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Held Hostage by the Health System
The Senate Finance Committee's hearings on health reform earlier this month did not include testimony from any advocate for single-payer insurance. Physicians for a National Health Program, which represents 16,000 doctors, asked the committee to invite me to testify, but it chose not to. If I had been invited, this is what I would have said:
The reason our health system is in such trouble is that it is set up to generate profits, not to provide care. We rely on hundreds of investor-owned insurance companies that profit by refusing coverage to high-risk patients and limiting services to others. They also cream off about 20 percent of the premiums for profits and overhead.
In addition, we provide much of our medical care in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most physicians are paid fee-for-service, which gives them a similar incentive, particularly specialists who receive very high fees for performing expensive tests and procedures. Nonprofits behave much like for-profits, because they must compete with them. In sum, healthcare is directed toward maximizing income, not maximizing health. In economic terms, it's a highly successful industry, but it's a massive drain on the rest of the economy.
The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it - an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments. Initiatives such as electronic records, case management, preventive care, and comparative effectiveness studies may improve care, but the Congressional Budget Office and most health economists agree that they are unlikely to save much money. Promises by for-profit insurers and providers to mend their ways voluntarily are not credible.
Nearly every other advanced country has a largely nonprofit national health system that provides universal and comprehensive care. Expenditures are on average about half as much per person, and health outcomes are generally much better. Moreover, these countries offer more basic services, not fewer. They have on average more doctors and nurses, more hospital beds, longer hospital stays, and there are more doctor visits. But they don't do nearly as many tests and procedures, because there is little financial incentive to do so.
It is often argued that the first order of business should be to expand coverage, and then worry about costs later. But it is essential to deal with both together to stop the drain on the rest of the economy and the further fraying of healthcare. The only way to provide universal and comprehensive coverage and control costs is to adopt a nonprofit single-payer system. Medicare is a single-payer system, with low overhead costs, but it uses the same profit-oriented providers as the private system and also preferentially rewards specialists for tests and procedures. Consequently, its costs are rising almost as rapidly as those in the private sector. Representative John Conyers introduced an excellent bill that calls for extending Medicare to everyone in a nonprofit delivery system. That could be done gradually, by lowering the Medicare age a decade at a time.
A single-payer system is ignored by lawmakers because of the influence of the health industry lobbies. They raise the specter of rationing and long waits for care. There are indeed waits for some elective procedures in some countries with national health systems, such as the United Kingdom. But that's because they spend far less on healthcare than we do. For them, the problem is not the system; it's inadequate funding. For us, it's not the funding; it's the system. We spend more than enough.
I urge you to consider a nonprofit single-payer system. The economic interests of the health industry should not be permitted to hold the rest of the economy hostage and threaten the health and well-being of the public.
- Posted in
28 Comments so far
Show AllSioux Rose
Dr. Angell defines the ONLY sane course, but sanity is not given much value in a nation that's witnessed its leaders bow down at the altar of Mammon, when not offering unlimited fiscal homage to Mars (the MIC).
Imagine the costs of enforcing the current version of legalized extortion, making us all pay? And the ones in the pay pool will have to pony up as the costs just continue to rise as this may well be the next bubble. Just as no viable regulations were in place to keep housing prices from escalating like a hot air balloon until they finally popped, taking thousands (millions?) of persons' equity along for the ride. When it comes to life or death matters, price isn't the first thing that matters to most people. So here we have the next "disaster capitalist" pool with lots of fish about to be swooped up by the vulture capitalists who regard EVERY aspect of life (from the sacred to the profane) as a viable business opportunity. And so long as they grab all the $, they can pay their political and media sycophants to "stay on message" and deliver a program beneficial ONLY to them and their small circle of friends.
No matter the outcome in Iraq, a blood soaked nation, the military is given the moolah to march onto the next nation to "conquer."
No matter the CEO pay-offs and how many trillion in derivatives that have nothing to back them up? The banks are given an embarassment of riches.
No matter the death toll to citizens, the insurers are given seats at the banquet table, assured of their profits against the likely deaths and handicaps of how many thousands?
With priorities like these, the US does not require any outside enemies. The threats are all home-grown! And I didn't even get to the energy corporations, the drug war, the seizing of the media by the rightwing, and so many other travesties that have become other dimensions of the lead story: The Banality of Evil.
