By Phil Mattera,
Corporate Research Project
February 26, 2007
Healthcare reform is in the air.
Ideas for dealing with the 46 million Americans without medical insurance seem to be popping up faster than new cases of the winter flu. President Bush proposes to use tax deductions to help people buy individual plans. California Governor Arnold Schwarzenegger wants to make it mandatory for everyone in his state to obtain insurance and would force employers who don't provide coverage to pay into a fund.
Democratic Presidential candidate John Edwards would raise taxes on the affluent to pay for subsidies to help those with low incomes obtain policies. Some members of Congress are promoting insurance purchasing pools for small businesses. An odd bedfellows coalition including the Business Roundtable, AARP, the Service Employees International Union and Wal-Mart is pushing for some kind of expansion of coverage but is not saying what form it should take.
What these varied plans have in common is the assumption that, at least for the foreseeable future, most of the working population (and their dependents) will continue to receive coverage through private insurance carriers. Public officials across the political spectrum are, in effect, seeking to expand the customer base for a highly profitable industry.
Surely, it is a good thing to provide coverage to the uninsured, but it is remarkable that almost everyone assumes that coverage has to come from for-profit (or, in some cases, private non-profit) providers. Despite the overwhelming evidence from other industrial countries -- and even domestic programs such as Medicare -- that government-run health plans are much more efficient, the U.S. political class seems to be on a mission to save private insurance.
A Paternalistic Reform?
To understand the current debate, it is helpful to recall some of the tortured history of health insurance in the United States. In the late 19th Century European countries began adopting government-funded social insurance plans, but the U.S. failed to follow suit. When progressives made a push in the 1910s there was opposition not only from corporate interests but also from organized labor. AFL President Samuel Gompers denounced national health insurance as a paternalistic reform, fearing that its adoption would weaken the role of unions in improving the living conditions of workers.
Consequently, Americans both rich and poor continued to pay the vast majority of medical costs out of pocket. That began to change in the 1930s. While the Roosevelt Administration focused on retirement benefits and unemployment insurance at the expense of health coverage, physicians and hospitals struggling to survive the Depression set up private group insurance plans to bolster demand for their services. The most successful of these were the non-profit multi-hospital plans that grew under the rubric of Blue Cross. These were later followed by Blue Shield plans, which covered outpatient physician services. Once the Blues paved the way, commercial insurers also entered the field, though their coverage tended to be more restricted.
After the end of World War II, there was great momentum toward expanding the portion of the population with some form of sickness insurance. In 1945 President Harry Truman proposed a national program establishing a right to medical care and protection from the "economic fears" of illness. But once again, opposition to government involvement in healthcare emerged, this time reinforced by a Cold War hysteria about "socialized medicine" stoked by groups such as the American Medical Association.
As Truman's plan went down to defeat, what grew in its place was a system of employer-provided coverage, stimulated by aggressive bargaining on the part of unions that had come to regard improving employee benefits as a mission as important as increasing wages. This put pressure on non-union employers to follow suit, and by the mid-1950s, about two-thirds of the country was getting coverage through either their own jobs or those of spouses or parents. The Blues, which held the largest share of this booming market in the early postwar period, began to fall behind the commercial carriers by the late 1950s.
Around that same time, there was growing concern about the large number of retired workers who were left out of this workplace-oriented system. This eventually led to the 1965 creation of the federal Medicare program for seniors, along with the federal-state Medicaid program for the poor, but most of those with insurance continued to get it from the private sector.
In the wake of these significant expansions of coverage, liberals renewed calls for comprehensive
national health insurance. These efforts, however, were drowned out by a rising chorus of concern about escalating health costs -- a problem that was greatly exacerbated by the growth of for-profit hospital chains. During the 1980s, Congress created a cost-control system for Medicare, while growing numbers of employers transferred their workers from traditional plans into health maintenance organizations (HMOs) -- both non-profit and for-profit. The Clinton Administration tried to reach the goal of universal coverage through a complex system that preserved the role of HMOs and other private insurers, but it was crushed by business interests and the medical establishment.
Awash In cash
The failure once again to create a system of universal care left the American people at the mercy of the market. The ranks of the uninsured swelled as many employers solved their health finance problems by eliminating coverage or by shifting premium and co-payment costs to workers to such an extent that they opted out. Many of those who tried to obtain individual coverage found themselves priced out of the market or rejected because of a pre-existing condition. Those workers who retained workplace coverage increasingly had to confront HMOs and other purveyors of "managed care," whose business plan depended on restricting the use of medical services. A 1994 Wall Street Journal article stated: "Health maintenance organizations are all about penny pinching, yet they are so awash in cash that they don't know what to do with it all."
At the forefront of these service (non)providers was U.S. Healthcare, which grew out of the first for-profit HMOs in the 1970s. By the early 1990s, it was the largest publicly traded HMO, with annual revenues of more than $1 billion. The company -- a notorious proponent of gag clauses in physician contracts that prevented doctors from giving patients a thorough description of their treatment options -- took on the mission of revolutionizing the insurance industry. In a 1992 interview with Business Week , U.S. Healthcare founder and chairman Leonard Abramson expressed scorn for traditional carriers, calling them "dinosaurs" and saying they operated in "a dying world."
Four years later, U.S. Healthcare agreed to be acquired by one of those dinosaurs, Aetna Inc., for $9 billion. It was clear from the start that Aetna was going to be adopting the style of U.S. Healthcare and not vice versa. "Strong forms of managed care, gated managed care, is really coming into its own," said Aetna chief executive Ronald Compton, who also announced that Abramson would join the board of the parent company.
Aetna's marriage with U.S. Healthcare was part of a larger consolidation of the industry and a shrinkage of the non-profit portion. Aetna itself went on to acquire healthcare operations from New York Life and Prudential Insurance, while rivals such as United Healthcare (later UnitedHealth Group) also bought various competitors to rise rapidly in the field. For-profit hospital chains such as Columbia-HCA gobbled up insurers. Even the Blues were abandoning all pretenses that their main mission was to serve the community. Some set up their own HMO subsidiaries, and by the late 1990s a bunch were preparing to take the next step: abandoning their non-profit status and becoming for-profit enterprises. A few such as Anthem Inc., formerly Blue Cross and Blue Shield of Indiana, went yet further, becoming publicly traded companies.
Meanwhile, there was a growing effort to tame HMOs through the courts. In 1999 several of the country's leading trial lawyers announced plans to bring a wave of racketeering lawsuits to pressure companies to provide better coverage. Some physician groups also sued managed-care firms over restrictions on their members. The legal assault was counting on the fact that HMOs had become the most reviled industry in the United States, but the judiciary was a harder sell.
