Our False Debate on Health Care Reform

"Healthcare is a good, not a right." So says Congressman Ron Paul (R-TX). Needless to say, I completely disagree with his assertion, but I commend him at least for having the chutzpah to declare out loud and proud the true opinion of many opponents of universal health coverage. Like BMWs, iPhones and tickets to the Super Bowl, health insurance, according to these people, is a luxury item intended only for those lucky enough to have steady jobs providing insurance as a benefit, independently wealthy enough to afford insurance in their own right, or over the age of 65 and thus eligible for Medicare. Indeed, the amount of "me" emphasized in our society is at once staggering and shameful.

But perhaps I am being a bit too harsh and presumptuous. Americans are, after all, known for being a generous people; donations to charity are among the highest in this country compared to other developed nations. Few would argue that there should be absolutely no social safety nets whatsoever. Any attempt to privatize or scrap entirely Social Security or Medicare for our senior citizens would rightly be met by nothing short of a revolution. Yet when the subject turns to extending guaranteed health coverage to all Americans, a relatively small but very vocal minority literally shouts down such efforts at reform, and the large majority who support such change, including a robust public option (if not an outright single-payer system), sadly chooses to remain silent. So what gives?

After more than a little reading and reflection on the issue, I have come to the conclusion that the vast majority of reform opponents certainly are not bad or selfish people. They are, though, in my estimation, woefully uninformed and--more troublesomely--willfully ignorant regarding facts that are readily available at their fingertips. With organized conservative interest groups and prominent GOP mouthpieces--Sarah Palin, Newt Gingrich and their king Rush Limbaugh among them--spewing lies and poison regarding the ramifications of a public option, it is of little wonder that certain Americans, rightly nervous about their economic and health security in these challenging times, are easily manipulated into believing them. Contrary to what this trio and their merry band of rogue ideologues would have you believe, under the health care reform currently being considered, Mrs. Palin's parents would be under no threat of euthanasia, and her Down Syndrome-stricken infant would not be deemed unworthy of care due to any pre-judgments of his potential "level of productivity in society." Such blatant falsehoods are not only downright insulting to the American people and their intelligence, but also extremely damaging to efforts at reforming an unsustainable and immoral "system."

Forgive me as I indulge for just a bit in the serious, real-world, grown-up debate on health care. We have all heard seemingly forever about the tens of millions of Americans who have no health insurance; latest estimates say that number is around 47 million and rising. While I would think that the fact that one out of every six Americans lacks coverage would be enough to rally the country around the need for universal affordable coverage, this apparently is not exactly the case. Fine. Forget the poor and unemployed who simply have to hope that they can avoid accidents or serious illness. Instead, let's talk about the vast majority of Americans who ostensibly are perfectly happy with their current private insurance. The question they should be asking is "Will my insurance be there for me if and when I really need it?"

I would be willing to bet that virtually every single one of the younger people we see screaming at these town hall meetings on the evening news has been fortunate enough not to have catastrophic illness wreak havoc on their lives. How do I know this? Because if they had experienced such misfortune, it is likely that their illness would have caused them to lose their jobs--and thus their insurance--or, even if they were able to keep their insurance, they would have been denied the maximum amount possible by their insurance companies (which specialize in finding loopholes designed to maximize profit instead of the well-being of participants in their plans), resulting in large out-of-pocket expenses that often bring victims up to and over the brink of bankruptcy. And, even in those few instances when the insurance companies agree to pay their fair share for some treatments or procedures, they most certainly would dramatically increase the premiums for these patients, either effectively or expressly excluding these new found "risks" from their liability pool.

As for all those seniors yelling at their representatives and senators at these forums, the irony is that they are all eligible for (and probably all taking advantage of and enjoying) Medicare, which is--gasp!--a government-run, single-payer health insurance program for the elderly, a fact that some if not many of them fail to realize. Why don't we take that away and give them a real reason to get loud?

Can we please stop making excuses for this smorgasbord of a health care "system"? The truth is that the for-profit cabal of insurance companies currently holding Americans hostage bears far more resemblance to a "death panel" than the provisions in some of the proposed overhaul bills currently circulating through Congress that would provide completely voluntary counseling on important end-of-life matters (e.g. creating a living will, not advocating euthanasia). Like the rest of corporate America, insurance companies have a singular objective: to maximize profits. The easiest way to do so is to seek to deny coverage to individuals who they know have pre-existing conditions, and to jack up premiums on those who dare to actually need their insurance, often to a point at which they can no longer afford it. In other words, their aim is to insure as many people as possible (resulting in maximum revenues) while avoiding payments for medical costs whenever possible. They could hardly care less about the health and well-being of their customers.

