Now that we have a new president espousing health care reform and a Democratic majority in both houses of Congress, isn't this a time to be excited and optimistic for long-overdue reform? Much as we would like to say "Of course!", we cannot. The "reform" effort is already way off the track, despite the hype of "progress" in the uncritical mainstream media.
So what's going wrong? For starters, not all interests are at the negotiating table; noteworthy in its absence of advocates for the public interest. Fundamental questions as to the goals of reform are not being asked, and in fact are being kept out of the discussion. These questions include:
Who is the health care system for (e.g. patients and their families vs. corporate
market stakeholders and their investors)?
As a basic human need, is health care a right or not?
Should our system be based on the for-profit business model or a not-for-profit public financing system of social insurance?
Are there any alternatives that will actually save money?
Should the debate be based on evidence, ideology, or political power of the stakeholders in the present (failing) system?
The "debate" over health care reform has already been taken over by the very interests who are themselves a big part of the problem (reminds us of the banking industry and the bailout in process). True to their business model, the insurance, drug, medical device, medical equipment and related health care industries are naturally more interested in their future markets, profits and returns to investors than building a sustainable system of universal access that would rein in their profiteering and hold them more accountable to the public interest. For them, health care costs are revenue, and the "reform process" is an opportunity to protect and expand their future financial wellbeing.
And so we see the people, who are gathered around the White House's Health Care Summit table or invited to hearings of the Senate Finance Committee, are all committed to building on the flaws of our multi-payer, market-based system, despite all the evidence to the contrary. And in fact, health professionals and activists for the only reform alternative that can actually save money while guaranteeing universal access (single-payer Medicare-for-All), are being excluded and even arrested if they "act up or disrupt" hearings.
While everyone agrees that the soaring and increasingly unaffordable costs of health care should be the principal target of reform, the rhetoric and behavior of the stakeholders, predictably enough, do not match. These examples illustrate the point:
• Many of the stakeholders around the negotiating table have signed on to a voluntary effort to trim $2 trillion from health care spending over the next ten years; these include the American Medical Association, the American Hospital Association, and the trade groups for the insurance, drug and medical device industries. This pledge is based on such vague promises as increasing prevention and wellness programs, better management of chronic illness, reducing hospitalizations, and expansion of electronic medical records. But there is no plan, accountability or credible evidence that any of these approaches will cut costs, and such an effort is already raising antitrust concerns. So this ends up as a vacuous gesture of goodwill in an attempt to avoid major change of the health care marketplace.
• While raising their premium prices at levels four or five times the cost of living and family incomes, and continuing to engage in questionable marketing practices, America's Health Care Plans (AHIP) fight fiercely against a competitive public option; in the individual market, Blue Cross Blue Shield of Michigan is raising its rates this month by about 50 percent; AHIP pledges to guarantee issue to all comers, but only if the government mandates that everyone should have insurance and provides subsidies to lower-income people to purchase coverage -- quite obviously an enormous windfall for a failing industry.
• Even as AHIP postures about opening up its coverage policies and better policing its marketing practices as part of health care reform, Blue Cross Blue Shield of North Carolina stands poised to launch a large disinformation ad campaign against a public plan option if it becomes part of a reform package.
• The Lewin Group, a well-known health services consulting firm, has carried out studies comparing various financing alternatives in a number of states (e.g. California, Vermont, Maryland, Georgia), concluding that single-payer is the only way to provide universal coverage and still save money; however, the Lewin Group was bought last year by Ingenix, in turn owned by UnitedHealth, the second largest insurer in the country; is it any surprise that Lewin's spokesperson before the Senate Finance Committee was recently silent on the advantages of single-payer?
• PhRMA spent $47 million on lobbying in the first quarter of 2009, one-third more than last year, and many drug companies are raising their prices by 15 to 20 percent and more.
• HCA Inc, an investor-owned chain of 166 hospitals across the country, is reporting that its income before taxes nearly doubled in the first quarter of this year, even though it had fewer hospitals and its admissions declined; Richard Scott, former CEO of HCA until he was forced to resign in 1997 in what became at that time the largest fraud case in American history, now heads up an astroturfing organization, deceptively named Conservatives for Patients' Rights, that plans to spend some $20 million to kill an Obama health reform plan.
• As opposition gathers on both the left and right of a developing reform proposal, political compromises under the banner of bipartisanship progressively dilute the proposal itself. Showered as they are on both sides of the aisle in Congress by campaign contributions from stakeholders in the medical-industrial complex, legislators seek out political cover of a watered-down bill. Senator Charles Schumer proposes that any public option, if it survives, play by the rules of private insurers, while Blue Dog Democrats rise up against such a public option. The Center for Responsive Politics has documented that fundraising by the average U.S. senator more than tripled over the last eight years; Senator Max Baucus, adamantly opposed to the single-payer option as Chairman of the Senate Finance Committee, raised more than $11 million during the 2003 to 2008 election cycle, including more than half a million dollars from each of three industries -- insurance, pharmaceuticals/healthcare products, and health professionals.
So the snake oil is flowing, the political trap is set as moderates and centrists run
for cover in a bipartisan attempt to craft a "reform" bill that won't upset the stakeholders too much. Ideology and bald political power are controlling the "debate", which appears certain to derail serious health care reform. Left out of the equation are the track record of the stakeholders, a sense of history, and the interests of the growing population that can no longer afford health care. We seem to have forgotten that the passage of Medicare and Medicaid in 1965 was a bitterly fought battle down to the last vote, without any semblance of bipartisanship. As George Bernard Shaw observed many years ago: "We learn from history that we learn nothing from history".
Under these circumstances, no bill is better than a bad one that will not rein in costs and will set back health care reform for years to come. Future posts will consider some of these issues in more detail.
John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008 by John Geyman. With permission of the publisher, Common Courage Press
Buy John Geyman's Books at: http://www.commoncouragepress.com/index.cfm?action=book&bookid=376