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By Miriam Raftery
June 28, 2009 (San Diego)— Last week, President Barack Obama presented his “prescription for America” (http://abcnews.go.com/Politics/story?id=7922187&page=1). The President aims to create a public option for a government healthcare program similar to Medicare that would compete against private insurance companies.
As debate in Washington D.C. heats up, local advocates are speaking out, holding forums, and mobilizing citizens in San Diego and East County to lobby legislators in favor of healthcare reform—a move they say is needed to counter heavy lobbying by health insurers, pharmaceutical companies and other healthcare industry interests. But while some applaud the Obama plan, others believe it doesn’t go far enough—and believe only a single-payer plan which eliminates private insurance will solve our healthcare crisis. Still others oppose any government healthcare plan option, arguing it will prove costly and cost jobs in the private healthcare industry.
THE PROBLEM
According to the World Health Organization, the U.S. ranks 72nd in overall health system performance—behind Iran and Bosnia—and 37th in healthcare quality. Our nation is 24th in life expectancy and also ranks higher than other developed nations in infant mortality. Yet we spend more on healthcare than any nation on earth—about $2.2 trillion last year. That’s more than has been spent on the Iraq and Afghanistan wars, and more than the gross domestic product of China.
Two-thirds of all bankruptcies in the U.S. are due to healthcare costs—and most of those people had insurance. The uninsured die younger; an estimated 137,000 adults died from 200-2006 because they lacked health insurance, the nonprofit San Diegans for Healthcare Coverage reports. women with breast cancer are 30-50% more likely to die if they don't have insurance.
In the U.S., 46 million people are uninsured--including over half a million in San Diego County, with the number growing as unemployment rises. The majority (60%) of those who are uninsured work for small businesses, according to the nonprofit Employee Benefit Research Institute. Many small businesses are often unable to afford insurance for employees or can’t compete against larger companies offering better benefits.
Millions more people are under-insured, discovering too late that even some major insurers won’t cover life-saving treatments such as chemotheraphy, or try to deny coverage by accusing policy-holders of hiding pre-existing conditions.
Lack of healthcare costs not only individuals, but businesses and our economy. New America Foundation estimates employers and workers pay 17% more in premiums to cover costs of uncompensated care for the uninsured and under-insured. We pay higher taxes to fund care, yet there are fewer hospitals and emergency rooms to serve communities due to closures and longer waits at emergency rooms flooded by the uninsured. Lackof preventive care also leads to an unhealthy workforce.
“There is no question that the healthcare system in America is seriously broken,” said Reynaldo Hernandez, a former insurance agent who spoke at a Ramona Forum meeting last weekend. “I felt guilty selling policies that cost people more and covered less,” he said, adding that insurers regularly deny coverage for serious conditions even to those who have insurance—and won’t sell to those with pre-existing conditions.
Hernandez decided to become an active advocate for healthcare reform after a friend lost insurance temporarily and couldn’t afford to see a doctor for troubling symptoms until he became old enough to qualify for Medicare. “They found non-Hodgkins lymphoma—a tumor on his spine that has metastasized to his bone marrow. He’s in trouble—it’s at stage four,” said Hernandez, adding, “He fell between the cracks. Now I may watch my lifelong friend die.”
But even those with insurance often find their coverage lacking when a crisis strikes. Hernandez described a woman who bought insurance, then was diagnosed with breast cancer. “Her portion was $100,000,” he said, adding that the 31 year woman is a five-year cancer survivor. But people without the means to pay such high deductibles and co-pays are dying as a result.
THE SOLUTIONS
One solution proposed is a single-payer system for all Americans (similar to the current Medicare system for seniors) in which the government becomes the single handler of claims and payments to providers, eliminating overhead and administration costs. (Note: This is not “socialized medicine” because the government would not own hospitals and doctors would not be employed by the government.) The more likely option Obama plans to propose is a public option, in which private insurers will compete with a government-sponsored system. Still others opt for addressing serious flaws legislatively (such as prohibiting insurers from denying coverage for certain conditions) or simply allowing the free market to prevail.
“The cure is to get rid of the healthcare industry,” Dr. Jeoffry B. Gordon of Physicians for National Healthcare Reform, said during a rally in San Diego in early June outside the annual convention of American Health Insurance Plans. “The cure is single-payer Medicare for all.” But he said citizens will need to speak out so their voices will be heard, since legislators are heavily lobbied—and in some cases, financed—by the healthcare industry which has thus far succeeded in shutting out discussion of single-payer options in committee hearings on healthcare. “If you are dumb enough to think that Countrywide and Washington National were going to protect your home and Lehman Brothers was going to protect your retirement fund, then you would think United Healthcare and Wellpoint are going to protect your health,” he said, adding that insurers’ goal is to protect profits for shareholders, not health of policy holders. They rally attracted “an energizing and spirited turnout with lots of honks from drive-by supporters and a wide variety of groups and individuals represented,” said Jady Montgomery, an organizer with Focus On Change/Single Payer Healthcare Coalition San Diego.
