Featured Commentary
Posted July 1 2010
"In Health Care, Some More Equal Than Others"
Christine Adams, Ph.D.
Statewide Secretary, Health Care for All Texas
I recently visited my father’s grave at Arlington National Cemetery. He received the Silver Star for risking his own life to protect his men during an ambush in WWII. He received the Purple Heart for the permanent, disabling wounds he received in doing so. Like him, the row upon row of patriots resting there embody our finest values: equality, justice, and sense of duty to our family, friends and larger American community.
Sadly, our health care system fails to live up to these core American ideals. In our present system, some people are apparently more equal than others, more worthy of life and good health. Take just one example: nearly 45,000 people die each year in the United States because they lack health insurance and can’t get the timely medical care they need, according to a recent Harvard research study (“Health Insurance and Mortality in U.S. Adults”. American Journal of Public Health, Sept. 2009).
Our fragmentary distribution of health care is unfair, even merciless. All other industrialized nations have based their health care systems upon the moral principle that everyone deserves protection from illness and suffering. Our system is based on profit. We have market-driven health care that excludes those who can’t pay. People you know. People like you.
Why is supporting health care for all so hard for Americans? We’re a moral, generous, caring nation. We don’t believe people should suffer or die from lack of money. However, we also believe people should be responsible and self-reliant. Americans hate freeloaders. Our values are in conflict, creating a serious dilemma. We don’t want good people to suffer, but we don’t want our generosity exploited, leaving us vulnerable to suffering ourselves.
The new Patient Protection and Affordable Care Act will have a profound impact on our health care system. Although perpetuating our deeply flawed and unsustainable system, there are a few useful healthcare reforms that will provide some people temporary relief. Medicaid will be expanded, there will be more money for primary care centers, preventive services will be added to the Medicare benefit and reimbursement for Medicaid patients will increase among other positive changes. Unfortunately, the bill still leaves out 23 million Americans and will not control costs. The legislation will not help our health care system become either universal or affordable because it does not eliminate the root of the problem, the for-profit health insurance companies.
The solution that best integrates our values and resolves this dilemma is single-payer national health care or “Medicare for All.” Single payer would be far less costly than our present system, saving about $400 billion annually in wasteful paperwork and bureaucracy. We would have choice of provider with more control over the system through our participatory democracy. And there would be no co-pays or deductibles.
Under an “improved Medicare for All”, citizens would not be “medical-loss commodities” but human beings deserving of compassionate care when they get sick. Because funding would be tax-based (with taxes amounting to less than what we pay now in premiums and out-of-pocket expenses), all would contribute their fair share. Few could cheat or avoid shared responsibility.
In this case, the best moral solution is also the best economic solution.
If we are one nation with justice for all, our health care system must be for all. Without access to quality health care, one’s right to life, liberty and pursuit of happiness is abridged. My father and his Arlington compatriots sacrificed for all, not some, Americans. As long as we have inequality in our health care system, many of us remain less equal than others, not because we’re undeserving or irresponsible, but because we simply don’t have enough money. That’s immoral and un-American.
Posted June 10, 2010
HCFAT Blast
Why Health Care is a Human Right: Balancing the Rights of the Individual with the Public Good for a Civil Society.
(On May 14, 2010 Health Care for All Texas participated in a debate at Baylor College of Medicine on health care as a right. Read our opening and closing statements in support of health care as a human right.)
The U.S. stands alone as the only industrialized nation that has not declared health care as a human right and as a result has not established a national health care program. In the U.S., the clash over whether health care is a human right is fundamentally a disagreement over inalienable rights.
In brief, the term inalienable rights refers to "a set of human rights that are fundamental, are not awarded by human power, and cannot be surrendered." Rights are either negative or positive. A negative right is basically the "right to be left alone, to not be acted upon, especially through coercion." Among some rights considered negative rights are: freedom of speech, freedom of worship, habeas corpus and ownership of property. A positive right permits or obliges action. Rights considered positive rights include civil and political rights such as police protection of person and property and cultural or economic rights such as public education, health care.
