The Blog

Uninsured, Out of Work and No Public Option? Now <i>That</i>'s Un-American

As a physician taking care of people who are losing health care coverage, it's astounding how much distortion I hear in the news about what the president's plan will do to citizens if it's enacted.
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As a physician taking care of people who are losing health care coverage, it's astounding how much distortion I hear in the news about what the president's plan will do to citizens if it's enacted. Many of us are in such a state of media-propelled fear and panic that we can't think straight.

Here's four facts every American should know:

• 46 million Americans -- 18% of the American population under 65 yrs of age -- are without health insurance

• The majority of Americans who are uninsured are native or naturalized citizens - 85% of the population

• 7 million more Americans are projected to lose their health insurance not due to job loss between 2008 and 2010

• Even when employees do work in a job offering health insurance they often choose not to take it because it is so expensive

Fear of excessive delay in medical diagnosis for critical medical problems such as cancers is one argument proposed against the public option. People who hear this argument seem to forget that we already have experience in a publicly-run medical care system; it's called Medicare. It's basically a public option model and it works. True, it has budget problems and over the years we have modified it, but it denies no one timely medical care.

The second argument against the public option is that medical insurance will self-regulate itself. This just isn't so. Health care costs have been skyrocketing since the 1970s. Markups hidden in medical expenditures are pervasive. Take medication costs: we still have over a 60% mark-up for pharmaceuticals in the U.S., leaving Americans scrambling to purchase their medications on-line from overseas in order to save money. Premiums continue to rise, primarily because insurance companies devised highly restrictive systems called "managed care" supposedly to contain costs but they continue to pay millions in salaries and bonuses to their top level CEOs. Over a 5-year period ending in 2005, $14.9 billion was paid out to executives of the top 23 health care companies. With this track record what makes anyone think that self-governance of the private health care sector is possible?

Each day, $1.4 million is spent on lobbying against the public option. The Pharmaceutical Research and Manufactures of America (PhRMA) spent nearly $7 million in the first quarter of 2009 to maintain the status quo. It's a clear case of David and Goliath; Main street versus Wall Street with a substantial media blitz pushing the panic button on the public's fears of decreasing health care access. (Funny how we're not hearing any discussions of curtailing CEO bonuses or stock option grants.)

An option is not a mandate. An option is a choice, there will still be private health insurance if we have a public option for those who desire it. If we have a public option, 46 million people who have no insurance will be able to get some medical care without waiting until death is knocking on their door. If we have a public option the government will finally be able to bring down that 60% markup on pharmaceutical medications so average Americans can afford their prescriptive medications and basic health coverage.

The inscription on Statue of Liberty seems sadly out of sync with the realities of our time:

"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me.
I lift my lamp beside the golden door."

This inscription seems designed for recruiting cheap labor from overseas, and the allusion to the "tired and poor" now realistically describes not only to the newly arrived but also the huge number of American citizens who are denied "a lamp beside a golden door."

We need a public option and we need it now.