In 2002 a federal judge in Miami hearing the consolidated cases granted class-action status to claims that managed-care plans systematically denied and delayed payments to more than 600,000 doctors, but he rejected that status on behalf of some 145 million members of the plans. Five companies ended up paying nearly $650 million in settlements with the doctors and their lawyers, while two others (including UnitedHealth) went to court and had the charges against them dismissed.
What ails private insurance
These lawsuits may have shaken the industry somewhat, but they did not put an end to the abuses that characterize managed care. Here are some of the key remaining issues that surround the business:
Consolidation has continued unabated. There are now two superproviders that increasingly dominate the for-profit healthcare field. One is UnitedHealth, which capped a long series of acquisitions with the 2005 purchase of Pacificare for some $8 billion. In 2006 United's health services revenues reached an astounding $64 billion, and its medical enrollment rose to about 28 million individuals.
The other giant is Wellpoint Inc., created through the blockbuster 2004 merger of Anthem Inc. and Wellpoint Health Network, formerly Blue Cross of California. Wellpoint later spent $6.5 billion to acquire WellChoice, the publicly traded parent of New York's Empire Blue Cross Blue Shield. By 2006 Wellpoint controlled the Blues in 14 states, had some 34 million members and took in annual revenues of about $52 billion.
The second tier consists of Aetna (2006 revenues and members, respectively: $25 billion and 15 million), Humana ($21 billion and 11 million), Cigna ($16 billion and 9 million) and Health Net ($13 billion and 7 million). The non-profit wing of the industry also has big players, led by Kaiser Permanente with 8.6 million members.
There is no evidence that the consolidation has enhanced efficiency or improved the quality of coverage. Instead, the big carriers simply accumulate more power over healthcare providers and patients, using it to their own advantage.
While millions remain uninsured or underinsured, the industry's profits swell. Last year, the top six health insurance companies had combined profits of more than $10 billion. What's amazing is that they netted so much after spending prodigious amounts on marketing and administration. In 2006 Wellpoint alone burned up nearly $9 billion in such costs -- nearly one quarter of what it paid out in actual benefits. By contrast, in Canada's government-run single-payer system, administration accounts for only about 3 percent of total costs.
Legal controversies continue to plague the industry. Lawsuits over the denial of care are still being filed against the big insurers. For example, two hospitals in Queens, NY recently sued UnitedHealth, alleging a "pattern of racketeering activity." At the same time, UnitedHealth has been the subject of a federal investigation following reports last year that the company was routinely backdating stock options awarded to executives, especially long-time chief executive William McGuire, who -- on top of annual salary and bonuses totaling $10 million -- had accumulated some 29 million shares through option awards. Thanks to the backdating scheme, McGuire had racked up paper gains of more than $1 billion on those shares. In October McGuire was forced to resign and to give up an undisclosed portion of those gains.
McGuire's excesses are emblematic of the fundamental conflict in the industry -- the clash between maximizing gains for executives and shareholders, and the need of its customers for services that are often a matter of life and death. Public officials should abandon the mission of saving commercial insurance and devote themselves instead to creating a healthcare system that substitutes the public interest for private profit.
Philip Mattera heads the Corporate Research Project, an affiliate of Good Jobs First. (c) 2007 Independent Media Institute. All rights reserved.
View this story online at: http://www.alternet.org/story/48371/
February 27, 2007
Diane Archer is the founder and past president of the Medicare Rights Center. She is an attorney and a national expert on Medicare.
The health insurance industry is full of surprises, but history and experience show that insurers will never surprise us with a good, affordable health care system for America. No cocktail of regulations, subsidies and tax credits will provide health security to the uninsured, underinsured and anxiously insured—virtually all Americans.
Two dirty little secrets about the insurance industry reveal why offering Americans a publicly administered alternative like Medicare is the only way to guarantee Americans good, affordable health care:
Dirty Little Secret #1: If for-profit insurers were forced to provide good health care coverage to all Americans, they would still try as hard as possible to avoid insuring the people with the costliest conditions and charge premiums even higher than they currently charge.
That’s why Medicare was established. The health insurance industry was either unwilling or unable to offer affordable coverage to half of America’s seniors. It’s too costly for them. So, to rein in costs and ensure every older adult had coverage, the federal government offered the coverage directly.
As predicted, Massachusetts is now seeing that requiring insurers to cover everyone in the state costs almost twice as much as projected. The way to reduce costs is not to eliminate benefits as some are suggesting , it is to eliminate insurance industry waste.
Dirty Little Secret #2: Eliminating insurance industry waste in our health care system—administrative waste and excessive prices—would cut our health care costs substantially.
Check out the health insurance systems in France, Germany and Japan. They spend half as much as we on health care and deliver better results by relying on a publicly administered integrated health care system that pools risk and negotiates rates on behalf of their entire citizenry. (To learn more, read Sager and Socolar, Durable Health Care for all Will Require Cost Conrol.)
Right here in the U.S., Medicare demonstrates that we can eliminate some 17 percent in administrative expenses alone through a publicly administered system. Medicare also shows the power of large group purchasing to achieve substantially lower health care prices; Medicare pays about 15 percent less than private insurers for the same services.
Unlike private insurance, Medicare works for older and disabled Americans because it pools risk and does not punish people financially because they need costly health care services. It works because it has predictable benefits and offers reliable coverage. And it works because coverage is automatic, unlike Medicaid and SCHIP, ensuring all eligible persons coverage and protecting them against the risk of losing coverage for failing to sign up or recertify.
Of course, every health policy expert out there knows that a publicly administered system would guarantee all Americans good, affordable health care at far less cost than we can ever achieve through private insurers, and they’ll say so at the dinner table. It’s time they went public.
The truth about the health insurance industry should be at the heart of the public debate, not the short-sighted and misguided calculus of what people think is feasible. While they keep silent, an ever-growing number of Americans are pushed into bankruptcy because of a medical need or, worse still, forced to forego necessary care. And employers who offer good coverage to their workforce see their ability to compete in the global marketplace, and their profits, eroding.
It would be un-American to force Americans to give up their private insurance coverage if they like it or to undo a multi-trillion dollar insurance industry in one fell swoop. But, it is inhumane and unconscionable to offer solutions that we know will not work and wish this health care crisis away, while tens of millions of Americans suffer. That’s why recent polls show that an overwhelming majority of Americans—including white, middle-class Republican men—favor health care reform that gives them the option of a publicly administered health plan as an alternative to private insurance.
