially
shameful, since the professional societies that represent most actual
physicians favor national health insurance.
The second reason that liberal politicians wimp out on single payer is that
the self-styled realists in this debate have decided that Medicare-for-All,
even if it's the first-best system, is too hard politically. But think about
it. Has the administration picked up one Republican vote by supporting the
present system plus a public option? Hardly. The current House leadership
bill, offering a mixed system, with a robust public option, a requirement
that employers provide good insurance or pay a tax, and that insurers not
discriminate against pre-existing conditions, is just as heavy a political
lift as national health insurance--and far inferior policy. So why not just
go for the first-best?
The advocates of Medicare-for-All have become something of an embarrassment
to the liberals. The White House forum on health reform on March 5th, which
boasted a diverse range of viewpoints, including representatives of the
Business Roundtable, the health insurance industry, the drug lobby, as well
as a broad spectrum of business, labor and Congressional leaders, left
advocates of Medicare-for-All banging on the door. None were included,
despite requests for invitations.
When Sen. Bernie Sanders recently arranged for five prominent advocates of
national health insurance to have a courtesy meeting with Senate Finance
Committee Chair Max Baucus, the story was newsworthy because the political
elite usually pretends that this viewpoint doesn't exist, much less that it
represents the desires of two Americans in three. The mainstream media have
also colluded in the general effort to keep the single-payer option out of
the limelight. The organization FAIR recently published an important study
in its heroic magazine, "Extra", titled "Media Blackout on Single-Payer
Healthcare."
Indeed, the Sunday New York Times-CBS poll didn't even offer
Medicare-for-All as a free-standing option. It took the Obama position as
the left edge of the debate.
As for that rogue doctor at the Philadelphia veterans' hospital, quality
control is not what it should be throughout our fragmented system. And the
oases of public medicine are particularly starved for resources. Yet studies
consistently find that on average, the VA does more with less than its
private sector competitors. Phil Longman has written the definitive book on
the subject, "Best Care Anywhere." Here is a summary.
In this case, the offending radiologist, Dr. Gary D. Kao, was actually a
contract employee and not a VA physician.
Only by having a comprehensive system can we marry quality, cost-effective
care, and universal access. One of these days, a national leader will have
the nerve to embrace national health insurance and fight for it. Until then,
we will keep paying more money for less care, and liberals will defend
reforms they themselves scarcely believe in.
Robert Kuttner is co-editor of The American Prospect, and senior fellow at
Demos. His recent book is "Obama's Challenge".
***
VENICE ECO-FEST 2009
Saturday, June 27th, 10:00 AM to 6:00 PM
At Venice Beach
www.veniceecofest.org
Presented by Venice Chamber of Commerce and Earth Day LA
VENICE ECO-FEST 2009
MUSIC AND ARTS ECO-FEST and EXHIBITS
Venice Beach Invites You
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FREE TO THE PUBLIC!
Featuring Green Technology, Eco-Businesses and Services, Great Entertainment
at the Solar Sound Stage, Art Gallery, Eco Booths and Displays, Tasty
Organic Food Delights, an Interactive Children's Court, Bicycle Parade, Fun
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Our purpose at the Venice Eco-Fest is to honor the Earth and all of life,
as well as to:
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