Among San Diego’s Congressional delegation, only Democrat Bob Filner has called for single payer. “We should’ve started with single payer,” he said during a Democracy for America meeting in San Diego on July 1. “McCain, all these guys who say they’re opposed have had `socialized medicine for years through the V.A.,” he said of the Veterans Administration’s government-run healthcare program. Medicare, another single-payer healthcare program, has resulted in the number of seniors living in poverty dropping from 80% to 20%, Filner added. He also believes any healthcare reform bill should increase Medicare reimbursements to physicians to keep doctors from pulling out of a public program.
Filner believes President Clinton made a mistake in “trying to please all” in a healthcare plan. He said there is intense pressure on Congress by insurance industry lobbyists to take a public option off the table. The Congressman urged those who share his view to contact their legislators, speak out, and visit members’ offices to say “We want single payer now.”
Not everyone agrees. The California Chamber of Commerce sent a letter applauding Governor Schwarzenegger for vetoing SB 840 last year, a bill that would have created a single-payer healthcare system to provide full medical, dental, eye care and mental health coverage for all Californians. The Chamber argued that creating a “government run health care system in California” would lead to “billions of dollars in new taxes on individuals and businesses” and “create a vast new government bureaucracy” that could “jeopardize our economy.”
The American Medical Association (AMA) has weighed in against any new public insurance option. But the AMA represents just 20% of doctors, down from 75% in 1960. Mayo Clinic physician Chris McCoy recently made headlines when he resigned his AMA membership in protest over the organization’s opposition to a public health insurance program.
Physicians for a National Health Program, a rival professional group, supports single-payer healthcare. Another doctors’ group, National Physicians Alliance, supports public insurance. National Medical Association has issued a press release applauding Obama for convening a White House forum on health reform and expressed enthusiasm that the President will be able to sign “meaningful legislation” for healthcare reform during this session of Congress.
The Obama plan seeks to straddle the fence among diverse groups, creating a public health insurance option similar to Medicare for all who choose to opt in, while allowing people who prefer an existing healthcare policy to keep it and retaining the private insurance system. Patients would be free to choose their own doctors and be guaranteed basic care under the public option, similar to how Medicare (a single-payer system) works currently. A study by the Lewin Group has estimated that if such a plan were open to all employers and individuals, and if it paid doctors and hospitals the same as Medicare, the government plan would quickly grow to 131 million members, while enrollment in private insurance plans would drop sharply. The government would be able to set premiums well below what private plans charge, the study estimated.
But the Obama plan could still leave 24 to 28 million people uninsured, since it would not require all Americans to get coverage—and there would still be premiums to pay, albeit lower than for comparable coverage with private insurers.
Under single payer, by contrast, all Americans would receive comprehensive coverage and care would be based on medical need, not ability to pay. While how to pay for such a system remains a thorny issue yet to be resolved, supporters of single-payer note that there are currently tens of thousands of different healthcare organizations, such as HMOs and other insurers, hospitals, doctors, and billing agencies. Having the government collect all healthcare fees and pay out all healthcare costs through a single payer system would reduce overall health costs by hundreds of billions of dollars a year, the nonpartisan Congressional Budget Office has estimated.
Congressman Duncan Hunter, in a newsletter to constituents, stated that under a government-run healthcare program, “personal healthcare decisions would no longer be made by patients and doctors,” a contention disputed by Sylvia Hampton, Healthcare for All San Diego. Hampton calls that argument “Totally untrue,” adding, “Medicare is a single payer, publicly financed system where seniors have total control of which doctor to go to and the doctors make the medical decisions, not the government. If anything, the private insurers are more controlling and bureaucratic than the government.” The government would however control how much doctors get paid, just as insurances currently decide payment levels. Ultimately if everyone is paying into a single payer system, she predicts doctors could be paid more than under Medicare, though less than under some present insurance systems.
Hunter and others question how a government-sponsored program would be funded. “The only reliable option is to increase taxes on working Americans, including a rollback of tax-free health benefits,” Hunter has stated.
But Hampton counters that currently, consumers can pay huge premiums only to have an insurer deny claims and refuse coverage. In addition, workers pay premiums but may lose coverage when they change jobs or become unemployed. “Those dollars would, for most workers, be fewer and go into the health care fund to be available to you whenever and wherever you may be, with or without a job,” she said.
