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A Prescription For True Reform

If you are like me, you have become both very bored and hugely disgusted with the current health care debate. Day after day we witness newscasters interviewing our leaders in Washington who continue to lie through their teeth about how hard they are working to bring health care reform to millions of uninsured and underinsured people.

The truth is that their agenda is totally political and not designed to fix the broken health care system. The Republicans just want Obama to fail and by stonewalling him on health care reform they think they can do that. They have used deliberate lies and misinformation to create doubts and fears about what will happen if health care reform passes. However, even with all their attempts to spread confusion and fear, they haven’t fooled a majority of the American people who still want meaningful health care reform that includes a public option.

Then there are members of both parties who are heavily subsidized by the insurance, pharmaceutical and health care industries and get their marching orders from lobbyists who are spending over $1.4 million a day to keep any meaningful reform from happening. They also use deliberate misinformation to shoot down even compromise suggestions such as a public option, saying it will force hospitals to close and the insurance industry to go bankrupt. Again, for what it is worth, a majority of the American people doesn’t seem to be buying these lies and half-truths, even though our representatives continue to mouth them.

The Betrayal of The American People

We elected a President whose mandate was to change Washington “politics as usual.” However, even before the debate began, Obama declared that the single payer plan was “off the table” for discussion. What? This is arguably the best way to fix the broken health care system and we can’t even discuss it? I thought he came to Washington to bring us “Change We Can Believe In.”  The only change these people are interested in seems to be the large chunk of change they are receiving from lobbyists and special interest groups that lines their pockets.           

How much money did health care lobbyists have to contribute to Obama’s election campaign and have to continue to offer him to get him to nix arguably the best solution to the problem?  As a result, Obama continues to give just lip service to compromises such as the public option and when pressed on the issue says that the public option isn’t even essential to health care reform. Without the single payer or the public option, whatever reform bill passes Congress and Obama signs will amount to just a huge give-away to the insurance, health care and pharmaceutical industries. 

It won’t be health care reform for the people who need it. It will be all about profits and very little about the promised reform. Sure they can point to eliminating pre-existing conditions, but no one mentions how much your insurance will cost you if you have a pre-existing condition.

The media outlets all owned by corporate America have conspired to spin this issue to drive up profits and ratings. Instead of doing the honest investigative reporting needed to expose the lies that are being told, they are busy creating an “us vs. them” drama between the various factions.

The Failed Grass-Roots Strategy

The grass-roots strategy has been to appeal to the consciences of our leaders by showing them how broken our health care system is and how it is creating endless personal and economic hardships for million of American people. People are sending our elected officials millions of letters telling of horrible personal tragedies that they have suffered because of either being denied coverage or not being able to afford to pay for health insurance and health care. To make sure they understand the seriousness of the problem we also present them with sobering statistics such as these:

• Over 46 million people are without health insurance. And millions more are underinsured.
• 62 percent of all bankruptcy filings are due to medical debts. In 2009 alone this amounts to roughly 2.4 million people. (No other country in the world that has a national health insurance system in place has ever heard of a medical bankruptcy)
• Almost 45,000 people die this year because they cannot afford the necessary medical treatment they needed.

Then to make sure they get it, we do studies that show the economic impact over the next ten years if they fail to act. A recent study by the Urban Institute shows what is likely to happen by 2019:

• A 30 percent increase of number of uninsured people.
• A 60 to 100 percent increase in premium costs for businesses.
• The number of people getting health insurance through their work would decrease by more than 10 percent.
• A 75 percent rise in the cost to states of the current SCHIP program for children.
• A 100 percent increase in uncompensated health care due to emergency room visits, etc.

The lead researcher on this study concluded: “ …if comprehensive health reform that reduces the rate of health care cost growth and provides affordable coverage options is not enacted, there will be serious economic strain on individual, businesses and governments in all 50 states and the District of Columbia.”

You would think with all this personal testimony, statistics and projections of the cost of doing nothing being thrown at them to get them to “vote their conscience,” would have the desired effect. How much more do they need to know in order to do what is morally the right thing to do?

