A single-payer system would be best
A few months ago, I wrote in this column that the country needs to decide whether health care is a universal right, or whether it is a vehicle for providing profit to the insurance industries. As I have observed the not-so-pretty political process leading to this week’s Senate finance committee vote, I have become increasingly convinced that this is the decision before us. Now, as the House and Senate work to reconcile their own committee bills and develop one bill to become law, it is time for the rubber to hit the road.
Ultimately, if health care is about providing access to medical care for all Americans, the most effective and cheapest option will be a single-payer, publicly funded option. Oh yes, I know that one looks expensive on the books, but that is because nobody can predict how much actual costs will come down once insurance companies have to compete with the public option. But in comparing our system (or lack thereof) with those of other countries’, it is clear that those costs, particularly the bureaucratic overhead generated by our Byzantine insurance market, will come down dramatically, just as they have everywhere else (in some cases, as low as 2 percent compared to our 20-30 percent).
If we are not to have a public option this year, as seems likely, we could still protect American’s access to health care by mandating that health insurance companies become nonprofit. This is akin to the model that Switzerland adopted—and Switzerland is also a conservative country that faced strong opposition to its health care overhaul. The system enjoys widespread support even from previous opponents.
A nonprofit model would still allow insurance companies to stay in business and even to make a profit. But because nonprofits don’t have shareholders and must demonstrate that they provide a public good, they do not have the incentive to drive up short-term profits on behalf of shareholders by adopting practices such as denying coverage to “risky” patients at the expense of their clients.
Any bill that does not provide one or both of these provisions is a statement that the goal of health care in America will continue to be profit for insurance companies.
Meanwhile, a recent poll conducted by the Las Vegas Review-Journal indicates that while Nevadans are united (92 percent) in believing that some kind of reform must occur, there are deep, partisan divisions about what that reform should look like. Reflecting the power of unsubstantiated conservative claims to shape public opinion, slightly fewer than 50 percent of Nevadans believe that health care reform will raise their taxes and that it will cut Medicare programs (not just waste). Only 25 percent of my neighbors in this state support the idea of a public plan. Oh well, so much for that popularity contest I was hoping to win. At least 43 percent do support Obama’s plan, although what comes out of congressional deliberations may have only passing resemblance to the principles Obama stated in his address to the nation.
And, I have to admit that I do agree with one point raised by the more rational conservative critiques of the congressional plans—they do not do enough to control the costs of drugs and health insurance overhead. Mandating that health insurance companies go nonprofit might help to solve part of that. But drug price fixing is forbidden by George W. Bush’s 2005 health care law—so if we want to take on controlling drug costs, we’ll need to repeal that first. And how ironic is it that our friends on the right, after waving the free-market flag all these years, argue that we should be doing more to curtail the free market—capping drug prices and reducing insurance profit? Almost as ironic as the argument that our current manifestation of socialized medicine, also known as Medicare, needs to remain fully intact.