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posted July 24, 2009
Is Hope for Healthcare Reform Realistic?
Political heavyweights are already weighing in against a single-payer system; major reform depends on a grass-roots effort
By Don Monkerud
A Medicare-like optional insurance plan for everyone, regardless of age and past medical history, is shaping up to be the most contentious battle in the coming healthcare debate in Congress.
“What role should the government play?” asked Michael Leavitt, Secretary of Health and Human Services under Bush. “Should healthcare be more like food, where the government sets the rules, organizes the system and subsidizes those who need assistance? Or should it be more like national defense, where government pays for it with taxes?”
Leavitt repeatedly clashed with Tom Daschle, former US Senate Majority leader, when they met March 30 at The Panetta Institute for Public Policy in California to discuss the issue, “Can Healthcare Reform Finally Happen?”
While highly respected politicans, both men have ghosts in their closets. Daschle received over $220,000 from the healthcare industry and over $5 million as an advisor to corporations in the past two years. He withdrew as Obama’s Secretary of HHS nominee after failing to pay $128,000 in taxes. Questions plague Leavitt about backroom deals to open up millions of acres of wilderness to private exploitation while he was governor of Utah. Before he and Bush left office, he changed regulations to limit women’s access to abortion, contraception and information about healthcare options and, incidentally, his fortune while he was in Bush’s cabinet shot from $7.7 million to $34 million.
Daschle pointed out that healthcare is not a private system; the government already provides 40 percent of healthcare services. This private-public system lacks integration and the government could play an important role in integrating care to make it work better. The government needs to offer an insurance program for those who are unhappy with their insurance or whose employers drop their insurance.
“Are we looking for a new system to benefit the insurance industry or the American people?” Daschle asked. “American’s want the greatest degree of choice. What’s wrong with offering a publicly funded proposal for those who can’t get insurance any other way? We offer this today; it’s called Medicare.”
Leavitt opposes government-sponsored insurance because he says its effects will run wild as it competes with private insurance companies to push them out of the market. Employers would enroll their employees in government insurance and undermine the private system. A former trustee of the Medicare trust fund, Leavitt said reforming healthcare must begin with Medicare because its cost will bankrupt the country. In a few years, Leavitt predicts healthcare will represent 30 percent of the nation’s budget.
Both Daschle and Leavitt agree on a number of problems with the current healthcare system, although neither of them suggested the problems are due to a primary focus on private profit. Americans spend $2.5 trillion a year-$8,000 per individual-on healthcare, an 85 percent increase since 2000. Some 47 million are uninsured, and a third of the population under 65 spends part of the year without insurance.
They also agree that more money doesn’t buy better care. The World Health Organization ranks the US 37th in the world in healthcare, between Costa Rica and Slovenia. The US has the most expensive healthcare in the world, but it excludes 42 percent of the population, and yearly cost increases often hit double digits. Those without insurance use emergency rooms that are paid out of the premiums of insured families at a rate of $1,000 per year. Incentives drive the healthcare system toward more expensive procedures rather than toward providing well-being. The system is wasteful; paperwork and administration consume 30 cents of every dollar spent; and the emphasis is on volume rather than quality.
Daschle and Leavitt agree on a “public-private framework” for reform and both want individuals to accept more responsibility for their own healthcare. Leavitt wants the government to “organize the marketplace” and subsidize those who can’t afford insurance, but he doesn’t want the government to “own” the system. He favors “an individual mandate” that forces an individual to buy insurance from a private provider.
According to both men, there’s a small window for change; they expect Congress to find a solution by August. Leavitt sees an incremental change and Daschle estimates a 50-50 chance of substantial reform. If there was ever a time for citizens to speak out, it’s now.
At the entrance to the forum, the Young Democrats of Monterey County, California handed out leaflets supporting single-payer healthcare; HR 676, now sponsored by 92 members of Congress. Single Payer is similar to Medicare and would provide affordable healthcare for everyone, eliminate overpaid CEOs, profit and paperwork, and put the patient and doctor in charge of medical decisions instead of insurance companies. A major selling point for a government-run option is the reduced cost due to less overhead and private profit because the government could negotiate lower prices.
Neither Leavitt nor Daschle are receptive to Single Payer. Leavitt said Medicare will become insolvent by 2016 and universal coverage would dramatically diminish the amount of budget available for other uses. “Can we afford to dramatically expand healthcare to include the whole population?” he asked.
“I realize a number of people believe in Single Payer,” said Daschle. “But they are not the majority and most people like what they have and don’t want to change.”
With half the population “somewhat” or “completely” unprepared to deal with a costly medical emergency, according to the National Coalition for Health Care, this is a strange argument. Opponents cry “socialized medicine,” which is no less than Medicare for everyone. Obama doesn’t leave room at the table to consider Single Payer, which is promoted by many citizens’ groups, but he has room for every for-profit medical provider.
As citizens, if we want to see more affordable care, an increase in quality, more transparency and better coverage, now is the time to call our representatives. Otherwise, this small window of opportunity will close.•