Undernews is the online report of the Progressive Review, edited by Sam Smith, who has covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

February 9, 2009


Daniel P. Wiert, MD, Houston Chronicle - A majority of physicians (59 percent) and an even higher proportion of Americans (at least 62 percent) support single payer national health insurance or "Medicare-for-All". In spite of this, virtually all we are hearing about today are mandate plans that would require everyone to buy the same private for-profit insurance that is already failing us. The for-profit insurance companies and their plethora of plans make for a terribly complex, fragmented, costly and inefficient system. Administrative overhead consumes about 31 percent of health care dollars in the United States, and the for-profit insurance companies are responsible for half of this, or 15 percent of $2.4 trillion. This money, more than $350 billion per year, provides no health care: it is consumed by enormous administrative costs, profits for investors and shareholders, and large salaries for managers of these for-profit insurance companies.

All of the incremental reform programs proposed tax subsidies, health savings accounts, individual or employer mandates, increased regulation of for-profit insurance companies keep these proverbial foxes in the henhouse and are doomed to fail to control costs and provide universal access. Competition among the foxes does not benefit the chickens, the patients, the doctors or the hospitals. The for-profit insurance companies fundamentally reduce choice. Your preferred doctor or hospital is "out-of-network"? Too bad, we won't pay, says your insurance company.

Incremental reforms, mostly mandate schemes which retain the for-profit insurance companies, have been tried in seven states over the past two decades: Massachusetts, Tennessee, Washington, Oregon, Minnesota, Vermont, Maine. In all of these states the reforms have failed to contain costs. In all but Massachusetts, they have failed to reduce the number of uninsured. In Massachusetts, there has been a modest decrease in the number of uninsured, falling from 13 percent of adults in 2006 to 7 percent of adults in 2007, but at the cost of a substantial increase in public spending . . . Most of the gain in Massachusetts has come from expanding Medicaid and subsidizing the purchase of private insurance; very few people have signed up for the unsubsidized private insurance. Not to mention that 7 percent uninsured is unacceptably high. Far from controlling costs, these mandate plans will add hundreds of billions of dollars to the nation's health care costs.

The United States spends about twice as much per capita on health care as other industrialized countries. Yet it is a myth that the United States has the best health care in the world. The United States ranks near the bottom of industrialized countries in terms of important morbidity and mortality outcomes (for example, life expectancy and infant and maternal mortality).

About 18,000 American adults die unnecessarily every year due to lack of insurance. As reported in the Archives of Internal Medicine in 2003, repair of an aortic aneurysm cost $8,647 in Canada and $13,432 in the U.S.

What accounted for the substantial difference? Most of the difference was due to much greater overhead costs in the U.S. The surgeons and surgical facilities are top-notch in Canada. The surgeons are very well paid. The difference is that Canada has adopted a true insurance system for financing health care, one that spreads risk across a broad population: a publicly funded single-payer national health insurance plan that eliminates the parasitic, investor-owned "insurance" companies that make profits by enrolling the healthy, screening out the sick and denying claims.

Single-payer national health insurance for financing health care is NOT "socialized medicine."

Under a single-payer, "Medicare-for-All" system, delivery of health care remains private. The providers of health care remain private. Patients choose any doctor and any hospital. . .

We have an American system that works. It's Medicare. It's not perfect, but Americans with Medicare are far happier than those with for-profit insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. And keep in mind that Medicare insures people with the greatest health care needs: people over 65 and the disabled. We should improve and expand Medicare to cover everyone. In contrast to the for-profit insurance companies, Medicare has a very low overhead about 3 percent. . .

A single-payer "Medicare-for-All" system is embodied in a bill currently in the U.S. House of Representatives, H.R. 676, sponsored by U.S. Rep. John Conyers, D-Mich., and cosponsored by 93 other members of Congress.

Its features are: automatic enrollment for everyone; comprehensive services covering all medically necessary care and drugs; free choice of doctor and hospital, who remain independent and negotiate their fees and budgets with a public or nonprofit agency; processing and payment of bills by a public or nonprofit agency; promotion of job growth and the entire U.S. economy by removing the excessive burden of health care costs from businesses; coverage for everyone without spending any more than we are now.


Anonymous Anonymous said...

America's governance is now all about one thing and one thing only: protecting the inequality extremes. Anything that transfers wealth and power upwards is good, anything that spreads the wealth and benefits downward is bad.

The American Dream of Freedom was the dream of freedom from the tyranny of the moneypowers. It was never the dream of being free to become limitlessly rich at the expense of fellow Americans and the health and wealth and sustainability of the entire nation.

Somewhere along the line everybody became a Libertarian schmuck, abandoned the good sense of the founders - and erected the same tyranny they had fled.


February 10, 2009 7:52 AM  
Anonymous Anonymous said...

It was always a good time to realize that the private, for-profit system is the very least efficient vehicle for delivering healthcare to people. Now it is crucial, inescapable, that we cannot afford to have healthcare tied to employment any longer.

Why don't we ever get jiggy with the fact that we can have all the wealth and all the power in the hands of a few or we can have democracy, liberty, freedom, prosperity, fraternity, peace and equality - but we cannot have both???

February 10, 2009 8:51 AM  

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