Healthy Healthcare Policy by Dr. Rick Bayer
This fall, voters choose our next leaders. The political lines dividing Democrats and Republicans have never been clearer. Presidential candidates Barack Obama and John McCain present tremendous contrast in policies, including healthcare.
At www.johnmccain.com, it starts out great, “John McCain believes we can and must provide access to health care for every American”. Nevertheless, he has no plan to support this vision.
Senator McCain’s big reform is to end employer-paid healthcare insurance by eliminating the ability of business to deduct the costs. He offers tax credits of $2500 per individual or $5000 per family for persons to purchase private policies on the open market. He fails to regulate private insurers or managed care. And, since average premiums for a family are closer to $12,000 annually, McCain will increase the numbers of uninsured. Those with pre-existing illnesses remain excluded from standard underwriting. Mental health parity laws, like Oregon’s that mandate mental health coverage be equal to physical health coverage, may be overturned.
The only people who benefit from Senator McCain’s plans are health insurance executives and the rich who have insurance plus cash to cover deductibles and co-pays. Even those with insurance are confused, which explains the huge number of medical bankruptcies among the “underinsured”. Lastly, there is a timid promise to meet with governors to work out a solution. If it were that easy, then governors like John Kitzhaber would have solved it for us.
At www.barackobama.com Obama says, “We now face an opportunity—and an obligation—to turn the page on the failed politics of yesterday’s health care debates… My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness”.
Obama will remove pre-existing conditions and require payment for mental conditions just like physical conditions. Some healthcare advocates applaud his promise of access to the same policy choice as Congress. The reality check is that for normal folks, insurance premiums compete with budget items like rent and food.
Obama makes no mention of single payer healthcare success like Medicare. So, he will shrink the gap where Medicare covers the aged and Medicaid covers the young; but the working poor remain left out. Universal care will never happen unless Obama improves his healthcare policy to include single payer healthcare—like Medicare—for everyone.
Years ago, reformers said states were the cauldron to cook up solutions. The Oregon Health Plan was truly innovative, but failed. Others plans are worse. Currently, eyes are on the latest Massachusetts plan that allegedly covers everyone. In the fine print, Massachusetts attempts universal coverage by fining its citizens who do not buy insurance—even if they cannot afford it. Fining citizens who have no money for health care insurance is sadistic. And guess what? Massachusetts’ fourth attempt at universal coverage is not working…again.
It is scandalous to watch other countries provide universal healthcare at a cost far less than Americans pay. This basic business principle to fix our problem is uncomplicated and very American. Affordable universal coverage must remove the middle agent—in this case, the insurer—who removes premium dollars without providing direct patient care.
In other words, we must get the maximum amount of premium dollar to treat sick Americans instead of using premiums for profit. While Medicare devotes about 97% of premiums to healthcare, public for-profit insurers devote about 75% to patient care and use the rest for CEO bonuses and stockholder dividends. Non-profits like the Blues are in between Medicare and private plans but still generate huge administrative waste and monster executive pay packages. Our sad American story is that healthcare executives and stockholders make millions while patients die for lack of care.
Currently, HR 676, sponsored by Representatives Conyers and Kucinich offers Medicare to all Americans but languishes in Congress. Why do no candidates mention HR 676? Because political candidates fear the insurance lobby. Why is Canada’s single-payer so successful? Under intense pressure from citizens, Canadian politicians found the guts to eliminate private healthcare insurance as obstructive to good community health. This way, all Canadians use Canadian Medicare so the rich cannot dump an inferior product on the poor (as we do with American Medicaid). When everyone takes personal ownership, citizens get a better product.
During the campaign, candidates are too frightened to tackle the insurance industry, so don’t expect to hear much about single-payer healthcare. Lobbyists box in McCain. And Obama’s plan is so superior to McCain’s that Obama can sit tight during the elections to avoid the liberal or socialist label.
Strangely, Americans like socialized police and fire departments, highways and bridges, public education, and so forth. But socialized medicine? Like liberal, it has become a pejorative label. Even though Canadian single-payer healthcare is not socialized medicine because it is run like American Medicare with self-employed doctors; Americans are programmed to fear. Politicians capitalize on fear to win elections. Americans strongly support “Medicare for all” in polling. Perhaps after the election, we can return to a “Medicare for all” debate so single-payer health financing can finally command the rational discussion it deserves.
Richard “Rick” Bayer, MD, FACP is board-certified in internal medicine, a Fellow in the American College of Physicians (FACP), practiced, and lives in Oregon.