Certainly, there are legitimate concerns about what to establish as a right because whenever one right is established, it inevitably intrudes on another right. However as Thomas Hobbes noted, if we wish to live in a peaceful society we must “give up most of [our inalienable] rights and create moral obligations" in order to establish a political and civil society. So the debate is really about to what degree an individual must give up some inalienable rights in order to live in civil society.
One of the most bizarre claims made by some opponents of a national health care program is that if health care is established as a human right in the U.S., doctors would be required to treat for free anyone who wanted health care. This implausible claim is designed to scare the public and health care professionals. Clearly upon reflection this would never happen. No doctor or health professional or facility would be forced to work involuntarily.
What would actually happen if the U.S. established the right to health care would be the creation of health facilities, goods and services, such as hospitals, doctors and drugs, that would be of good quality and available to all, on an equal basis. All health professionals would be paid for their work and would not be required to work for free against their will.
Fear that we cannot afford universal health care is another significant obstacle to establishing health care as a right. But in the case of health care, universal, high quality health care is quite affordable – if we eliminate the for-profit health plans from our health system. Such a change would not decrease the quality or scope of services. Instead, it would redirect health care dollars that are now spent on wasteful administrative costs by insurance companies and advertising by pharmaceutical companies, as well as eliminating unjustified and excessive private sector profits.
The United States is already the world’s biggest health care spender, exceeding countries that provide universal access to health care. According to the U.S. government’s General Accounting Office, “If the U.S. were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage.” Establishing health care as human right and creating a national health program where access to health care is affordable and based on need, not on ability to pay, is morally right and economically better for our nation than keeping the current system.
Dr. Margaret Nosek
Department of Physical Medicine and Rehabilitation
Center for Research on Women with Disabilities
Baylor College of Medicine,
Health Care For All Texas
Single Payer is health care based on need, not ability to pay
Huffington Post Op-ed July 27, 2010
Quentin Young, M.D., National Coordinator
Physicians for a National Health Program
RX for Medicare: Expand it to All
Medicare, one of our nation's most cherished social programs, turns 45 on Friday. I was in active medical ractice when, o July 30, 1965, Medicare was signed into law by President Lyndon Johnson. The law's...
Houston Chronicle Op-ed July 30, 2010
Christine Adams, Ph.D., Statewide Secretary
Health Care for All Texas
After 45 years, Medicare needs support
July 30th marks the 45th birthday of Medicare the public insurance program that guarantees basic medical coverage to all seniors and people with severe disablilities of their income, health status or where they live. In Texas...
Op-ed Houston Chronicle 2009
"Medicare-for-All' Cure for Health Woes Single-Payer System is Best Reform Approach"
Dan Wirt, M.D.
Health Care for All Texas
Physicians for a National Health Program
The data and evidence are clear: To a scientific certainty, only a single-payer "Medicare-for-All" system of health care financing will solve the serious cost and access problems and achieve good, affordable health care for all in the United States. As a scientist and physician, this is my conclusion after studying the data for years. The data are voluminous, stretching back to World War II, and come not only from the United States, but from all other industrialized countries. Except for the United States, all industrialized countries have some form of universal health care.