That’s the route offered by Yale Professor Jacob Hacker in his Health Care for America plan: let the private insurers continue as they will for anyone who wants their coverage but force them to compete with a publicly administered plan that pools risk, negotiates rates and guarantees affordable coverage to the tens of millions of Americans who elect it. Through this American solution, we could rein in costs and ensure that everyone in the country has good affordable health care.
This is also what former Senator Edwards has proposed. In exchange for paying your fair premium share, you get coverage, choice of doctors and hospitals, reliable benefits at an affordable price and, if you would prefer, you can buy private insurance to cover your care. It makes so much sense.
So here’s a call to arms for a publicly administered health care plan for America. Join the action. Email Jeff Cruz at email@example.com and visit www.ourfuture.org
By Mary Otto
Washington Post Staff Writer
Wednesday, February 28, 2007; Page B01
Twelve-year-old Deamonte Driver died of a toothache Sunday.
A routine, $80 tooth extraction might have saved him.
Deamonte Driver, sitting next to his mother, Alyce, shows the scars
from incisions for his brain surgery. (By Linda Davidson -- The
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren't so hard to find.
If his mother hadn't been focused on getting a dentist for his brother,
who had six rotted teeth.
By the time Deamonte's own aching tooth got any attention, the bacteria
from the abscess had spread to his brain, doctors said. After two
operations and more than six weeks of hospital care, the Prince George's
County boy died.
Deamonte's death and the ultimate cost of his care, which could total
more than $250,000, underscore an often-overlooked concern in the debate
over universal health coverage: dental care.
Some poor children have no dental coverage at all. Others travel three
hours to find a dentist willing to take Medicaid patients and accept the
incumbent paperwork. And some, including Deamonte's brother, get in for
a tooth cleaning but have trouble securing an oral surgeon to fix deeper
In spite of efforts to change the system, fewer than one in three
children in Maryland's Medicaid program received any dental service at
all in 2005, the latest year for which figures are available from the
federal Centers for Medicare and Medicaid Services.
The figures were worse elsewhere in the region. In the District, 29.3
percent got treatment, and in Virginia, 24.3 percent were treated,
although all three jurisdictions say they have done a better job
reaching children in recent years.
"I certainly hope the state agencies responsible for making sure these
children have dental care take note so that Deamonte didn't die in
vain," said Laurie Norris, a lawyer for the Baltimore-based Public
Justice Center who tried to help the Driver family. "They know there is
a problem, and they have not devoted adequate resources to solving it."
Maryland officials emphasize that the delivery of basic care has
improved greatly since 1997, when the state instituted a managed care
program, and 1998, when legislation that provided more money and set
standards for access to dental care for poor children was enacted.
About 900 of the state's 5,500 dentists accept Medicaid patients, said
Arthur Fridley, last year's president of the Maryland State Dental
Association. Referring patients to specialists can be particularly
Fewer than 16 percent of Maryland's Medicaid children received
restorative services -- such as filling cavities -- in 2005, the most
recent year for which figures are available.
For families such as the Drivers, the systemic problems are often
compounded by personal obstacles: lack of transportation, bouts of
homelessness and erratic telephone and mail service.
The Driver children have never received routine dental attention, said
their mother, Alyce Driver. The bakery, construction and home
health-care jobs she has held have not provided insurance. The
children's Medicaid coverage had temporarily lapsed at the time Deamonte
was hospitalized. And even with Medicaid's promise of dental care, the
problem, she said, was finding it.
When Deamonte got sick, his mother had not realized that his tooth had
been bothering him. Instead, she was focusing on his younger brother,
10-year-old DaShawn, who "complains about his teeth all the time," she
DaShawn saw a dentist a couple of years ago, but the dentist
discontinued the treatments, she said, after the boy squirmed too much
in the chair. Then the family went through a crisis and spent some time
in an Adelphi homeless shelter. From there, three of Driver's sons went
to stay with their grandparents in a two-bedroom mobile home in
By September, several of DaShawn's teeth had become abscessed. Driver
began making calls about the boy's coverage but grew frustrated. She
turned to Norris, who was working with homeless families in Prince
Norris and her staff also ran into barriers: They said they made more
than two dozen calls before reaching an official at the Driver family's
Medicaid provider and a state supervising nurse who helped them find a
On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth,
took an X-ray and referred him to an oral surgeon. But the surgeon could
not see him until Nov. 21, and that would be only for a consultation.
Driver said she learned that DaShawn would need six teeth extracted and
made an appointment for the earliest date available: Jan. 16.
But she had to cancel after learning Jan. 8 that the children had lost
their Medicaid coverage a month earlier. She suspects that the paperwork
to confirm their eligibility was mailed to the shelter in Adelphi, where
they no longer live.
It was on Jan. 11 that Deamonte came home from school complaining of a
headache. At Southern Maryland Hospital Center, his mother said, he got
medicine for a headache, sinusitis and a dental abscess. But the next
day, he was much sicker.
Eventually, he was rushed to Children's Hospital, where he underwent
emergency brain surgery. He began to have seizures and had a second
operation. The problem tooth was extracted.
After more than two weeks of care at Children's Hospital, the Clinton
seventh-grader began undergoing six weeks of additional medical
treatment as well as physical and occupational therapy at another
hospital. He seemed to be mending slowly, doing math problems and
enjoying visits with his brothers and teachers from his school, the
Foundation School in Largo.
On Saturday, their last day together, Deamonte refused to eat but
otherwise appeared happy, his mother said. They played cards and watched
a show on television, lying together in his hospital bed. But after she
left him that evening, he called her.
"Make sure you pray before you go to sleep," he told her.
The next morning at about 6, she got another call, this time from the
boy's grandmother. Deamonte was unresponsive. She rushed back to the
"When I got there, my baby was gone," recounted his mother.
She said doctors are still not sure what happened to her son. His death
certificate listed two conditions associated with brain infections:
"meningoencephalitis" and "subdural empyema."
In spite of such modern innovations as the fluoridation of drinking
water, tooth decay is still the single most common childhood disease
nationwide, five times as common as asthma, experts say. Poor children
are more than twice as likely to have cavities as their more affluent
peers, research shows, but far less likely to get treatment.
Serious and costly medical consequences are "not uncommon," said Norman
Tinanoff, chief of pediatric dentistry at the University of Maryland
Dental School in Baltimore. For instance, Deamonte's bill for two weeks
at Children's alone was expected to be between $200,000 and $250,000.