Hunter proposes his own solution, implying he would favor tighter regulation of insurers but not a public option. “I strongly believe we should focus on creating a health care system that promotes competition, offers plenty of choice at affordable rates and maintains the doctor-patient relationship,” he said in a letter to a constituent. “This system must also ensure that every American, regardless of income or pre-existing conditions, receives affordable access to reliable coverage. Of course, it is important that we restructure the private insurance market as part of this process.”
A poll on Hunter’s website in late June asked if constituents would support a “government-imposed” healthcare plan even if it meant higher taxes. When more than 5,000 responses were received and a substantial majority responded “yes,” the poll was removed from the site. Whether the poll reflected a true cross-section of voters in the district or vocal outreach of pro-healthcare reform activists is uncertain. But clearly, those supporting a government healthcare program are no longer a silent force.
Healthcare for All San Diego has been urging its members to attend local rallies and meetings on healthcare issues. Each Saturday from 9 a.m. to noon (including July 4), the group hosts a “Fun-in-the-Sun for Single Payer” rally at Nobel Drive near I-5. On July 11, organizers urge supporters to attend a Town Hall Community Forum on healthcare reform featuring Congressman John Conyers, Jr. Conyers has introduced a single-payer healthcare bill in Congress, but thus far has been denied a hearing in committee. The Conyers event will be held from 1 to 4 pm at the Joe & Vi Jacobs Center Celebration Hall, 404 Euclid Ave., San Diego, CA 92114. For more information, call (619)231-9300 ext. 3104.
The organization also recommends that citizens to urge their U.S. Senators and Congressional members to be sure that any plan passed by Congress includes an option allowing states to pass more comprehensive plans of their own—and assure that no law is passed prohibiting California from providing better healthcare options than the federal government.
Jim Stieringer, Board President of the Grossmont Healthcare District, believes our healthcare system, while imperfect, is not broken. He believes any government effort at reform should focus only on those who are uninsured (6 million in California).
Asked about those left uncovered by policy gaps, huge co-pays or denial of coverage once people become seriously ill, he replied, “Perhaps the answer is legislative, i.e., requiring that insurance policies include additional coverages and that the correction of clinical errors be compensable. I recognize that the system is not perfect. My point would be that the current imperfect system may be preferable to the system that emerges from Congress.”
Hugh Moore, spokesman for Healthcare for All San Diego, says he personally will support “any plan that will increase the number of people who get coverage” though he would prefer a single payer plan. But he believes the Obama plan is likely to fail because it won’t set up a single information system unless all insurance companies cooperate, limiting cost savings. In addition, he adds, “A key question is how good is basic care going to be? I assure you, it is not going to be good. The insurance industry is in business to make money for their stockholders.”
He disputes the contention that people would have less choice under a government-run program. “With single payer you would actually have more choice,” he said, noting that in HMOs and other private systems, people are limited to only doctors on their plan.
He also disputes the Chamber of Commerce argument that government healthcare would be bad for business. “If a single payer option goes through, workman’s comp payments go away,” he noted. “There is no need for workman’s comp if everyone has insurance.” Businesses that currently provide insurance for workers would pay less under a single payer system—and no longer have to pay workman’s compensation costs. In addition, he said, “small businesses that don’t even have access for buying into the big plans now would have access to get the same rate that the big companies--Yahoo or IBM or General Dynamics—get under single payer through the whole state or nation.”
Switching to a single-payer system would save the San Diego Unified School System $500 milliion a year just on health insurance for comparable coverage, if not better, said Moore. “That’s just teachers and administrators and school employees,” he added, noting that local government could save far more when you add in savings for police, firefighters and other government workers.
Hernandez, a military veteran who voted for Republican Congressman Duncan D. Hunter and his father before that, recently visited Washington D.C. to lobby both Democratic and Republican representatives on the need for serious healthcare reform. Rep. Hunter has voiced opposition to any public healthcare plan, though Hernandez said the Congressman spent thirty minutes meeting with him and hearing his concerns. He also met with representatives for Senator Barbara Boxer and Senator Diane Feinstein, who have voiced support for healthcare reform but not specifically for a single payer system.
“We are the only developed country on the planet where people go bankrupt because of healthcare. It’s unheard of in Europe,” said Hernandez, who had to go without healthcare himself for over a year due to skyrocketing premium costs while waiting until he was old enough to go on Medicare. “But in this country, we are scared of isms. We are scared of socialism and communism. Now,” he concluded, “I’m scared of capitalism.”
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