Ending Private Insurers' Chokehold on Health Care

For once, I agree with Republicans on health care reform. We should scrap it all and start over. Thursday's encounter between the two parties was good talking-point theater but awfully runny with repeats of the past year's parroting of a "government takeover of health care" and other dim-witted fabrications. (Don't talk to me about a government takeover of health care when the biggest fort you're defending is Medicare.) Instead of acting like the grown-up majority they are, Democrats, led by their chief appeaser, deferred to a minority of cranks and shills, each one of them better insured than most of us, as if the Republic's future depends on them. It doesn't. Quite the contrary.

The Republican minority, by its calculated prevention of progress on any issue of importance since March -- health care, jobs, taxes, global warming -- is ensuring that America's appointment with has-been status will be moved up a few decades, to China's delight. Democrats are complicit. So go ahead. Make the Republicans' day, and scrap it all.

But scrapping the Democrats' proposal isn't enough. A few details aside, even the best of the Democrats' idea of reform is not significantly different from what's in place now, which is to say that it isn't that different from the do-nothing approach Republicans favor. It builds on an existing system dominated by private insurers whose twin goals are to cover as few of the sick as possible while making as much money as possible when covering the healthy. That's not an insurance system. It's a predatory swindle. And it's certainly not a health care system.

Care isn't defined by what you can afford, but by what you need. Anything short of that is health care's equivalent of segregation, which is what we have now. Sure, some of the best care in the world is in the United States. But aside from the elderly, who have it all, most of us are barred from it. We're either slaves to insurers' orders or priced out of the swindle altogether, as some 50 million Americans are.

I'd be all for reforming the system by building on what works. We know what does. Build on Medicare, goddess of 45 million Americans. That works. Insurance for all, universal choice of providers, no interference between govern- ment and doctors, cheapest overhead, and no permission required for any procedure from some pinhead adjuster in a call center who doesn't know care from crap. Instead, by deferring to the private insurance industry, what we've done so far is attempt to build on what kills. It hasn't been working. Why should it work any better by subsidizing it with tax dollars?

The problem isn't "socialized medicine." That doesn't even exist in France or Germany, two countries with far better health systems than the United States. The problem isn't defensive medicine either, or rich doctors, or Taj Mahal hospitals.

The problem is the for-profit insurance industry. A system designed first and last to make money is posing as a guardian and underwriter of care. The two are fundamentally incompatible in principle. A patient's needs should never depend on an adjuster's rules as opposed to a doctor's judgments. Yet they do every day. The same people who claim to fear government interfering with their care seem to have no problem with those adjusters denying them care. That's where ignorance meets ideology.

If relying on private insurers to arbitrate care is incompatible in principle, it's even more so in economic terms. Why should 20 cents of every health care dollar I spend line the pocket of a shareholder or sustain the redundant bureaucracies of hundreds of insurance companies when hundreds of billions of dollars a year could be saved by eliminating profits and redundancies? That's what government insurance does. And no, Medicare fraud, salacious stories aside, doesn't come near the cost of private-insurance frauds, swindles and the immeasurable cost in dollars and dignity of care denied. It's fraud every time a private insurer drops an individual who gets sick. It's a swindle every time a private insurer denies coverage for a procedure recommended by a doctor, since that insurer is still pocketing premiums.

Health care is more than a right. It's an entitlement. What should be mandatory isn't for every American to carry insurance, but to have every opportunity to access the best care possible without risk of bankruptcy, without making choices between care and other necessities, without submitting to an insurer's actuarial lotteries. That's how civilized nations treat their citizens. The elderly aside, it's not how America treats its own. The best care in the world means nothing when it's leashed by the worst private-insurance system in the world. That system doesn't bear reforming. It bears eliminating. Until then, mark your calendar for that appointment with the America formerly known as a great nation.