The federal government requires states to provide oral health services
to children through Medicaid programs, but the shortage of dentists who
will treat indigent patients remains a major barrier to care, according
to the National Conference of State Legislatures.
Access is worst in rural areas, where some families travel hours for
dental care, Tinanoff said. In the Maryland General Assembly this year,
lawmakers are considering a bill that would set aside $2 million a year
for the next three years to expand public clinics where dental care
remains a rarity for the poor.
Providing such access, Tinanoff and others said, eventually pays for
itself, sparing children the pain and expense of a medical crisis.
Reimbursement rates for dentists remain low nationally, although
Maryland, Virginia and the District have increased their rates in recent
Dentists also cite administrative frustrations dealing with the
Medicaid bureaucracy and the difficulties of serving poor, often
transient patients, a study by the state legislatures conference found.
"Whatever we've got is broke," Fridley said. "It has nothing to do with
access to care for these children."
Ohio Attorney General Jim Petro has certified our petition to get the Health Care For All Ohioans Act on the ballot, opening the door for us to start collecting signatures. Click to see full text of the Petition. For a handy guide to the most important provisions of the Petition, click INDEX. For commentary that clarifies and expands upon the Act's funding formula, click FUNDING FORMULA.
New York Times, March 5, 2007
By ROBERT PEAR
SALISBURY, N.C. — Vicki H. Readling vividly remembers the start of 2006.
“Everybody was saying, ‘Happy new year,’ ” Ms. Readling recalled. “But I remember going straight to bed and lying down scared to death because I knew that at that very minute, after midnight, I was without insurance. I was kissing away a bad year of cancer. But I was getting ready to open up to a door of hell.”
Ms. Readling, a 50-year-old real estate agent, is one of nearly 47 million people in America with no health insurance.
Increasingly, the problem affects middle-class people like Ms. Readling, who said she made about $60,000 last year. As an independent contractor, like many real estate agents, Ms. Readling does not receive health benefits from an employer. She tried to buy a policy in the individual insurance market, but — having had cancer — could not obtain coverage, except at a price exceeding $27,000 a year, which was more than she could pay.
“I don’t know which was worse, being told that I had cancer or finding that I could not get insurance,” Ms. Readling (pronounced RED-ling) said in an interview in her office, near the tree-lined streets and stately old homes of this city in the Piedmont region of North Carolina.It is well known that the ranks of the uninsured have been swelling; federal figures show an increase of 6.8 million since 2000.
But the surprise is that the uninsured are not necessarily the poor, the unemployed and the undocumented. Solidly middle-class people like Ms. Readling are one of the fastest growing subgroups.
And that is one reason, according to a recent New York Times/CBS News poll, that the problems of the uninsured have jumped to the top of the domestic political agenda in Washington and on the campaign trail.
Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker.
Ms. Readling’s experience is typical; people who have had serious illnesses often have difficulty obtaining insurance. If coverage is available, the premiums are often more than they can afford.While the government does not have an official definition of “middle class,” one commonly used point of reference is the median household income, which was $46,326 in 2005.
Katherine Swartz, a professor of health policy and economics at Harvard, said the soaring cost of health care was a major reason for the increase in the number of uninsured. She said it also reflected long-term changes in the economy, like the decline in manufacturing jobs and the growth in the share of workers in service industries and small businesses, which are less likely to provide health benefits.
Moreover, Ms. Swartz said, “Companies have become more aggressive in hiring people as temporary or contract workers with no fringe benefits.”
The National Association of Realtors says 28 percent of its 1.3 million members are without health insurance.
“Because real estate agents are independent contractors, they are forced into the individual insurance market, where there is no negotiating or leverage,” said Pat V. Combs, president of the association.
As an independent contractor with a Century 21 real estate brokerage, Ms. Readling had bought insurance on her own, a temporary extension of coverage from a prior job. But she was unable to renew it after she had surgery for breast cancer in 2005. Most insurers would not offer her coverage, she said, and one carrier quoted a price of $2,300 a month for coverage with a deductible of $5,000 a year.
Concerns about health insurance permeate her life.
To save money, Ms. Readling said, she defers visits to the doctor and stretches out her cancer medication, which costs her about $300 a month. She takes the tiny pills three or four times a week, rather than seven days a week as prescribed.
“I really try to stay away from the doctor because I am so scared of what everything will cost,” said Ms. Readling, who is divorced and has twin 18-year-old sons. Before every doctor’s visit and test, she asks, “How much are you going to charge me?” She says she tries to arrange “the best deals I can.” But in many cases, the price is still unaffordable, and “I have to do without.”
Even those with insurance have reason to be concerned, economists say, because they end up paying for the uninsured in various ways. Some of the costs are also passed on to taxpayers and employers. To help cover the cost of treating the uninsured, hospitals often increase charges to other patients. Insurers then increase premiums for companies that provide health benefits, and they in turn shift some costs to employees.
Ms. Readling is engaged to be married in June, to another real estate agent. But she said she may postpone the wedding because she would not want her husband to be legally responsible for her medical bills.
“I am scared to get married because I don’t have insurance,” Ms. Readling said. “If I have to go to the hospital and I can’t pay my hospital bills, what happens? Do they go after him? Can they take your home?”
To collect unpaid medical bills, health care providers often obtain judgments against a patient’s spouse, as well as the patient, and file liens against their homes. Ms. Readling says she does not own a house, but her fiancé does.
The idea of universal coverage, in the form proposed by President Bill Clinton, proved politically untenable. Since the Clinton plan collapsed in 1994, the politics of health care have changed because of the steady rise in health costs, the increase in the number of uninsured and the erosion of employer-sponsored insurance. Politicians are once again speaking about universal coverage as a goal, though opinion polls show that many voters still oppose the idea of a government-run health care system.
Ms. Readling said it was stressful enough visiting doctors every few months for her cancer follow-ups. Without coverage, she said, the experience is even more stressful.
“When you go to any medical person and they ask for your insurance card, you are so ashamed because you have to say, ‘I don’t have insurance,’ ” Ms. Readling said. “You just feel like you are dirt.”
Ms. Readling said she often woke up at night, terrified of the cost of getting sick without insurance.
“Anything that goes wrong with my health could destroy me financially,” Ms. Readling said. “I could be ruined.”
She said she had never voluntarily allowed her insurance to lapse and could not understand why she was being blackballed.
“What did I do wrong?” Ms. Read-ling asked. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”
Knowing her health benefits from her prior job would expire in January 2006, she began shopping for a new policy in May 2005. But in June 2005, she learned she had cancer.“At that point,” Ms. Readling said, “I called everybody I could think of, begging for help. But no insurer would touch me.