Well folks, you and I both know that isn’t happening. Actually, everybody I know with a conscience is convinced, so why are they not convinced? Is it that these leaders don’t even have a conscience? It sure looks that way. How else could these elected officials who have pledged to work for the welfare of their constituents continue to ignore all these personal tragedies and appalling statistics and predictions?

The Political System Is Broken

This all points to a horribly broken system. However, this time I am not talking about the broken health care system, but the broken political system of greed, power, money and special interests in Washington and elsewhere. Until that system is reformed, there will not be any true health care reform enacted or actually any reform at all that would threaten the status quo.

By focusing all our energies on trying to fix the broken health care system, we actually have gotten a closer look at how broken our political system is and how it operates. Do we need to see any more? All we have to do is connect the dots between the amount of contribution money these elected officials are receiving from lobbyists and special interest groups and the words that come out of their mouths.

How To Fix A Broken System

Unless someone writes a prescription for members of Congress and the President to all receive a “conscience transplant,” our efforts need to be focused on the only true reform that is possible in Washington: Campaign Finance Reform. Let’s stop fooling ourselves into thinking that just because one political party controls the White House and both Houses of Congress we can have true reform that fixes what ails this country.

No matter what they tell us in order to get elected, it ain’t going to happen. In addition to not being able to pass true health care reform legislation, they will not be able to pass energy legislation that protects the environment and stops global warming or fixes our broken educational system or does any of the other things we need to do to take back this country from the money and power brokers. It will take radical action by all of us to prevent those highly invested in maintaining ‘business as usual” from continuing to call the shots in Washington.

If we all mobilized and brought our collective will to the task of reforming the sick and broken political system, this could be accomplished. In the next election cycle, we must demand practical proposals on implementing public financing for all elections from every candidate that is running either for election or re-election. Then we have to make sure they follow through. As Michael Moore suggests in his latest film, Capitalism: A Love Story, we have to replace capitalism, as it exists in this country, with democracy. In order to do that, we all have to be committed to making it happen.

Health Care Reform: Is the Public Option Too Good of a Deal?

With every day opposition mounts against the inclusion of a public option in any health care reform legislation. The single payer option isn’t even “on the table.” It sure looks as if there are a lot of Senators and Congresspersons who are scared of the competition that a public option or what a single payer system would do to the private insurance companies. Why I even heard some of them say they believe the public option or the single payer system would drive the private insurance companies into bankruptcy. Poor babies. You would think that these private insurance companies are on the verge of bankruptcy and are in need of a bailout. The truth is that these companies are making enormous profits and paying their CEOs millions of dollars.

They might have to make less profit on health insurance if there were a public option to compete with them or even a single payer system, but they would continue to sell other kinds of insurance and could still sell premium health insurance packages to those who could afford to pay for them. But going bankrupt is not one to the likely outcomes they face. 

Mind you I am not opposed to anybody making a profit. Heck, maybe the government could even make a profit off of the public option. The way I do the math, the public option or the single payer system would be totally paid for out of the premiums collected some subscribers, the same way the private insurance companies get paid. This would make it “deficit neutral” and “revenue neutral.”     Now here is the difference, the public option or single payer system would have administrative overhead of about 4-5 percent also paid from premiums while the private insurance companies have administrative overhead of around 30 percent that are also paid by the premiums they charge.

Do you know what this administrative overhead consists of? First of all, it covers the wages of the insurance companies employees who process claims and decide how to deny benefits to customers. Did you know there are 30 health insurance employees for every health care provider in this country? They also have to spend money to advertise their company’s products. They have to pay to build fancy buildings in the “high rent districts” to house their companies. They have to pay their top executives enormous salaries and benefits. Finally, they have to satisfy their stockholders and achieve hefty profits. 

Gee, why couldn’t the government pocket most of the differences between their 5 percent overhead and the 30 percent overhead of the private insurance companies? If we had a robust public option or better yet a single payer insurance system run by the government, this could be used to pay for the whole health care reform package without having to raise any taxes. What a deal!  

