With a year to go before the presidential election finally silences the debate among candidates over government’s role in healthcare reform, the system flounders. Some small providers of care to poor children won’t survive the protracted legislative wrangling and presidential vetoes over funding for SCHIP. They will have filed for bankruptcy while poor children get sicker.
Another legislative logjam has blocked the Governator’s “Year of Health Care Reform,” which aims to insure all California residents. His $12 billion plan to cover the state’s 6.6 million uninsured is floundering even with an added proposal to use state lottery revenue to fund it. Other states watch as the Democrat-controlled Legislature approved a modest plan to cover only two-thirds of the uninsured. The governor insists on total coverage paid by fees or taxes on employers and hospitals, and now an estimated $2 billion from the lottery. Republicans balk at any new taxes, which could be decided by voters in yet another ballot initiative, in November 2008. Some people can’t wait that long.
Hard-working people can’t make ends meet with health care premiums increasing four times faster than wages. Efforts to reduce costs spawn poor health policy that in the end costs more.
Another state thought its problem was solved in 2005. But small businesses that purchase health insurance for their employees from Blue Cross Blue Shield through a state-subsidized pool called Insure Montana just got a rude shock. Informed that a 32 percent increase was needed to keep benefits at last year’s level, changes were resolved by a 12.6 percent increase and decreased benefits. Renewal notices to 785 businesses note the program’s “premier” plan, used by two-thirds of the 5,500 enrollees, will pay individual deductible increases from $500 to $750 and copays from 20 percent to 25 percent. Plus a $100 per person deductible for prescription drugs. Yikes!
The “standard” plan increases the individual deductible from $1,000 to $1,500 with copays from 30 percent to 40 percent and the prescription drug deductible will double to $200. Note the word individual. Think what this could do to a family with two adults and two children. The copay shares alone could preclude them from taking drugs to control diabetes, asthma and hypertension or even have screenings to detect these problems before conditions become life threatening. Some state employees are encouraged to forego annual checkups as a cost-cutting measure. Economically and morally this makes no sense.
Insure Montana, funded by a $1-per-pack cigarette tax, subsidizes half the policy cost to small businesses and 20 to 90 percent of employees’ premiums. Eligible businesses aren’t locked into the Blue Cross plan, but may choose from eight business association plans. To date, none have done so, but with the steep increases, they may.
Some say more direct government interference is not the answer. That if state legislatures or Congress want to get involved, they should start with tort reform. I would argue that medical malpractice suits are the last resort of patients who have been harmed by poor diagnoses, delayed treatment and general incompetence. Often by providers of health plans to which they pay exorbitant premiums. But HMOs and insurance companies are beholden as much to their shareholders as they are to their patients. Hence the agreements enrollees sign to have disputes settled by arbitration.
Presidential campaigns are funded by donations from insurance companies as well as manufacturers of pharmaceuticals and medical devices including expensive diagnostic scans. Doctors and hospitals feel compelled to use these costly tests to protect themselves from lawsuits. So it would seem that manufacturers have a vested interest in a system that promotes excessive use of their products. Would they spend more money to defeat healthcare reform than to fix it?
Is this why candidates, even Democrats who profess reform, base their proposals on perpetuating insurance-based plans partially subsidized by government? Why are they so quick to deny that their plans even resemble Universal Health Care (branded Socialized Medicine by Republicans) or a single-payer system?
They defend our system as the best in the world even though we spend twice as much per person as Canada, and have poorer life expectancy, higher infant mortality rates and about 47 million people without coverage.
And we buy this because?
Are we so disenchanted with government that we don’t trust them to run anything? Good point. But if we don’t fix the insurance-driven system itself, we will be stuck with its basic flaws well into the next century. Republicans tell us we shouldn’t have to pay higher taxes for anything. Not to fund their ill-conceived wars, not to clean up the environment, not to pay for universal health care. They prefer to lavish tax breaks on those who don’t need them and those who can’t use them because they don’t earn enough to pay for the things they would get tax breaks for. Think health savings accounts.
They jigger the numbers by lowering the poverty line, by cutting Medicare, Medicaid, Veterans Affairs spending, forcing eligible recipients to wait years for services. Isn’t that what they say is wrong with Canada?
Maybe we could all tell the candidate of our choice to brave up and float the kind of reform we need before it’s too late.