”Barbara Morales Burke, the chief deputy insurance commissioner of North Carolina, said state law did not guarantee the availability of health insurance for individuals. “Most insurers decline to issue policies to those individuals whom they deem to be too risky because of their medical history,” Ms. Morales Burke said.
Blue Cross and Blue Shield of North Carolina will sell to anyone, regardless of the person’s medical condition, she added, but the premiums may be very high for people who have had serious illnesses.
Heidi Deja, a spokeswoman for Blue Cross and Blue Shield of North Carolina, said, “Rates are based on the anticipated cost of providing care.” For people who have had serious illnesses, she said, monthly premiums “can run into the thousands of dollars.”
A 1996 federal law limited the ability of insurers to discriminate against people because of pre-existing conditions. But consumer protections are much more extensive in the group health insurance market.
“In the individual market, the federal protections provide precious little help to people seeking coverage,” said Karen L. Pollitz, a research professor at the Georgetown University Health Policy Institute.
When Ms. Readling was shopping for insurance, she found two responses particularly galling. One insurer, she said, suggested she return to her prior job, at a furniture company, so she could participate in its group health plan, though she loved her work as a real estate agent. Another insurer suggested she remarry her former husband to get back on his insurance plan.
Working with her doctors, Ms. Readling raced to get as many tests as possible before her coverage expired. She recalled her anxiety in the final months: “It’s like a freight train coming at you, and it’s going to get you. And there was nothing I could do.”
Ms. Readling said she was mystified by the inability of real estate agents to band together and buy health insurance as a group.
“Why can’t Realtors in North Carolina, or a few counties, have coverage under one umbrella?” she asked. “You would think that some insurance company would want our business.”
Janet S. Trautwein, executive vice president of the National Association of Health Underwriters, which represents insurance agents and brokers, said employee groups were more attractive to insurers for several reasons.
“In a group health plan,” Ms. Trautwein said, “the employer typically pays a large share of the premium, so most employees sign up as soon as they are eligible, regardless of their health status.”
“The health plan covers a mix of sick and healthy workers,” she said. “By contrast, individuals and independent contractors are more likely to defer coverage until they need it, so the pool of people insured is, over all, less healthy. Sick people consume more health care. As a result, the cost to insure them is higher.”
Though satisfied with her care, Ms. Readling continually wonders if doctors and nurses treat her differently because she is uninsured.
“Are they going to turn their nose up at you because you don’t have insurance?” Ms. Readling asked. “Will they take care of other people first? They can make more money on patients with insurance. What am I? I am just a financial loss to them.”
Even Republicans acknowledge it's ravages, but what's the best way to slay the beast?
By David Moberg
IN THESE TIMES
March 7, 2007
Like the creature from the Black Lagoon, the health insurance monster has returned, creeping back onto the public stage. After President Clinton's jury-rigged pen to contain the monster collapsed in 1994, it never really went away. Political leaders tried to ignore the beast or deal piecemeal with its ravages, but it pushed more unsuspecting civilians into the uninsured pit, devoured more family budgets, squeezed even giant corporations' ability to compete globally, and raised fear and insecurity among the populace.
Now its depredations have become too loathsome to ignore for even cautious politicians and business executives -- who still are inclined to see the monster as one of their own. After a rebuff in the fall elections, when voters ranked health care as one of their top concerns, President Bush offered a plan that almost certainly would not deliver his promise of "quality, affordable health care for all Americans."
Recently, chief executives like Lee Scott of Wal-Mart -- under attack for its skimpy health insurance coverage of employees -- and Steve Burd of Safeway -- which endured a long strike by southern California grocery workers to cut their health insurance -- joined progressive leaders like Service Employees Industrial Union (SEIU) President Andy Stern, head of the nation's largest health workers union, to call for major changes in the health care system. Under fire from both other labor unions and many citizen health care groups for joining with strange bedfellows on behalf of very broad principles, Stern argues that "the most essential change is to get everyone in a system where they have health care," then work to improve it.
Although the war in Iraq is likely to dominate the already energetic Democratic presidential primary race, health care is emerging as the leading domestic issue in both parties. Shortly after announcing his candidacy, John Edwards laid out a comprehensive health care plan. Barack Obama said that the nation should provide universal insurance coverage by the end of the next president's term, though so far he has mostly advocated for minor and politically easy reforms, like computerizing health records. Republican candidate Mitt Romney signed a flawed plan for universal health care when he was governor of Massachusetts, and California Gov. Arnold Schwarzenegger, after vetoing statewide single-payer legislation passed last year, has his own health insurance plan.
There's reason for hope when leaders across the political spectrum recognize the problem. But there's no guarantee that such agreement will lead to a good solution. For more than a decade, conventional wisdom has dictated that only incremental steps should be taken. Now more politicians are willing to consider bolder steps -- but the right is still determined to push its agenda. And many progressive reformers are cautious about pursuing their ideals, as they continue to nurse scars from the fight business interests waged against the Clinton plan.
"Overwhelmingly, people are trying to find incremental responses instead of a national response," says Marilyn Clement, national coordinator of Healthcare-NOW, a coalition advocating a public insurance program as the single payer of health care bills. "They are still putting forward the same proposals as last summer, such as 'The first step is to get national health care for children.' Well, that's good, but we won the election. It's time to escalate our hopes."
The first crucial step is to define the problem. For many people, it's the rising number of Americans without health insurance, now nearly 47 million. But equally problematic is the decline in quality and scope of coverage for those who have insurance. And much of the public ranks the cost of health care as their top medical and economic concern. Focusing primarily on insuring everyone won't necessarily solve those problems. Indeed, the skyrocketing cost of health care is the main reason that the ranks of the uninsured continue to grow. Faced with rising insurance premiums, businesses have been trying to cut costs by evading responsibility for providing health insurance, leading Stern to declare that "the employer-based health care system is dead."
But the more fundamental problem is our reliance on private, for-profit corporations to provide health insurance -- the real monster in this saga. They're the main reason for rising costs (making health insurance in the United States about twice as expensive as in most industrial countries), for the growing number of uninsured, and for the inferior health results for the average American. In 2004, the United States spent $6,100 per capita on health care, compared to $2,250 per capita on average by the countries in the Organization for Economic Cooperation and Development, which have national health insurance programs. Because public expenditures cover 60 percent of American health care costs, U.S. taxpayers are paying more than the cost of national health insurance, but not receiving it.
