RE: [CHA]Health insurance and us

[Guest guest]

Here is a very good article about the health insurance issue. I hope it

spurs more of us to get involved as to solutions that make sense such as

single payer universal coverage and that this affects all of us regardless

of payment.

 

 

Mike W. Bowser, L Ac

 

 

 

 

 

 

 

June 13, 2005

One Nation, Uninsured

By PAUL KRUGMAN

Harry Truman tried to create a national health insurance system. Public

opinion was initially on his side: Jill Quadagno's book " One Nation,

Uninsured " tells us that in 1945, 75 percent of Americans favored national

health insurance. If Truman had succeeded, universal coverage for everyone,

not just the elderly, would today be an accepted part of the social

contract.

 

But Truman failed. Special interests, especially the American Medical

Association and Southern politicians who feared that national insurance

would lead to racially integrated hospitals, triumphed.

 

Sixty years later, the patchwork system that evolved in the absence of

national health insurance is unraveling. The cost of health care is

exploding, the number of uninsured is growing, and corporations that still

provide employee coverage are groaning under the strain.

 

So the time will soon be ripe for another try at universal coverage. Public

opinion is already favorable: a 2003 Pew poll found that 72 percent of

Americans favored government-guaranteed health insurance for all.

 

But special interests will, once again, stand in the way. And the big debate

among would-be reformers is how to deal with those interests, especially the

insurance companies. These companies played a secondary role in Truman's

failure but have since become a seemingly invincible lobby.

 

Let's ignore those who believe that private medical accounts - basically tax

shelters for the healthy and wealthy - can solve our health care problems

through the magic of the marketplace. The intellectually serious debate is

between those who believe that the government should simply provide basic

health insurance for everyone and those proposing a more complex, indirect

approach that preserves a central role for private health insurance

companies.

 

A system in which the government provides universal health insurance is

often referred to as " single payer, " but I like Ted Kennedy's slogan

" Medicare for all. " It reminds voters that America already has a highly

successful, popular single-payer program, albeit only for the elderly. It

shows that we're talking about government insurance, not government-provided

health care. And it makes it clear that like Medicare (but unlike Canada's

system), a U.S. national health insurance system would allow individuals

with the means and inclination to buy their own medical care.

 

The great advantage of universal, government-provided health insurance is

lower costs. Canada's government-run insurance system has much less

bureaucracy and much lower administrative costs than our largely private

system. Medicare has much lower administrative costs than private insurance.

The reason is that single-payer systems don't devote large resources to

screening out high-risk clients or charging them higher fees. The savings

from a single-payer system would probably exceed $200 billion a year, far

more than the cost of covering all of those now uninsured.

 

Nonetheless, most reform proposals out there - even proposals from liberal

groups like the Century Foundation and the Center for American Progress -

reject a simple single-payer approach. Instead, they call for some

combination of mandates and subsidies to help everyone buy insurance from

private insurers.

 

Some people, not all of them right-wingers, fear that a single-payer system

would hurt innovation. But the main reason these proposals give private

insurers a big role is the belief that the insurers must be appeased.

 

That belief is rooted in recent history. Bill Clinton's health care plan

failed in large part because of a dishonest but devastating lobbying and

advertising campaign financed by the health insurance industry - remember

Harry and Louise? And the lesson many people took from that defeat is that

any future health care proposal must buy off the insurance lobby.

 

But I think that's the wrong lesson. The Clinton plan actually preserved a

big role for private insurers; the industry attacked it all the same. And

the plan's complexity, which was largely a result of attempts to placate

interest groups, made it hard to sell to the public. So I would argue that

good economics is also good politics: reformers will do best with a

straightforward single-payer plan, which offers maximum savings and, unlike

the Clinton plan, can easily be explained.

 

We need to do this one right. If reform fails again, we'll be on the way to

a radically unequal society, in which all but the most affluent Americans

face the constant risk of financial ruin and even premature death because

they can't pay their medical bills.

 

E-mail: krugman

 

Copyright 2005 The New York Times Company