On health care reform, the choice between the Democratic and Republican candidates is crystal clear. The two leading Democratic candidates tell the American people the truth about the American health care system – it is too expensive, leaves out 50 million people, and burdens employers. One can argue that the Clinton and Obama plans do not go far enough toward creating universal single-payer coverage that citizens of other developed countries take for granted, but at least the Democrats are talking about steps toward solution. By contrast, McCain and the Republicans offer nothing but tired rhetoric and more tax breaks for people that do not need them. If you cannot afford health insurance, then putting aside money into a medical savings account is a cynical, if not blatantly cruel “solution” to the problem.
This recent editorial in USA Today highlights the uphill battle we face as the media seek to muddy the waters and muddle the public.
The editorial notes that health care costs per person in the United States are double the per-capita rates in other countries, including Canada and the members of the European Union. It grudgingly admits that many Americans lack health insurance and therefore access to quality care. However, the rest is nothing but disinformation.
First, the editorial dismisses the proposals offered by Obama and Clinton as ineffective and deceptive.
More important, both might be low-balling the cost of their plans, and neither proposes the kind of tough-but-necessary measures needed to control surging health care costs. If there is anything to be learned from state experiments to expand coverage, it is that they cost more than expected. Massachusetts now says that subsidizing the poor will cost $1.35 billion per year, about twice the estimate just two years ago. An effort to provide universal coverage in California died recently when its estimated cost soared.
It is ironic that the editorial uses plans created or proposed by Republican governors as a way to discredit the ideas of the Democrats. There is no attempt by the editorial to justify the charge that the Democratic plans are underestimating the costs beyond the example of mandated coverage plans in Massachusetts and California, which lacked an existing government-sponsored alternative to private insurance and were forced to subsidize individual insurance payments to private insurers. Instead, the Democrats are blithely accused of “low-balling costs,” a charge certain to create antipathy among an ill-informed populace.
The bias is further reinforced when the editorial contrasts the Democratic and Republican plans.
Both Democrats’ health care plans are more ambitious than that of presumptive Republican presidential nominee John McCain, who proposes much more modest adjustments to the health care system, centered on tax changes to encourage consumers to take a more active role in choosing, and paying for, their health coverage. Even so, Clinton and Obama are heavy on promises about making insurance affordable and available, and light on the more painful details.
The reader is presented a false-dichotomy. Do you want an ambitious plan that will likely increase your federal taxes or tax-breaks to cover your out-of-pocket expenses? So how is it medical savings accounts will help people that cannot afford private insurance? How will medical savings accounts contain costs, particularly of health insurance premiums rising at 2-3 times the core inflation rate? The Republicans get to wave a tax break that fixes nothing and increases disparities in access to health care without nary an objection or critical analysis.
The editorial veers into pure fantasy when describing their prescription for curing the ills of the American health care system.
Costs are rising largely because health care providers and consumers lack incentives to economize. With third-party insurers paying most of their bills, consumers don’t make the kind of tough choices they do when shopping for other goods and services. Similarly, makers of medicines, medical devices, hospital equipment and other products operate in a world with few restrictions or attempts to set priorities. Insuring more people doesn’t address those issues.
The abject dishonesty in this assessment centers around the idea of consumer choice – another Republican talking point that does not exist in the real world. Most health insurance plans limit choice. They provide specifically tiered reimbursement schedules. If you get care from providers in their network, the plan will cover between 80-90% of costs. If you get care from out-of-network providers, covered costs drop to 60%. These restrictions do not permit flexibility and comparison shopping, but the editorial prefers the fantasy that health care is a free market to the reality of a system controlled and distorted by insurance companies. Insurance companies negotiate discounted rates from providers to determine network inclusion. Provider choices within a network are particularly few in rural areas, often forcing consumers to travel hundreds of miles to get care if they do not like the provider options in their area. The consumer has no meaningful choice in the process, but is ultimately blamed for not making tough choices.
Not once in this editorial did the issue of overhead costs of insurance companies enter the discussion. Those overhead costs include profit, advertising, and bloated executive compensation. One might ask what choice consumers have in containing the 30-40% of health insurance premium costs unrelated to medical care.
The editorial also saw fit to ignore the consequences of forcing employers to shoulder most of the costs of medical care in the United States. Companies have a disincentive to locate businesses in America because of the health insurance tax, putting America at a competitive disadvantage and American jobs at risk.
Republicanism protection of health insurance control over the American medical care system will not solve the problem of rising costs, decreasing access, and employer burden. In fact, a strong case can be that McCain and friends will guarantee the collapse of the American medical care system by 2012 by doing nothing for four more years.
Any country that can afford to spend 10 billion a month on a senseless war in Iraq and 500 billion a year on the Department of Defense can make sure its citizens have access to affordable health care. It would take 6 attacks on the scale of 9/11 to equal the 18,000 Americans that die each year because they lack health insurance and access to quality health care. Who needs to worry about terrorists when we have forced euthanasia? If fact, we can do a better job of protecting Americans and American jobs by ending the war in Iraq and slashing the Pentagon budget to pay for universal health care. Why do Republicans complain that government run health care reimbursement would be inefficient while actively promoting the most inefficient and bloated government-run agencies (Defense and Homeland Security) in existence? The answer is simple – because they have no fear that media will point out the contradiction.
One only need to peruse the comments to the editorial to see the reach of republican talking points. The 52 comments are dominated by three basic themes. First, the costs of medical care in America are inflated by litigation for malpractice and illegal immigrants rather than bloated overhead costs for insurance and pharmaceutical companies. Second, Americans are at fault because we are overweight, inactive, and smoke. You mean like Limbaugh? Third, health care is not a basic right, so let charities pay for the poor.
You have to wonder what it will take to push reform forward and nail the coffin of republican talking points. Will it take number of uninsured reaching 100 million? Will it take more outsourcing of jobs as companies look to avoid paying the health insurance tax? It is hard to imagine change when too many still believe in republican myths such as this gem from the comments section.
Why do people keep saying fix the health care industry? Our health care is better than anywhere in the world.
I lost count of the number of times the myth of American superiority in health care was repeated during the Republican party debates. It looks like we will need to fix the education system before we can fix health care.