"How much can a new system depend on private insurance companies to provide affordable, good health care for everyone?" asks Roger Hickey, co-director of Campaign for America's Future, a Washington, D.C.-based progressive advocacy group. "That should be the debate."
Now the country is faced with two radically different proposals for reform. The first, pushed by conservatives and embraced by Bush in his new plans, would make individuals more responsible for buying their own health insurance. While giving them tax breaks to help pay the premiums, it would push them in the direction of lower-cost, less comprehensive plans (partly by taxing employer-provided insurance as income). As part of this strategy, conservatives have also undermined Medicare, first, by subsidizing private insurance companies to provide Medicare insurance and, second, by establishing a prescription program only available through private insurers.
The Bush strategy would be a boon for wealthy and healthy individuals, as well as employers and insurance companies, but it would ultimately leave most Americans paying more for less health security. The harsh edges of the plan could be softened -- by regulating the insurance companies' attempts to charge more or deny coverage to people seeking insurance, or by offering tax credits or direct subsidies to the poor instead of tax deductions. But these changes still embody what economist Jared Bernstein, of the progressive think tank the Economic Policy Institute, calls YOYO ("You're On Your Own") economics.
The diametrically opposite alternative is to recognize that "we're in this together" (WITT, in Bernstein's schema) and move towards social insurance, or a plan like Medicare. In this case, the federal government -- through a public agency -- would provide comprehensive insurance. It would be financed directly by progressive taxes on individuals and business, unlike the current system, which provides $200 billion a year in economically regressive and largely unrecognized tax deductions to subsidize employer-based health insurance. The public insurance agency would then bargain with health care providers, drug companies and others to control prices and improve quality of care.
The Bush YOYO strategy assumes that when health care consumers -- otherwise known as patients -- confront costs of medical care, they'll consume less, and overall medical costs will go down. But Americans already spend more out-of-pocket on health care and use doctors and hospitals less than citizens of almost every other industrialized country. Yet, while the overall health cost in the United States is much higher, the outcomes -- by virtually every measure of health -- are worse. U.S. health care costs more mainly because of private insurance: Overhead at insurance companies runs close to 20 percent of total revenues, compared to less than 4 percent for Medicare. When the extra administrative costs imposed on providers are counted, the overall overhead that private insurance imposes on the system eats up about one-third of what Americans spend on health care. Eliminating those costs, as proposed by Rep. John Conyers (D-Mich.) and supported by Ohio Rep. and Democratic presidential candidate Dennis Kucinich, could finance most of a Medicare expansion to cover all Americans much more comprehensively than the program does now.
MOST PROGRESSIVE REFORMERS acknowledge that Medicare for everyone would best slay the health crisis monster, but many strategists worry that trying to eliminate the private insurers will provoke a withering counterattack. Consequently, many current proposals try, as Hillary Clinton did in 1993, to preserve a more regulated role for the insurance companies and at the same time expand public programs, on the model of Medicare, to provide a competitive alternative to private insurers.
Edwards' plan would require employers to cover employees or help pay for their insurance (what's widely known as "pay or play"). Everyone would have to buy insurance, taking advantage of tax credits, expanded programs such as Medicaid and the State Children's Health Insurance Program, or new regional "health markets" that would provide a choice of competitive private plans and a public plan. Along the same lines, but with a simpler design and more robust public component, Yale political scientist Jacob Hacker proposes that everyone not in Medicare be covered either by insurance at work or a public insurance pool, including both regulated private plans and a Medicare-like plan.
Both these proposals move in the direction of Medicare for all, but strike a compromise with the existing system, losing the potential for better efficiency and more equity in the bargain. Why not push for universal Medicare (aka, a "single payer" plan)? Proponents of compromises say Medicare for all is a political non-starter. Americans, they argue, are suspicious of government, like choices and often like the private insurance they already have. And besides, they say, the insurance industry -- along with most business interests and political conservatives -- would launch a scorched earth campaign against such a proposal.
"There are a lot of dedicated, smart people who have made the judgment that taking some steps toward a comprehensive system with a public health care plan is better than waiting for the perfect system," says Hickey, whose organization supports Hacker's proposal. The labor movement, which was divided over support of a single-payer system in the '90s, seems even more cautious now. "The political will isn't there now, but it could get there for single-payer," says AFL-CIO health care lobbyist JoAnn Volk. A close union ally adds, "Most of the labor movement has already accommodated to the reality that we're not going to get a pure single-payer system. They have made the judgment that it's just not within the range of possibility."
SEIU's Stern -- who has argued that the United States needs an "American" plan, and not a foreign model like Canada's single-payer system -- says, "First we should create [a health care system] in which everyone is covered, then we can figure out how to rationalize it. It will cost more money than if we did it the other way [i.e, pursing the best alternative], but I think we have more chance of getting it done. The perfect cannot be the enemy of the good."
ALTHOUGH A SMALL but rebounding movement for some form of Medicare-for-all exists, some progressive groups that would be its natural partisans are reluctant to commit themselves to a specific plan. William McNary, president of USAction, a national group of statewide citizen organizations, notes that many of their allies are splintering over proposals. "Things are fracturing," he says, "it would be best for us to line up behind principles," and not a plan. Jim Dean, chairman of Democracy for America, a liberal movement within the Democratic Party, thinks the United States is ripe for universal health care, but worries about both infighting over the best plan and the specter of corporate attacks. He wonders, "Can we figure out a way to talk about this so as not to get bogged down, sway, with "Harry and Louise" commercials [that the insurance industry used against President Clinton's plan]?"
But there's no guarantee that insurance companies won't launch a war against these compromises, especially any that curtail insurance industry profits. And corporations that support universal health insurance will almost certainly oppose any plan that doesn't seriously reduce their financial responsibility, which would threaten to shift costs to individuals. "Everyone says they're for universal health care," says Don Bechler, chair of the California Universal Health Care Organizing Project. "But the fundamental question is, 'Who pays?' Is [universal health care going to be] a sliding scale health care plan where everyone is entitled to first class health care, or a flat tax to sell junk insurance?"
When Clinton tried to finesse such political opposition by making insurance companies central to his plan, he suffered merciless attacks. No plan worth having will win without a massive grassroots organizing and education campaign. And Medicare for all is the one most likely to do so, while simultaneously strengthening progressives politically.
The American people are at least open to the argument. In a 2003 Washington Post poll, one of the few to pose alternatives fairly, 62 percent of respondents said they would prefer a universal health insurance program like Medicare, run by the government, to the current health insurance program. And support for the Medicare program remained nearly as high even if it limited the choice of doctors or led to waiting lists for non-emergency procedures.
