The Social Medicine Portal

What's in for me? Musings on the politics of health care reform

Lately, several people, including readers of Social Medicine, have asked “what’s in for me” in the new rendering of the “uniquely American solution” coming out of Washington D.C. Some have also expressed concern about the change that a single payer system would bring to their relatively adequate current health insurance plan.

One thing to fear is that a bad step that consolidates the power of insurers maybe worse that doing nothing. And one thing to be skeptical about is our president’s promise that any of the Washington-cooked plans will “allow you to keep your insurance if you like it”. As many readers may suspect or know, there is no guarantee that whatever we have today will be there tomorrow (quite literally), or that tomorrow, what we have today, whatever that may be, will be affordable (assuming we still have that job through which we buy our insurance). And what is true of our policies is also true of those of our friends, children, and other loved ones.

And it gets worse: as some readers may know, our current insurance, however satisfied we are with it, may be adequate so long as we do not get too sick. Indeed, three fourths of those who declared bankruptcy for medical reasons had insurance (largely private) when they declared bankruptcy.

How could this be so? Isn’t health insurance supposed to insure me against the financial burden of disease? It is, but in our case it does not. Our health insurance system is not designed primarily to pay for your medical needs, but to make a profit. We are the only industrialized, wealthy country that leaves the medically necessary care of over 70% of the population at the mercy of a for profit insurance system. We only pay collectively for the “deserving downtrodden” — the too poor, the disabled, and the elderly  (yes, the “bad customers” that private insurers do not want). And there is little reason to believe that this situation will change substantially or enough with Washington’s “health care overhaul” (for a full explanation of why this is so please click here for my KQED series on health care reform). .

So back to the “what’s in for me” question: the New York Times’ editors, in yet another classical display of corporate media news selectivity, answer this question today, with no mention of better alternatives than keeping for profit insurers in the middle of the game. But are they to blame? They are in line with, or simply following on the footsteps of, no other than the president, who has laid out the “menu” of health care reform “alternatives” including nothing that could disrupt the powers that be — maybe, he says, ”taking some of the profit motive out of health insurance will make insurers offer better products“! (yes, he said it with a straight face — one’s got to recognize the talent!).

In the same edition of the Times, reporter David Leonhardt “enlightens” us further with his economic wisdom, explaining that if we believed that the critical problem in our health care system was greedy for profit private insurers who have co-opted the political process were were mistaken all along (yes, also with a straight face!): the real problem, argues Leonhardt, are those greedy doctors who won’t accept being paid a salary and insist on fee-for-service.

(For the record, I personally think that fee for service is a poor way of paying doctors, and as a practicing physician I was on a salary most of my career, and loved it, but it is not fee for service that explains why we pay over twice as much for health care as do Canada or Taiwan, both countries that rely heavily on fee-for-service to pay doctors — it’s the administrative overhead coming from our crazy ”choice of plans”-based system, and our lack of collective purchasing power which leads to, for instance, our paying the highest prices on the planet for pharmaceuticals and other services).

And still, some a#@$%#@#$ in congress keep on screaming at the top of their lungs about the “dangers of socialized medicine”, and appealing to the politics of fear,  that has been so successful in the past, to remind us about the long lines to see a doctor in those early winter mornings in “communist countries” such as Canada, the UK, or Germany.

To the point that some folks in Canada got so mad about the malicious misrepresentations of Canadian health care that they even wrote a letter to President Obama, demanding that this misrepresentation stop. Indeed, a recent major Canadian survey showed that Canadians have excellent access to primary care and that 92% of them would even recommend their family doctor to a friend, far more than any of the “happy carriers of private insurance” in America can say, constrained as we are by in-network lists of doctors, hospitals, and the like.

Okay, back to the “what’s in for me in a single payer system” question. How can I compare its benefits to what Washington insists on selling us (or rather, ramming down our throats)?

Here’s an excellent comparison back to back between corporate supported health care reform (yes, even AARP, a major seller of for profit private insurance, congratulated Congress for the plan!) and single payer.

And if all this makes you mad, you can keep faxing your legislators demanding real reform (it’s easy and free…). Or support, or even join, MadAsHellDoctors (students in the health professions are welcome!).

It’ll take many, many of us….