Health Care, not health insurance. It’s not too hard a concept. Universal Health Care, not universal health insurance. Did the concept get any more difficult? Universal Single-Payer Not-for-Profit Health Care, not universal mandated health insurance. It’s still not too hard to differentiate between them.
So, which does your candidate support? Well, we know that there’s only one candidate who supports Universal Single-Payer Not-for-Profit Health Care (not health insurance).
Why is that?
Maybe the other candidates believe in the myths about Health Care!
These six well-worn myths have been perpetuated over the years by stakeholders in our present market-based system.
Let’s see what they are:
1. “Everyone gets care anyhow”
Purveyors of this myth assume that the uninsured and underinsured are able to access health care within an extensive safety net of community health centers; emergency rooms and outpatient clinics of public hospitals and not-for-profit community hospitals; local health departments; or other public sector clinics and hospitals, such as the Veterans Administration or National Health Service Corps. While this belief may absolve their guilt about serious access problems within the
present system, it is a total misperception on many counts. Access to health care is more complex than it may appear, even for the insured. Eisenberg and Power (28) have drawn the analogy between access to health care and electrical current passing through resistance-even for the insured, access suffers with each voltage drop, whether their needed services are actually covered, their choice is informed and available, or primary and specialty services are available.
Of course, with Universal Single-Payer Not-for-Profit Health Care this would not be a myth!
2. “We don’t ration care in the United States”
This is a common notion, often used as a put-down for those countries with
national health systems without full coverage for every conceivable health care service (e.g., chronic renal dialysis for elderly patients, cosmetic surgery). This myth flourishes while the prevailing public attitude (fueled by powerful stakeholders in the present system) is outright denial that rationing is common, necessary, or moral. Consider these examples of ways in which health care services are rationed in everyday practice:
• Either by self-referral or through a gatekeeper, sick HMO patients have
about twice as much difficulty in seeking needed care as do healthy patients in HMOs, PPOs (preferred provider organizations), or point-of-service programs (33).
• Many managed mental health programs have overly restrictive admission
policies for detoxification, such as requiring delirium tremens to occur before hospital admission is approved (34).
• Comparative rates of preventable hospitalization between those in affluent and poor zip codes are much higher in U.S. cities than in Canadian cities (e.g., more than twice as prevalent in San Francisco and New York than in Ottawa or Toronto) (35).
• Use of essential drugs decreased by 9 percent in elderly persons and by
14 percent in welfare recipients after cost-sharing was introduced, resulting in a doubling of the rates of serious adverse reactions in both groups (36).
In a for-profit health insurance system, you make money by keeping people from getting the care they need. Cruel, of course, but profitable!
3. “The free market can resolve our problems in health care”
This myth continues to underpin pro-market health care policies of both major political parties, with the belief that the marketplace can effectively resolve access, cost, and quality problems in delivery of health care services. Touted as the “American way,” this view reflects the belief that a private, competitive market exists in health care. Yet there is incontrovertible evidence that health care markets do not behave in a freely competitive way. Robert Evans (38), health care economist at the University of British Columbia, has pointed out how market mechanisms in health care yield distributional advantages for particular groups, including providers, suppliers, insurers, and more affluent and
healthier people. He calls attention to the natural alliance between providers, suppliers, and higher-income citizens in support of private financing of health care, leaving the burden of financing care for the sick and uninsured to the public sector. As a result, the farther such privatization goes, the more difficult it is to finance basic health care services for sick and lower-income people through a smaller risk pool.
Ah, the market solves everything! Let’s let the regional market solve the health insurance problem!
4. “The U.S. health care system is basically healthy,
so incremental change will address its problems”
Incrementalism has been the prevailing approach to health care reform for at least 30 years in the United States, and is still the most politically popular. Strongly supported by influential stakeholders in the present system, incremental changes are periodically put in place, which fail to address the more fundamental problems of the system. Examples include the attempt to contain rising hospital costs by the DRG (diagnosis related groups) prospective payment system (costs soared again 11 years later) (42) and the State Children’s Health Insurance Program (SCHIP) enacted in 1997 (but by 2000 up to 21 million American children were still estimated to have significant access problems) (43).
Incremental reform is all that we can do! Something is better than nothing! What great rallying cries!
5. “The United States has the best health care system in the world”
How can one look at the list in the Appendix and still believe that we have the best health care system in the world? Yet this remains a widespread view, which again is nurtured by the stakeholders in the present system. That such a view is not only untenable but also arrogant toward countries with better-performing health care systems is demonstrated by these examples:
• The average ranking for the United States on 16 health indicators in a 1998 comparative study of 13 countries by Starfield (24) was twelfth, second from the bottom. The top five, in decreasing order, were Japan, Sweden, Canada, France, and Australia.
• In another study by Starfield (27, 49) of 11 Western countries, the United States was ranked last with respect to its primary care base and its per capita health care expenditures (the highest), while ranking poorly on public satisfaction, health indicators, and use of medication.
• A 2000 study by the World Health Organization based on various indicators (including disability-adjusted life expectancy, child survival to five years of age, social disparities in care, experiences with the health care system, and out-of-pocket health care expenditures) found the average ranking of the United States to be fifteenth out of 25 countries (50).
• A 1998 meta-analysis of 39 prospective studies in U.S. hospitals estimated that more than 2.2 million patients had serious adverse drug reactions in 1994, resulting in 106,000 deaths (51).
• A 2000 report on the epidemiology of medical error estimated that about
1 million preventable injuries occur to U.S. patients each year (52); these include transfusion errors, adverse drug events, surgery on the wrong side, and mistaken identity (53).
USA, USA, USA! Oooops!
6. “National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative”
Since national health insurance (NHI) would require fundamental restructuring of the health care system, it poses a threat to the stakeholders in the present system. For many reasons, when NHI is raised as a policy alternative, it therefore becomes a target of opportunity for interests vested in the status quo. Each time this occurs it obscures a national debate on the real issues, which should focus on which of the policy alternatives best serves the public interest.
The question is raised again: What does your candidate believe? What do you belive? Do you buy into any of these myths? Are these myths being used by your candidates to justify their health insurance proposals?
As editor of the New England Journal of Medicine, Relman (63) warned in 1980 of the corrosive effects of the medical-industrial complex in medicine and health care. The ensuing years have fully demonstrated these effects. In 1990, Coddington and colleagues (64), in their book The Crisis in Health Care: Costs, Choices, and Strategies, predicted these outcomes under our market-based system:
• More than 40 million uninsured
• Continued gaps in safety net coverage
• Double-digit health plan rate increases
• Smaller employers cutting coverage or even dropping health plans
• Increased copayments and deductibles for employees
• Large rate increases for private insurers in shrinking markets
• Numerous failures of HMOs and withdrawal from the market by larger
• Continued cost shifting in an increasingly fragmented market
• Continued inflation of health care costs
Twelve years later, every one of these outcomes has taken place, precisely as predicted.
Shocking, isn’t it? The question becomes one of if the for-profit insurance system has failed, why in the world would we continue to think that it’s going to work if only we add some window dressing? Why would it work now?
Does your candidate support HR 676? Or do they support incremental change, mandated health insurance or the market?
Here’s Dennis on the subject (and more) from his recent visit to Reno, NV:
For those of you who wish to support Dennis campaign, you can sign up for the December 15, 2007 moneybomb. If you wish to donate directly to the campaign now, you may do so online or via US Mail! You can also donate through my ActBue page for Dennis!
As always, now more than ever,
Originally posted here: http://www.dailykos.com/story/…