Maybe it would also level the “paying field” and bring down health care premiums and at the same time we as the stockholders would benefit as well. Health care reform is starting to look like a good deal after all, particularly if you factor in the public option or the single payer system. Oops, I forgot, the government cannot make a profit off of health care. Maybe the question is: “ Should anybody make a profit off of somebody’s illness.” In most developed countries of the world the answer is “no.” In this country, however, bottom line profits, greed, waste, fraud and abuse are what drive our health care costs to the highest per person level in the world. We can do better!

Stay healthy and be well.

Barry

Health Care Reform: Who Says Prevention and Wellness Costs More?

I have been involved almost daily in health care reform activism since Fall 2008 and now I am going to write a regular blog about what I have learned and how I see the health care reform debate unfolding in Washington and elsewhere. Much of my interest has been in researching ways to transform our current health care system from an emphasis on “sickness” into an emphasis on prevention and wellness.

             Currently, not much happens in this system until someone gets sick. That never made any sense to me. It is probably the least cost-effective way to run a health care system. As a result, we now have a sickness-oriented adult population with 2/3rds of us classified as obese.

            There are some signs of hope. The current legislation under consideration in Congress seeks to change this. HR3200 in the House has allocated $126 billion in funding for public health promotion over ten years to be used to support prevention and wellness. The Senate bill, out of the HELP Committee, has about $100 billion a year over ten years to promote prevention and wellness.

            What isn’t clear, however, is how this money will be spent. Some money will go to doing preventative screening tests on more people and this category is called “Clinical Prevention Services.”  The rest will go to building a foundation that can support a shift in consciousness in the entire population from “sickness” to “health” called “Community Prevention Services.” The former may actually increase health care costs, while the latter can significantly decrease health care costs over the long haul.

            There is also a problem of how to calculate the cost-savings from real community-based prevention and wellness programs. It is likely that it will remain a big part of any bill that gets hammered out in Committee after the Senate and House pass their versions of the health care reform bill because it has bi-partisan support.  If that does happen, it could mean enormous cost-savings over a ten-year period. However, the Congressional Budget Office, which is considered to be the “gold standard” on estimating the costs of legislation, says that these parts of the bills will not yield any cost-savings and might actually increase the cost of health care reform. How can they say that?

            Well, they are partially right. If they are only looking at the possible increased cost of more preventative screening tests, the most concrete variable they can measure, they will conclude that prevention means increased costs. Actually, this should not even be classified as prevention and should be called “early detection” and “early intervention.” There is even some recent evidence that the screenings for breast cancer with mammograms does not increase survival rates and neither does PSA screenings for prostate cancer. Wait a minute, that is the subject of another blog.

            Second, The CBO has no accurate way of measuring the potential cost-savings from the creation of “Community Prevention Services.” Their predictions work best when they can isolate a single variable such as the current cost of preventative screening tests and then estimate the cost of insuring an additional 50 million people and offering them screening tests they do not now get. They can easily predict increased health care reform costs from these additional screening tests. However, they cannot easily isolate the variables involved with creation of community prevention services because they are varied and cannot be easily grouped into a single variable. In addition, much of what is being proposed is new and there is no good base line information available to use for making predictions. So what happens?? They guess.           

Finally, it turns out that the Congressional Budget Office isn’t perfect, in fact far from it. On three occasions recently they grossly under estimated the cost-savings of various pieces of health care legislation. It appears that when they have to estimate more than one variable at a time, their accuracy goes down to almost zero.

            If the members of Congress rely solely on the cost-cutting estimates supplied to them by the CBO in making their decisions, it could result in  significantly reduced expenditures in the area of community prevention services. Please urge your representatives to use some plain common sense and help them see that we have to invest in community prevention services that promote health and teach people how to stay well. This is where the future of health care reform has to be. We simply cannot afford to pour more taxpayer money into a very expensive “sickness” oriented health care system and hope that we will be able to reduce the cost of health care, that is already the highest in the world. It ain’t going to happen.

 Stay healthy and keep well.

 Barry