Well said! The pilotless weapon we use to kill our enemies is called the Predator and the truth is our elite runs a whole system designed after that weapon. They live in their many homes and gated estates and send their legions of flunkies out to make sure the moolah keeps rolling in on time. The rest of us are nothing but ants to these people. If any of us get in the way were dealt with. Black and White Predator and Prey is how it is in America. U get busy eating others or they eat you.
We have allowed grifters to destroy our industries, including healthcare. That is the fundamental reason for the disappearance of goods and services, which has now become evident to even the middle class. The Labor Committees have been describing this process in great detail for decades, only to have the majority of us call them alarmists and nut cases. Maybe now we will start to listen up.
Promises by for-profit insurers and providers to mend their ways voluntarily are not credible.
Excellent observation and certainly backed up by historical behavior.
But Americans appear to have an amazing capacity to tolerate criminal behavior at the corporate level.
When the people fear their government there is tyranny,
when the government fears the people there is liberty.
~ Thomas Jefferson
The "solutions" proposed at these sham hearings--SLOWING the growth of costs at one and a half percent per year--are not even a Band-Aid on the mess we call the health care system. This a slap in the face to anyone who looks to Obama for anything close to reform.
How many of those hundreds of companies currently in the Health Insurance business think they are going to survive after even token reform? I can easily see the price of a private sector only solution being forced consolidation of the marketplace in order to more easily create larger net profit for the remaining players. I wonder if the smaller players, who are doing their part right now by running advertisements purporting to advertise affordable insurance, but is actually designed to reinforce the concept that private sector solution is working right now, really understand that they may well become sacrificed pawns in this particular chess game?
As a former trial lawyer who has battled giant pharma/insurance defendents countless times, there is so much to discuss about the nature of these bullies that I would have to write a book on it. These bullies can be defeated but there will need to be a lot of cooperation and dedication. As a lifelong victim of being bullied by my evil brother who I found out today posts as "Nebraska Nathan1", and I exposed him in other threads today, I can tell you that it is going to take a lot of skills and can-do attitude to be a successful counter to the bullies.
Our current poster child in the White House is sticking it to us yet again. He failed to heed the advice of the majority of reputable economists in the country and gave the financial barons of Wall Street a slap on the wrist, pawned off a bunch of "toxic" (aka worthless) assets onto the taxpapers while insulating the speculators who created the meltdown.
He hosed the automobile industries. His stimulus plan is a joke, and all the while millions of Americans are losing their jobs and their homes. Now comes the latest seduction, the healthcare ponzi scheme.
No single-payer advocate was allowed at the so-called hearings on revamping the industry (aka strategies for keeping the whole sordid and lucrative system in the hands of the bandits who have been screwing us for a half century) so they can continue to impoverish the most vulnerable among us, all in the name of providing "the best system of healthcare in the world." If that isn't bovine scatology, I don't know what is.
Obama is a member in very good standing of the Insiders Club. He is a ruthless poltician, a consummate liar and gives a good speech. While our economy and society crumbles, he will be feeding us a steady diet of verbal crap from the telepromters always so close at hand.
God help us all!
Sioux
PIOAGAPE: Right on "the money."
I finally got to view "Sicko" last night and Moore did a great job showing the ease with which other civilized nations manage health care for all. It makes as clear as day (by contrast) this nation's blatant immoral disregard for citizens' lives.
It must have been quite an experience for the crew of Moore's "Minnow" to take off for Cuba only to find that the medical complaints of its passengers were handled with generosity and grace by the staff of Havanna Hospital. Makes me want to assemble my own flotilla and head across the Florida straits!
The media does an effective job of using slogans and mantras to confuse American viewers so that they really don't know what better care exists outside our own "iron curtain."
Bravo.
If those who were not sick or at high risk were all to cancel health policies, the insurers would not have the money to lobby.
Why do Senator Backass and Washington DC control the debate on single payer health?
Dr Angell and the Harvard Medical School are in Boston.
John Kerry is on the Senate Finance Committee. Ted Kennedy is the senior senator from Massachusetts and a key senator for health care reform.
Angell and Physicians for a National Health Program can demand a meeting with Kerry and Kennedy.
If they cannot get around Backass and get representstives for single payer health invited to the party, a real health care summit should be held in Boston.
This debate is too important to be left to Washington.
Meetings in Massachusetts and other states should be used to tell Washington what to do.