Eventually, Medicare-for-all advocates might have to settle for a compromise. But the opportunity for major change in the health care system doesn't come around very often. Since any change will require a massive effort, why not fight for the best?
This article is permanently archived at: http://www.inthesetimes.com/main/article/3059/
David Moberg, a senior editor of In These Times, has been on the staff of the magazine since it began publishing. Before joining In These Times, he completed his work for a Ph.D. in anthropology at the University of Chicago and worked for Newsweek. Recently he has received fellowships from the John D. and Catherine T. MacArthur Foundation and the Nation Institute for research on the new global economy.
When it comes to genuine reform of the health care system, a band-aid solution won't do.
StarTribune / Minneapolis-St.Paul, Minnesota
March 14, 2007
The universal health insurance plan introduced last week by Healthy Minnesota (a coalition of providers, legislators and insurers) is nothing more than a band-aid on a system in need of a much bigger fix.
It promises universal access to health care by requiring all Minnesotans to "own" health insurance (called individual mandate).
On the surface, it may look good, momentarily, to claim that Minnesota has a universal health care plan, but without underlying repair of our overly complex and outrageously expensive health care system, the satisfaction won't last long.
Healthy Minnesota's proposal is similar to the universal-health-care-by-individual-mandate plan passed in Massachusetts last year. This is somewhat surprising, since the Massachusetts plan is already failing in its promise to make "affordable" health insurance available to all.
We need repair of the broken system to achieve universal health care. It's that simple, and it's that hard. Band-aid solutions are "politically possible." Genuine reform, which replaces our fragmented, failed system of multiple private insurers with a single payer and one single plan for all, is considered "politically impossible." But it is what we need to do.
It is not un-American to suggest that we work together to solve the health care crisis. It is a huge social and economic problem that affects each and every one of us. Eighty-six percent of Minnesota physicians believe "it is the responsibility of society, through the government, to ensure that everyone has access to good medical care."
We can't expect the private market to solve this problem: Entrusting it to manage health care just fractures the system and drives up cost. We need to work together on this one, and the only institution that represents all of us is government.
We don't want to waste any more time or money on band-aid solutions. We are ready for real reform: single-payer with universal coverage.
Lisa Nilles, M.D., of Minneapolis, is a graduate student in theology and a member of Physicians for a National Health Program.
©2007 Star Tribune. All rights reserved.
March 27, 2007
Political Players and Single Payer
By CORPORATE CRIME REPORTER
In most of the world, it is a corporate crime to sell private health insurance.
That's because most countries insure their citizens as a matter of right.
Private insurers dilute the public pool.
One nation, one payer.
Medicare for all.
Everybody in, nobody out.
No bills from the doctor.
No bills from the hospital.
No in network.
No out of network.
No corporate profits.
No threat of bankruptcy from health bills.
Health insurance will be the number one domestic political issue in the USA in 2008.
Polls indicate that the majority of the American people want single payer.
But who will deliver?
On Saturday, the Center for American Progress Action Fund and Service Employees International Union (SEIU) sponsored a forum in Las Vegas for presidential candidates to discuss health care.
No Republicans accepted.
Seven Democrats accepted.
All the candidates at the forum agreed that universal health care was the goal. (Even the Business Roundtable and the insurance industry now say they want "universal health care.")
But only one--Congressman Dennis Kucinich (D-Ohio)--accepts the only answer that will work--single payer.
Medicare for all.
The rest--including Barack Obama, Hillary Clinton, Chris Dodd, Bill Richardson, Mike Gravel, and John Edwards--want some mixture of public and private health insurance.
They know this public/private mix won't work--the healthy wealthy will buy private insurance, the sick poor will sign on with the government--and the government program will be crippled.
But they don't have the guts to stand up to the private insurance industry and say--get out.
Kucinich has introduced single payer legislation (HR 676) in Congress that would make it unlawful to sell private health insurance for benefits that are medically necessary.
Last week, we entered the belly of the beast--the American Health Insurance Plans (AHIP) 2007 National Policy Forum at the Capital Hilton in Washington, D.C.
AHIP is the trade association for the companies that will be sacked if single payer becomes law.
We walked into a session titled--Coverage for All Americans: Putting Access at the Top of the National Agenda.
The session was moderated by AHIP President Karen Ignagni.
Not once during the 90-minute session was single payer mentioned.
Universal coverage, yes.
Single payer, no.
But during the discussion, the geography of nowhere was laid out.
On one side, Ron Pollack, executive director of Families USA had teamed up with AHIP's Ignagni.
On the other, Bill Novelli, CEO of AARP and John Catsellani, president of the Business Roundtable.
AARP and the Business Roundtable have joined with SEIU to form something called Divided We Fail.
Divided We Fail is a corporate liberal answer to single payer.
All Americans should have access to affordable quality health care.
All Americans should have peace of mind about their future long-term financial security.
Families USA and AHIP do a separate dance but mouth similar platitudes.
But both Divided We Fail and Families USA/AHIP dismiss single payer as unworkable.
On the single payer side is Kucinich, about 60 members of the House of Representatives, the California Nurses Association, Physicians for a National Health Program, and Health Care Now.
Kucinich is now the single payer champion.
The problem with Kucinich, of course, is that if he doesn't get the nomination, he will take the stage at the Democratic Convention in 2008 in Denver--as he did in 2004 in Boston--raise the hand of the corporate nominee and endorse the corporate platform.
Then where will we be?
Corporate Crime Reporter is located in Washington, DC. They can be reached through their website.
By Robin Podolsky | bio
Again, thanks to Jon for bringing us together into this conversation and for laying out the contours of the problem so succinctly. It’s sobering, isn’t it, to realize how well his description of early 20th Century conditions corresponds to our own situation?
As a staff member for a state senator who is both the author of SB 840, California’s pending single payer legislation, and the Chair of the State Senate Health Committee and, therefore, obligated to work with all due speed for whatever useful reforms can be crafted, I appreciate Jon’s call for healthcare advocates to work in several time frames at once. But I would invert his concerns. While we don’t want to make the perfect the enemy of the good, neither do we want the incremental to be the strangling death of the remedial.
It’s almost once a week that I hear some variation of the ‘single payer won’t pass so why bother’ argument—and the assumptions behind it are more than a little disquieting.