One of the most commonly cited arguments against a public option is that people do not want some "government bureaucrat" playing middleman between them and their doctors. Never mind the fact that this is precisely the role that private insurance companies play today--doctors routinely ask their approval before providing what they believe to be necessary services and treatment to their patients. By contrast, doctors do not encounter anywhere near this much red tape from the government when dealing with patients on Medicare, a fact to which President Obama's own former physician can personally attest. As a government-run system is non-profit by nature, there exists absolutely no incentive to deny necessary coverage to individuals.

In my opinion, the moral imperative to disrupt and dismantle this massive scheme far outweighs any other concerns, including reducing costs. Frankly, if we can find nearly a trillion dollars to spend on a war of choice, then we most certainly can find a way to insure all of our citizens. That being said, I am more than happy to engage on this important issue as well. There is no way around it: health care costs are literally bankrupting this country and its citizens. Half of all bankruptcy filings in the United States are either entirely or partially related to excessive medical expenses. The U.S. spends 17 percent of its annual GDP on health care, amounting to more than $6,000 per capita (even when including the 47 million uninsured), easily the highest such share in the whole world. (No other country, including those that provide universal coverage, spends more than 11 percent.) Granted, some of this is due to the greater amount of research and development that occurs here, but that cannot be used to explain the rapid rise in insurance premiums, which recently has occurred at rates at least double that of inflation. Comprehensive health care reform can slow the acceleration of costs. In fact, the reason the private health care industry is so fiercely fighting against any attempt to reform the system, and particularly to offer a public insurer, is that it knows that competition from the government would force private companies to lower their premiums and be willing to accept a broader range of customers. Moreover, included in efforts to reform health care are sincere proposals to start emphasizing and promoting preventive care and healthful lifestyle choices, which could dramatically reduce long-term costs associated with expensive after-the-fact procedures and medications.

It is downright shameful that the richest nation on Earth still does not possess a health care system that ensures basic care for all of its citizens, especially when virtually all of our developed allies--and at least one less developed adversary--do. Indeed, according to the World Health Organization, the U.S. ranks 37th out of 191 nations in terms of health care outcomes despite its disproportionately high expenditures. It is even more disappointing that those with the power to change the status quo are too afraid of the political consequences of looking abroad to our allies for ideas on how to model a system here in the U.S., even though studies show that residents of these countries are significantly more satisfied with the quality of their basic health care than are Americans. (When Fox News reports this, that really is saying something.) Personally, I am most drawn to a system based on the one currently in place in France--yes, the country that was our very first friend but that we then decided to ridicule for the past eight years and that, incidentally, ranks first on the same WHO survey--which contains a hybrid of public and private insurance. Under this system, around 70 percent of coverage is provided by the government, with the remainder being covered by private insurers, usually available through one's employer. For certain serious illnesses, including diabetes and cancer, the government picks up 100 percent of the tab. Precisely because doctors and patients in France are fiercely defensive of the right to choice and autonomy, there is no government interference in physicians' decision-making or in patients' right to the selection of a doctor. Additionally, unlike in the single-payer systems in existence in Canada and the United Kingdom, there are no waiting lines for various surgeries and procedures (although, to be fair to those countries, waits occur only for some nonessential elective procedures, not for urgent ones). Of course, every country, including France, is running into difficulty dealing with the rising costs of health care, but none is affected to a greater degree than the U.S. precisely because these costs account for nearly one-fifth of its economy. Reform cannot wait any longer.

Regrettably, I am quite worried about the prospects for a meaningful bill being passed this time around. Despite their possession of large majorities in both houses of Congress, more than a few Democrats (most of them the so-called "Blue Dogs") join the Republicans in being bought out by and beholden to the very interests that are rejecting any and all attempts at reform, especially a public option. How any of these Democrats can look Senator Ted Kennedy in the face is beyond me. The scare tactics being used by the GOP and conservative interest groups, which are largely responsible for the destructive behavior at town hall meetings intended to be serious forums on health care policy, may well serve to intimidate others into opposing a bill with a public option as well.

For his part, President Obama cannot afford to treat this August recess as a vacation. His health care plan and the public's understanding of it are on the line. It is imperative that he use his bully pulpit to explain in a cool, calm and firm manner the real implications of reform and the serious costs of inaction. He needs to forcefully dispel the lies about the bills before Congress while reassuring the American people that, even after understanding how the current system operates, they are free to hold on to their private insurance if they so desire. He must remind them that everyone will end up paying a lot more if no serious effort is made to control costs. Privately, he needs to become more hands-on with Democrats on the Hill, making it clear that failure is not an option and that the moment is too great to allow the direction of the political winds to dictate action on this vital issue.

I have said it before and I will say it again: Reform with no robust public option is no reform at all. People's lives are at stake. I hope for the sake of our country that this opportunity does not slip by unused.