Obama must listen to the people - states are the only representative bodies that can listen to the people and work for the public interest.
Washington has failed us - Obama may fail us ... We can however regain control through state governments.
The most insidious fraud being perpetrated by Obama and his cohort of corporate liberals is the "public-option" plan. This proposal, although it purports to offer an appealing "public plan" as an alternative to the private insurers, is simply more of the same. Here's why:
The advantage of single-payer is in risk pooling--everyone is in the same pool: well, sick, young, old, sick, and poor, thus averaging out the risks and costs of guaranteeing coverage to everyone. In the "public-option plan," everyone is NOT in the same risk pool, as they would be in single payer. In a "pub-op" plan, the oldest, sickest, and poorest would end up in the public plan--the youngest and healthiest cohort would aggressively marketed by the private HMOs, because that's where the profits are. Hence the whole advantage of single-payer risk pooling would be lost: the whole point is to combine EVERYONE's resources (through taxation rather than private premiums) so that the healthy 80 percent subsidize the unhealthy 20 percent and thus achieve overall cost efficiencies not obtainable if these two groups are in separate pools. In a pub-op plan, the public sector, saddled with the sickest and oldest 20 percent, will incur unmanageable per capita costs and will be made to look unworkable. Moreover, it will have to charge premiums and impose deductibles, just like the private plans. It would be just more of the same, notwithstanding the "public" branding.
This is the sham in the making that is the Stark-Hacker-Obama pub-op plan: game the system so that the public sector founders, thus discrediting the idea of publicly funded health care for another generation. Pub-op is a Trojan Horse for the HMOs--a wolf in sheep's clothing, lipstick on a pig--chose your cliche, but that's what it is. What it is NOT is the real reform the public needs--it's just another scam to keep the private insurers in business--the HMOs Plan B to gull the public into believing that it is getting some kind of "reform."
A publicly funded plan can achieve real cost efficiencies ONLY through true risk pooling--that means EVERYONE IN--everyone in the same pool. That means single-payer Medicare for all. Pub-op is not a step toward single-payer--it's a sham, a step into the abyss.
I've heard this argument before, but I don't agree. Yes, the public option will draw the sicker people. (That's why the insurers accepted Medicare - it took the old people off their hands.) And so the gov't plan will lose money, and the insurers will try to say, "See, we told you gov't can't run anything."
But it's the federal government! It's not Massachusetts. They can tax and borrow to keep the plan going, just as they borrow to keep their military going. And the better care and less hassle people will face in the public option will draw healthier people into it. That's why the insurance companies are going all out to stop the public option.
I totally agree that a National Health Insurance ("single-payer" if you prefer that pretty lame term) plan would be better than Obama's plan. A National Health Service would be even better. But this plan IS a step forward - it will go broke, for the reasons vanmungo gives. But that doesn't matter, because it's the Feds. They've been broke for decades; they just keep borrowing.
You are wrong. The government hasn't been broke for decades. Only since Bush and the DNC copulated with the RNC to begat Geithner, Sumers, Bernake, Milton Friedman clones all.
In 1981 our national debt was about $800 billion. In 1989 it was about 3.2 trillion. That's $12,800 per capita (250 million). In 2001 our national debt was about 5.6 trillion. That's 18,666 per capita (300 million). This does not count Social Security "trust fund" of 2-3 trillion in 2001 and the Medicare disaster. Neither does it include private debt. They always said they never have to pay back the debt, just worry about the interest. I call that broke.
Robert Rubin and Summers were Clinton people and, along with Greenspan, mainly responsible for creating this current mess, but proud of running on debt goes back to, at least, Johnson; maybe Roosevelt or Wilson, and is totally bi-partisan.
You fail to recognize, much less address, the key problems inherent in a hybrid system. First of all, the public plan will have to charge premiums--medical services will not be free, as they are in Medicare now and would be under single-payer medicare for all. So the sickest and the poorest who will be shunted to this plan might not even be able to afford it, even if purchasing insurance is made mandatory; hence it will not achieve universal coverage. Tens of thousands of people will still face penury, untreated illness, and death for lack of coverage. That might sound like a "step forward" for the people who already have a semblance of decent insurance under the current system, but it won't cut it if you're looking chronic illness, poverty, or death in the face. I assume you are not, or you could not in good conscience advocate such a preposterous proposal.
