I find it remarkable how much the health care debate has changed in the last few years. Not long ago, it was anathema for many mainstream politicians to even suggest that Americans needed universal health insurance. Now, every Democratic candidate for running for president has his or her own plan. Republican candidates, while rejecting the idea of “government run” health care plans are proposing tax credits and other incentives which they believe will make health care easier to acquire.
By big margins, Americans are saying they have had enough with our current health care “system”. They no longer buy into the notion that America has the best health care. Perhaps it does, if you are independently wealthy. The rest of us are stuck with either substandard insurance through our employer, paying through the nose for our own policy or spending much of our free time praying that we do not get severely ill. Every year, assuming we do not join the ranks of the uninsured, our premiums and deductibles rise. Moreover, the list of covered procedures grows smaller.
Doctors and employers hate our health care “system” too. Unless they spurn insurance altogether, they generally are paid a fraction of their fee. For doctors, it seems like they spend more (uncompensated) time hassling with insurance companies than seeing patients. Insurance companies frequently override their recommendations for patient care. Patients like my wife, who have had several major operations, are sent home after just a night in the hospital. Ideally, surgeries are done on an outpatient basis. As for employers, providing health insurance becomes more problematic every year. Many small businesses do not even bother.
Movies like Michael Moore’s Sicko have documented how other countries are successfully providing universal health care. The fear mongering tactics of the insurance companies and HMOs no longer frighten us. How could anything the government comes up with be scarier than what we already have? How often do you see senior citizens bitching about Medicare? Now we understand that the money insurance companies saved by kicking us out of the hospital too soon is being used instead to coax congressional representatives and senators into making sure the system does not change. Finally, so many years later, it looks like our representatives are finally developing a backbone. Providing we elect a Democratic president and Congress in 2008, the chances for having universal health care in this country are excellent. It is about freaking time.
But which way to go? To me the Republican calls for tax credits are ludicrous and fully worthy of derision. They certainly do not provide universal health insurance. Health care savings accounts are fine if you have sufficient income to put money into them, but they are hardly a panacea to rising health care costs. If you are living from paycheck to paycheck, they are useless. One of the reasons I am so optimistic that Congress will go Blue next year is that Republicans still subscribe to ridiculous ideas like these. It is like saying they believe in the tooth fairy. Get real, Republicans! Not all problems can be solved by the marketplace. That is why governments exist: to step in where the public needs are not being addressed adequately by the private sector. It is right there in our constitution: our government exists in part “to promote the general welfare.”
As a liberal, revolutionary change excites me. Like many liberals, a single payer health care system strikes me as ideal. So why can I not fall in line behind it? I cannot because I know that, at least in this country, massive changes like this one tend to bollix up the whole system rather than solve the problem. Health care in America is too big and too institutionalized to change radically. It will doubtless cost us more, but to effect change that will actually work, we have to incrementally change what we have now, as imperfect as it is.
I spent some time today reading the health care proposals of Democratic candidates. With the exception of known eccentrics like Dennis Kucinich, the candidates are proposing measured and evolutionary changes in order to provide universal health care. Republican candidates are merely sticking their toes in the health care waters. Democratic candidates, on the other hand, are offering pragmatic and workable plans that build on the existing system.
Hillary Clinton was the latest candidate to release her health care proposal. Sometimes being last is best. Perhaps because of her presumed front-runner status, her proposal received a great deal of media coverage. It showed that she had thought through the mistakes she and her husband made in the 1990s. With her plan, if you are satisfied your current health plan you can keep it. If you do not like it, you can select from the many plans that are available to us federal employees, all of which have to take you no questions asked. Otherwise you are free to enroll in a public plan that will look a lot like Medicare. Her plan requires that every American purchase health insurance coverage but premiums are limited to a percentage of income. Rolling back some of the bigger Bush tax cuts for the very rich will help pay for her plan. She also thinks a lot of money can be squeezed from current inefficiencies in the system.
Will all of her savings be realized if enacted? Probably not. Many of these “savings” are likely smoke and mirrors. At this point, our health care system is so complex that it makes our tax code look simple. However, her plan and the many like them proposed by other Democratic presidential candidates are pragmatic steps that provide the universal coverage we need. Making the uninsured pay for even a portion of the cost of their care should mean that you would be paying less for your health care. Your premiums are so high in part because you have been indirectly subsidizing the uninsured all along.
Perhaps over time we can evolve into a single payer system. If so, it will likely take many decades. We will still be envious that other developed countries like Canada, Great Britain and France can provide better care at lower cost through their single payer systems. At least we will at last have some form of universal health insurance. It will not be a perfect system but it will be good enough. Doctors will keep billing. Insurance companies will still take their slice of the health care pie. Yet overall, it will be better. Employers can concentrate on making profits instead of worry about how they will afford double-digit health insurance premium increases. I hope that our doctors will spend more time with patients, and less on the phone haggling with insurance companies. While it will not be perfect, only multimillionaires will want to revert to the health care mess that we have now.