Incremental Health Reform: Whose Life Doesn't Count?

Listening to the purveyors of conventional wisdom, you might think only an incremental approach on healthcare reform is possible.

The most comprehensive reform, HR 676 in Congress, (and its state versions, such as SB 840 in California), providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible.

So, the pundits insist, settle for what we can get. Lower the expectations and turn down the public heat, they advise.

Gradualism - extending health coverage to some - is the mantra of the day, fawned over by some politicians and advocacy groups alike. The staged appearance of "bi-partisanship" or "strange bedfellows" for health reform is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.

Virtually all the gradual reforms being touted would reinforce a dysfunctional system with as many standards of care as there are dollars to purchase them. It would further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

For the proponents of political expediency, the question remains who will be left behind while we wait?

Every year, 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health coverage.

Among those un-covered, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment. Heart attack victims are less likely to receive angioplasty. People without pneumonia are less likely to receive X-rays or consultations. Those with colorectal cancer are 70% more likely to die within three years.

The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.

The public is fed up, and they're ahead of the politicians and policy wonks. A New York Times/CBS poll last month found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

As the polls show, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, provides one of the best arguments against incremental steps. When Medicare was enacted 42 years ago, following a broad grassroots campaign, many believed the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions - higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

Similarly, incremental healthcare reforms in Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee, that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured.

Moreover, by pushing further away the day of real reform, we open the door to some of the worst alternatives, from the Bush administration tax schemes to the current fad of forcing everyone to buy insurance.

Both of these schemes end up saddling people with high deductible insurance plans that more and more people are finding accelerate the healthcare crisis.

In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have "substantial problems paying their medical bills." And, a new study this week by Harvard Medical School researchers in the Journal of General Internal Medicine documented that the financial burden of such plans is especially onerous for women who typically need more routine medical visits than men, and thus bear double the out-of-pocket costs.

It's time to stop promoting inferior approaches and insist on real reform.

American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.