Second, the public part of the hybrid, saddled with the sickest and poorest, will incur far greater costs than the private sector--this will be played to the hilt by the corporate propagandists as an example of the inherent "inefficiency" of government operations. Far from advancing the idea of any government-run operation, this ill-conceived plan will set off an orgy of "I-told-you-so" tongue-clucking among the claque of corporate apologists in the media.
Third, there will not be unlimited funds available to fund this sector. It will have to survive on a pregiven budgetary allotment and premiums. This hybrid public sector will not have the bargaining power needed to reduce drug prices. This public sector will simply fail--the very idea is unworkable; it makes no sense whatsover except as a desperate pretext to keep the private profiteers in the game while offering a token semblance of "reform" that will not be reform at all--nobody who really needs relief from the chaos and expense of the current system will get it--no one.
Fourth, one of the architects of the pub-op plan, Jacob Hacker of Berkeley, has asserted that the hybrid plan will results in an INCREASED market share for private plans. He knows the system will be gamed.
The only reason to get the government in the game is to reduce costs and guarantee coverage through the efficiencies of public, single-payer financing of a privately administered system; the government would collect the revenues for the system and then disburse them as the "single payer." ONLY single-payer can realize these savings. Anything else is flim-flam from corporate sector and their hirelings and votaries in the academy and government.
If you think that there's anything progressive about perpetrating an inherently unworkable fraud on the American people, a fraud that will benefit no one but the big HMOs, then you need to study this more closely or rethink which side of the class divide you're really on.
For a detailed deconstruction of this pub-op sham, see the following:
http://www.pnhp.org/blog/2009/04/09/jacob-hacker-provides-details-for-public-option/
Sioux Rose,
Spoken too well. If...as Kipling wrote.
I don't think that appeals to reason or morality will penetrate these legislators. My rep, Jason Altmire, who has taken $700,000 from health insureance lobbies in the past 4 years snarled at us in a recent town meeting, "It's you people again--every town meeting I go to--I see the same faces over and over again. Well, I'm going to tell you one more time-- you are a minority, you don't represent the district and you are not going to get Single Payer Health Care."
Most legislators would not be so blunt, but Jason feels that he can treat us this way because he percieves that we don't have the political power to topple him. In fact I think he was confrontational to daunt us. Perhaps he is right. Until we do have enough power to at least challenge him in a primary he's not going to listen. Building a political movement strong enough to topple some of these arrogant legislators off their perches is the only way we will get Single Payer. Then instead of appealing and begging--we can tell them what they have to do to stay in office.
Your representative, like most, are not only out of touch but are hell bent on being the toughest kind of political bullies they think they can be. Altmire is obviously very desperate to keep taking money from the insurance lobbyists while feeling that those who voted for him aren't going to give him a farthing but will instead submit and vote for him anyway. This is the kind of bullying that must be confronted. Now would be a great time to start organizing and quietly finding a tough pro single payer opponent to knock him off in the primaries or even take him down in the general election. For right now, we may not be winning the war for Single payer but we sure as hell can first make sure that our bullying reps don't win either. Don't give up the fight for single payer. Political bullies can only go so far.
WPA Single Payers coalition has about a thousand members with about half that number in his district. Is that enough of a base to mount a challenge? Maybe I have cast Altmire in too negative a light. Rather than bullying I think he was expressing exaspiration. "Don't you know how Washington works? Don't you know who you are up against? Don't you know how vulnerable I would be if I supported you in a conservative Democratic district? (If I might read his thoughts.) But on the other hand if we could knock him off-- I think it would send reverberations across the country.
Dear Dr. Angell: If physicians sought out and treated root causes of disease and stopped treating symptoms as if stopping a symptom was the goal of treatment then we might not need to worry so much about health care costs. The AMA is just as guilty as Big Pharma and insurance companies.
It's not just the insurance companies that are milking the system.
Here is another article that expands the theme even more: More Insurance Isn’t Enough: Three Ways to Reform Healthcare
http://thesearethetimesmagazine.com/0905/
Thanks for the link. We are dealing with a monopoly that doesn't want to get off the dole. What this article says about the mental/emotional perspective can be said equally, and scientifically based, about nutritional medicine.
We have to change the system before we further subsidize it. We have to stop medical societies from "punishing" doctors who use "unapproved therapies" even when those therapies work. Then practitioners will feel free to incorporate unauthorized/unapproved methods and they will. Right now, it only takes 1 or 2 doctors in any state to lose a license for using "unapproved methods" and the rest are intimidated.