From all sides of the debate, I hear the following question: “What makes you think we can achieve single payer when Big Insurance opposes it?” After all these years, I’m hardly naïve about the role of money and lobbying in the legislative process. Law, sausages, yada. But are we actually willing to concede the boundaries of healthcare policy to a business interest that currently guards its profit margin by seeking to strip health coverage from sick people? (Lisa Girion; Los Angeles Times: Sep 17, 2006; February 16, 2007; March 22, 2007)
First of all, Jon’s right—-single payer makes sense. If we look at a study by the Lewin Group, an independent medical cost/benefit analysis firm (numbers available at www.sen.ca.gov/kuehl), we see that, if we remove the artificial middle-man (private insurance) and marshal California’s purchasing power to negotiate bulk rates for prescription drugs and durable medical equipment, we really can insure every Californian with comprehensive coverage, save some money in the short run and control costs in the long run.
So the question becomes, “Just because this is supposed to be a representative democracy, what makes you think we can achieve a common sense solution if a powerful interest opposes it?” If the answer is, ‘we can’t,’ then why are we even torturing ourselves with this dialogue?
In fact, in large part because of the grass roots support it continues to gain (as well as Senator Kuehl’s acumen in moving it through), SB 840 has emerged as the bill that wouldn’t die. This is the third two-year version that the Senator has introduced, and each year, as the bill stays in front of the llegislature and its varied constituencies, it garners more legislative co-authors and a diverse range of endorsers who run from labor to business to nurses and doctors, along with local governments. As other options are raised and defeated (a pay-or-play employer mandate, for instance, was rejected at the polls), and the discussion of concrete solutions continues, single payer is beginning to stand out, in the Capitol building and among advocates, as the Gold Standard to which we are advancing.
Also, as Joe Paduda argues, this isn’t exactly a case of Big Business vs. the Little Guy. This is Big Insurance vs. everybody else. Single payer would save money for almost all businesses that now pay for health coverage benefits, and it would level the playing field for everybody else. As one of our main advocates, John Hughes, President of Rhythm and Hues, points out, California’s entertainment industry is having a hard time competing with those of other industrialized nations (that offer universal coverage)for many reasons, not the least of which is the cost of insuring top level employees. Small business owners, for their part, are healthcare consumers too, with families and health problems of their own. They don’t appreciate being forced to go without insurance or pay whatever a monopolized industry can extract for substandard plans.
To make a more general point: automatic cynicism is as idealistic as reflexive optimism. Batting away any hope for positive change is like refusing to hear bad news—-both reflexes demand a rejection of factual evidence. In truth, change is protracted, difficult and imperfect; and it is possible. Or we wouldn’t have Social Security at all, or, for that matter, universal suffrage.
Last year, California history was made when both houses of the legislature passed this bill. The Governor vetoed it, but he too has acknowledged the need to make healthcare reform a key priority. While, as of this writing, the Governor has not found a sponsor for his own ideas for reform, which combine old ideas, such as individual mandate and pay-or-play for businesses, his own stated goals only make SB 840 look more attractive: affordability, shared responsibility and preventive care/wellness. Single payer answers those needs and realizes two more principles: a mandate for quality care and genuine consumer choice.
Which brings me to my final point of the day. I don’t agree, Jon, that single payer would wipe out “American-style competition” or freedom of choice. If we were all insured, all healthcare providers would be competing for our business. And we would have more personal freedom to make decisions about whether to start businesses, go to school, get pregnant or change neighborhoods, because our insurance would follow us.
Which brings me to my final point of the day. I don’t agree, Jon, that single payer would wipe out “American-style competition” or freedom of choice. If we were all insured, all healthcare providers would be competing for our business. And we would have more personal freedom to make decisions about whether to start businesses, go to school, get pregnant or change neighborhoods, because our insurance would follow us.
by Sol Littman
Ever since my wife and I chose to leave Canada and settle in Tucson, we have been amazed and angered by the distortions and misrepresentations in the American media of Canada's government-funded, one-payer medical system. Among them is the recent op-ed article in the Arizona Daily Star by Dr. Jane M. Orient.
For most of my adult life, I worked as a journalist in Canada and took full advantage of Canada's health-care system. My wife, daughter and grandchildren were free to choose their own primary doctors and specialists. Service was consistently kindly, prompt and concerned. If something serious was suspected, we were tested, X-rayed and examined in a matter of days. Our physicians were highly trained and the hospital facilities modem and pleasant.
Thirty years ago, I had my gall bladder removed and had to spend three or four days in hospital. When I was discharged, I was presented with the bill — a total of $5.50 for the use of the television set in my semi-private room. The Ontario Hospital Insurance Plan paid the rest.
It is important for Americans to know that people in Canada tend to live a couple of years longer than their U.S. counterparts and that Canada's infant mortality rate is lower. This is attributed to the fact that everyone — young, old, working or unemployed — is covered for basic hospital and medical care in Canada without co-insurance or deductibles. This is in contrast to the United States, where there are more uninsured people (over 40 million) than Canadian inhabitants.
American critics of Canada's health care are quick to cite the fact that there are lengthy waiting lists for non-emergency medical procedures. It is also true that there is considerable overcrowding in some hospitals, but this is due to the fact that emergencies are treated immediately even if it means a lineup of gurneys in the hospital corridor — a situation I have found exists in American emergency wards as well.
The Canadian system does not rely on private insurance companies. The system is run by 10 provinces and two territories. They pay the bills and set the rules.
Medicare, which services the American elderly, is the closest approximation to the Canadian one-payer system, but there are important differences.
In the United States, the government pays the bills but private insurance companies that are more wasteful than the government run the system. In addition, some of our American health-care dollars go to make the insurance companies rich and play no role in actual health care.
The waiting times for some procedures are longer in Canada than in the United States, but this problem is being actively tackled by the government in the wake of a Canada Supreme Court decision that "access to a waiting list is not access to health care." However, the decision did not abolish the one-payer system — in fact, it reinforced it by giving the Quebec government, which was the chief object of the lawsuit, 12 months to remedy the situation.
As a result, Quebec is working hard to catch up with the rest of Canada. The average wait for a hip replacement has been reduced to four to five weeks, and knee replacements usually take six to seven weeks. This may still be too long, but if you happen to be one of the 40 million uninsured Americans, you might have to wait forever.
Why have my wife and I chosen to spend our retirement years in Tucson? We did, in fact, worry about leaving behind our Canadian health care, but climate, the availability of year-round golf and relatively good health persuaded us to take the chance.
We have found medical services in Tucson excellent, but expensive and complicated. We don't like being at the mercy of an HMO and have yet to decipher the ins and outs of the new drug plan. We continue to long for the simplicity and efficiency of Canada's single-payer system.
Sol Littman is a former Canadian journalist living in Tucson with his wife, Mildred.
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