Medicare-for-All Goes Mainstream

The health care reform that dares not speak its name edged out of the shadows yesterday with a New York Times editorial suggesting:

"A new public plan--to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs--seems worth trying.

"Any new public plan would constitute only part of a much broader effort to provide coverage for 46 million Americans who currently are uninsured and many more who may soon join their ranks. Other major parts under discussion include strengthening employer-provided coverage, expanding existing public programs such as Medicaid and creating a national health insurance exchange where individuals without employer coverage, small businesses and possibly others could buy policies at inexpensive group rates from qualified private plans and, we hope, from a new public plan as well."

This tiptoe approach to what has been called Medicare-for-All is symptomatic of the political minefields surrounding what experts consider the best solution to health-care reform--a single payer system, which has been gaining the support of doctors, nurses and unions since Rep. John Conyers introduced a bill in the House last year but is not part of the Obama Administration's "incremental" approach to reform the system.

In fact, the downfall of Tom Daschle, the President's first choice for health czar, derailed the faint hope that such a solution would be considered, since Daschle had written a book advocating just that.

Meanwhile, private insurer profits and "administrative costs" keep draining one out of every three dollars spent, making US health care one of the most expensive and least effective operations in the world.

Getting Medicare-for-All on the agenda to compete with that system would be a start toward sanity.

White House Health Care Rally, Web Site

On a day dominated by news of falling retail sales and a diving stock market, the President held a pep rally for health care.

He told 150 members of Congress and heads of labor unions, business groups, doctors, hospitals, insurance companies and consumer organizations:

“Since Teddy Roosevelt first called for reform nearly a century ago, we have talked and tinkered. We have tried and fallen short, stalled time and again by failures of will, or Washington politics, or industry lobbying...This time, there is no debate about whether all Americans should have quality, affordable health care. The only question is, how?”

There were no specifics to Obama's call for "bottom up" reform, but his optimism got a reality check in a letter from five Senators saying they are "eager" to work with him while rejecting his campaign call for “a new public insurance program” to compete with private insurers.

“Forcing free-market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition,” said the letter from Minority Leader Mitch McConnell, Michael Enzi, Charles Grassley, Orrin Hatch and Judd Gregg, Obama's drive-by, would-be Commerce Secretary.

“Ultimately, we would be left with a single government-run program controlling all of the market.”

This is the same Bushspeak that led the former president to veto extension of SCHIP coverage for children and presages a bitter battle for health care reform.

But Obama seems ready to fight it. As he spoke, the White House unveiled a new Web site, www.healthreform.gov, and said it plans to hold town-hall meetings across the country to rally public support.

Teddy Roosevelt would approve.

Health Care: Too Big to Fail

In the frenzy over jump-starting the economy, the House stimulus bill includes, among other straws being grasped, $117 billion of spending for health care, most of it to maintain coverage for the disabled and newly poor. Otherwise, the political consensus is that we can't "afford" to reform the system.

If anything, there is a stronger case to be made that we can't afford not to. Paul Krugman scratches the surface today with the argument that "helping families purchase health insurance as part of a universal coverage plan would be at least as effective a way of boosting the economy as the tax breaks that make up roughly a third of the stimulus plan--and it would have the added benefit of directly helping families get through the crisis, ending one of the major sources of Americans’ current anxiety."

He cites research showing that Obama's campaign promise of universal coverage would add “only” about $104 billion to federal spending next year, but this overlooks the huge possible benefits in reforming a system that rewards greed and inefficiency.

Start with health care fraud by hospitals, doctors, pharmacists and other care providers. which the FBI estimates at between $60 and $100 billion a year. Stopping that could be a small growth industry to employ some of the analysts being laid off by the banks and Wall Street, to say nothing of starting to fix a system that has been criminalizing the healing profession in order to let its members survive.

But the big payoff would be in transferring the estimated one-third of the $2.4 trillion-and-counting that goes for insurer overhead and profits into patient care.

In the current economic climate, the SCHIP expansion of coverage for children which George W. Bush resisted on "philosophical" grounds is about to be signed by the new president, and the money in the House stimulus bill has aroused Conservative fears about "nationalizing" the health care system.

Just so, and it opens the way for a healthy debate over whether the current health care system, like greedy Wall Street, is really "too big to fail" and why it can't evolve toward the single-payer system that rational analysts favor.

Krugman cites Rahm Emanuel, the White House chief of staff, declaring that “you never want a serious crisis to go to waste” and points out that FDR "was able to enact Social Security in part because the Great Depression highlighted the need for a stronger social safety net."

In repairing the economy, health care can be both part of the stimulus and the 21st century social safety net.

Health Care in a Sick Economy

As jobs disappear and economic anxiety spreads, the incoming Congress is showing signs of getting serious about health care reform, and the entrenched health insurers are signaling their willingness to negotiate.

Two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, are saying they would guarantee coverage for people with pre-existing medical conditions, if they can get a mandate for individual coverage by everyone, sick or well.

This "concession" comes as seven senators responsible for health legislation met yesterday and promised to work together--Democrats Max Baucus, Chris Dodd, Ted Kennedy and John D. Rockefeller IV along with Republicans Michael Enzi, Charles Grassley and Orrin Hatch.

The imminent appointment of Tom Daschle as Obama's point man on the issue is another sign that the failing economy is putting more pressure on Washington to create a health care safety net for everyone just as the 1930s produced Social Security for the old.

Without limits on predatory premiums and safeguards against fraud by providers, guaranteed coverage would do nothing to solve the crisis in which one out of every three dollars spent on health is going to insurers' overhead and profits.

But at least the issue is on the table, and the Wall Street Journal is sounding the alarm about a "slow-motion catastrophe" that might "add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the 'market' in which it 'competes' with private programs--like playing both umpire and one of the teams on the field--they will crowd out private alternatives and gradually assume a health-care monopoly."

Sounds something like the approach of a single-payer system, which rational observers have been urging all along, but nothing could be worse than what we have now

Health Care: Slow-Motion Katrina

John McCain says free enterprise will make it more efficient, Hillary Clinton and Barack Obama want to tinker with it, but the evidence keeps mounting that American health care is a disaster that keeps overwhelming not only the uninsured but those who have "coverage."

Today the New York Times reports, "Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be--often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

"With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline."

Meanwhile, none of the presidential candidates is willing to acknowledge that the American health care system is broken by massive inefficiency, insurer greed and widespread fraud.

Even before they win the presidency and wider margins in the Senate and House, Democrat leaders are undermining the campaign promises of Obama and Clinton by making it clear that the next Congress won't follow through on even their watered-down proposals.

If voters want health care, they will have to hold their Congressional candidates' feet to the fire by letting them know that they are really hurting and not being treated right by the clients of the health care lobbyists who are blocking reform. Better yet, they should brush aside all the nonsense about "socialized medicine" and get a national conversation going about a single-payer system.