There's only one possible solution to the constant interference in, and buying off of, our government by special interests, such as the health care industry. LOBBYING our congressional and government personnel in any form from which either party gains a personal benefit must be OUTLAWED and made into a CRIMINAL OFFENSE!
It's the only way to return our country to a "government of the people, by the people, and for the people." Our congressional personnel are currently operating under a distorted belief that they are both the masters and beneficiaries of a "government of the elite, by the elite, and for the elite" (special interests) of which they are, de facto, a part.
Our political leaders are not stupid. They know "you don't bite the hand that feeds you." And they are constantly being fed plenty (in the form of money, privileges, and notoriety by every special interest imaginable, especially the health care industry). When are we going to wake up and DEMAND a return to the government that was fashioned by our founding fathers (who were common people) - a government of the people, by the people and for the people????? It literally disgusts me to see our political leaders (leeches) "orating" on TV, mouthing platitudes that sound good but which they have no intention of following through on.
Creating a third party is NOT the solution. It would be only a matter of time (and probably a very short time) before that third party would be just as dirty as the others.
MAKE LOBBYING A CRIMINAL OFFENSE!!!! (It unfairly robs American Citizens of the right to be treated “equally!”)
If we had a true "health care" system, its primary objective would be to strive to maximize the health of the American people. Instead, we have a system in which its component corporate players have as their primary objective the maximization of profits.
The only function of the "health insurance industry" (health insurance is itself a misnomer)is to provide a payment system that assures the income of the various medical providers as well as taking a substantial cut for itself. And not only do the insurance companies take profit out of the actual health care system, but they have created a highly bureaucratic and inefficient payment system -- one that interferes with the medical decisions of doctors -- that substantially raises the cost of medical care in the U.S.
In addition, because the insurance companies are also financial companies, it exposes the health care system to the same risks that causes the current economic meltdown. That's why a not-for-profit single-payer system (government-run or run by a government-backed entity) funded by taxes is a FIRST STEP to reform.
The only problem in this country is stupidity. There are enough people voting AGAINST their own interests because they are so stupid that they listen to politicians and elect those idiotic used-car-salesmen scam artists instead of civic-minded technocrats. The cure for this - and all the rest of our problems - lies in restricting the vote to ONLY the people who can articulate a credible knowledge of the issues of the day. Idiots need not apply. I am totally AGAINST any more 'voter registration' acts that merely allow idiots who watch TV all day and can't read - or have no sense of logic or reason - to make decisions for the rest of us. Things were much better BEFORE all the voting rights crapola that allows numbskulls to vote for charlatans.
There needs to be a serious TEST before anyone is allowed to vote or we will NEVER have an uncorrupted government. If people who are stupid enough to believe politicians campaign promises are allowed to continue voting - the 'democracy' model - we will never make any progress. Just look at India - the world's largest 'democracy' - where thousands of people commit suicide because living conditions are so dire. That's what you get with 'democracy' - tyranny of the stupid mobs. Same as in Rome.
How do you test wisdom and values? Most of the people who determine our war policies, our economic policies, our human rights practices graduated from Yale, Harvard and such. They would pass a literacy and information test, most of them. The problem is they choose to apply their skills for selfish purposes.
But you are right. We have to get over some of our cheap and frivolous habits in order to make better decisions. We live in a "Brave New World" and have been corrupted by all kinds of SOMA. We need to start seeking information and truth, developing the capacities for compassion and the ability to think for ourselves.
Joe
Here is an issue with no excuses. Even Obama says the stars are aligned for health care reform. (Do you agree, SR?) As half a million people a month have lost jobs and tens of thousands have lost dwellings, health problems and lack of insurance to address them must be burgeoning at this very moment.
Let the leading Democrats vigorously promote a health care bill. Conyers / Kucinich have done the groundwork. Of course I prefer single payer. But OK, if that is not "pragmatic" (as though people dying all over from lack of care is pragmatic) let's say for now some well-designed low cost universally available public insurance alternative.
Then if certain Democrats choose not to support it, they will have an opportunity to get up and explain themselves. If someone wants to filibuster I say BRING IT ON. Let the mendacious crooks get up there and argue for hours against something that the American people desperately want and need.
Joe