America Needs A Healthcare Transplant

Although on the campaign trail, Barack Obama claimed, "if [he] were designing a system form scratch, [he] would probably go ahead with a single-payer system," he has refused to travel in that direction in his quest to reform our badly broken health care system. Even more disheartening, the "public option" compromise seems to have been completely abandoned. The lack of will (or perhaps ideological belief) on the administration's part to pursue a single-payer system is of course disappointing, but maybe not entirely unexpected. But one would think that the Obama administration, which showed an extraordinary ability for political maneuvering during the nearly flawless campaign would have been smart enough not to play the compromise as their opening hand. Obama has dropped the ball, and unless he can resuscitate a swiftly fading legislative proposal, America will continue to pay the price.

Ideological Struggles

The United States remains the only first world, industrial/post-industrial nation that does not recognize healthcare as a basic human right, and does not provide blanket coverage to its citizens. Whatever problems exist within the Canadian/European models, they pale in comparison with the problems inherent in our market-based, commodity system. Yet, again and again, the discourse centers on a "uniquely American" solution, and refuses to acknowledge that in this arena, the United States is far, very far, from being the best in the world. Any healthcare proposal that fails to model itself on the "socialized medicine"adopted by the rest of the world is doomed to failure.

T.R. Reid's upcoming book on international healthcare systems, We're Number 37!, outlines 4 basic models that healthcare systems around the world follow:

• The Beveridge Model - The UK's system for healthcare, in which most hospitals are run by the government, and doctor's are government employees.
• The Bismarck Model - Used in Germany and France, where insurers ("sickness funds") are non-profits, financed by employers and employees through payroll taxes.
• The National Health Insurance Model- Most Americans are familiar with this as the Canadian system, where the hospitals and doctors are run private, but the government acts as the sole insurer.
• The Out of Pocket Model - Found in third world nation's, where those with money get healthcare, and those with no money do not.

Reid points out that the United States contains elements of all four of these systems:

When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

Beyond the problem of America’s millions of uninsured, is the problem of cost. We spend far more in pure dollar amount ($6096 in 2007 dollars), and as a percent of GDP (%16) on health care than any other country in the world. Spending twice as much per capita as the next closest nation (Germany), demands an explanation. Perhaps Americans just visit the doctor twice as much as Germans, but a far more likely explanation lies in the fact that whereas German insurers are non-profits that don’t compete, American insurers advertise, pay stock dividends, rack up corporate profits, and generously compensate their executives. Indeed, a good 30% of US healthcare expenditure is insurer overhead costs. This makes sense logically—if healthcare is treated as a commodity in a market based system, then the goal is obviously to profit from it. If there were no profit from healthcare, there would be no private insurers. And that is exactly the point of the European systems in question. None of them treat healthcare as a good to be profited from, but as a service to be provided to all citizens regardless of their economic status.

The only way to bring down costs is to either eliminate private insurers, or force them to reduce their profit margins. Otherwise we end up even deeper in the hole, with a bill that might extend coverage to millions more, but will ultimately cost us trillions of dollars that we don’t have. Obviously neither of the two aforementioned options are acceptable to insurance companies, so if they acquiesce to whatever bill comes down to a vote in Congress, its obviously not one that will best serve the American people. The harder the insurance companies fight a bill, the better that bill is for all of us not profiting from someone’s sickness and misfortune. This is why the public option is a must-have in lieu of a single-payer system. A public option will force insurers to reduce their profit margins enough to compete with a non-profit government agency providing coverage. If 20-30% of Americans switch from expensive private insurance to be covered under a public plan, then private insurers will have to lower their costs in order to retain and even gain new customers.

This is where we come to…

Political Struggles

The Republicans have had nothing to add to the debate besides screams of “socialized medicine!” that are completely out of touch with what the vast majority of Americans actually want out of a healthcare bill. So let the Republicans complain—we had an election in this country last November, and the American public soundly defeated the conservative platform, which was stridently and vocally opposed to any kind of government solution to our healthcare ailments. This debate is no longer about the Republicans, unless Democrats once again wallow in a pit of bipartisanship and make concession after concession to a party that is growing increasingly irrelevant.

In fact, Republican opposition is really the least of our worries. Centrist and Blue Dog Democrats are where the real problem lies, with senators like Ben Nelson who proclaimed the public option a deal breaker because it might not allow private companies to compete. Earth to Senator Nelson—this isn’t about companies competing, it’s about fixing a broken system that is costing us money and lives.

The Obama administration should have anticipated this waffling from the less-Democratic wing of the Democratic Party, and should have opened with a single-payer proposal. Then the Blue Dogs could have barked and yelped their way down to a public option. But now, if the center manages to have their way, healthcare reform will become healthcare massive fail, and Obama will take the heat in the next election. And more importantly, one of the most pressing problems we have will once again not be fixed.

More to come next week on what Canadians and Europeans actually think of their health care systems…

Bookmark this on Delicious