Americans are increasingly afraid that they can't afford to get sick, and with good reason. About half of all personal bankruptcies are caused by medical expenses, and 76 percent of these individuals had health insurance when they got sick or injured. Those of us with insurance are paying a greater share of the premium and more deductibles and co-pays as well. Thus, not only do we have 46 million Americans without health insurance, but at least an equal number who are seriously underinsured. With the recent economic downturn, the ranks of those who are uninsured and underinsured are growing. Many are faced with choosing between paying for medicine and needed health care and paying for food and housing. A typical story is: get sick or injured, lose your job, lose your health insurance, go bankrupt. A majority of physicians (59 percent) and an even higher proportion of Americans (at least 62 percent) support single payer national health insurance or "Medicare-for-All". In spite of this, virtually all we are hearing about today are mandate plans that would require everyone to buy the same private for-profit insurance that is already failing us. The for-profit insurance companies and their plethora of plans make for a terribly complex, fragmented, costly and inefficient system. Administrative overhead consumes about 31 percent of health care dollars in the United States, and the for-profit insurance companies are responsible for half of this, or 15 percent of $2.4 trillion. This money, more than $350 billion per year, provides no health care: it is consumed by enormous administrative costs, profits for investors and shareholders, and large salaries for managers of these for-profit insurance companies.
All of the incremental reform programs proposed - tax subsidies, health savings accounts, individual or employer mandates, increased regulation of for-profit insurance companies - keep these proverbial foxes in the henhouse and are doomed to fail to control costs and provide universal access. Competition among the foxes does not benefit the chickens, the patients, the doctors or the hospitals. The for-profit insurance companies fundamentally reduce choice - your preferred doctor or hospital is "out-of-network"? Too bad, we won't pay, says your insurance company.
The data are in. Incremental reforms, mostly mandate schemes which retain the for-profit insurance companies, have been tried in seven states over the past two decades: Massachusetts, Tennessee, Washington, Oregon, Minnesota, Vermont, Maine. In all of these states the reforms have failed to contain costs. In all but Massachusetts, they have failed to reduce the number of uninsured. In Massachusetts, there has been a modest decrease in the number of uninsured, falling from 13 percent of adults in 2006 to 7.1 percent of adults in 2007, but at the cost of a substantial increase in public spending (spending for "Commonwealth Care" was $629.8 million in fiscal year 2007, $1089.2 million in fiscal year 2008 and $1317.7 million in fiscal year 2009). Most of the gain in Massachusetts has come from expanding Medicaid and subsidizing the purchase of private insurance; very few people have signed up for the unsubsidized private insurance. Not to mention that 7.1 percent uninsured is unacceptably high. Far from controlling costs, these mandate plans will add hundreds of billions of dollars to the nation's health care costs.
The United States spends about twice as much per capita on health care as other industrialized countries. Yet it is a myth that the United States has the best health care in the world. The United States ranks near the bottom of industrialized countries in terms of important morbidity and mortality outcomes (for example, life expectancy and infant and maternal mortality).
About 18,000 American adults die unnecessarily every year due to lack of insurance (Institute of Medicine, 2002). As reported in the Archives of Internal Medicine in 2003, repair of an aortic aneurysm cost $8,647 in Canada and $13,432 in the U.S.
What accounted for the substantial difference? Most of the difference was due to much greater overhead costs in the U.S. The surgeons and surgical facilities are top-notch in Canada. The surgeons are very well paid. The difference is that Canada has adopted a true insurance system for financing health care, one that spreads risk across a broad population: a publicly funded single-payer national health insurance plan that eliminates the parasitic, investor-owned "insurance" companies that make profits by enrolling the healthy, screening out the sick and denying claims.
Single-payer national health insurance for financing health care is NOT "socialized medicine." Under a single-payer, "Medicare-for-All" system, delivery of health care remains private. The providers of health care remain private. Patients choose any doctor and any hospital.
Parenthetically, replacing the wasteful for-profit insurance companies with a single-payer national health insurance program for financing health care in the United States would save enough money (more than $350 billion) to not only achieve universal coverage, but allow the coverage to expand and be more comprehensive.
We have an American system that works. It's Medicare. It's not perfect, but Americans with Medicare are far happier than those with for-profit insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. And keep in mind that Medicare insures people with the greatest health care needs: people over 65 and the disabled. We should improve and expand Medicare to cover everyone. In contrast to the for-profit insurance companies, Medicare has a very low overhead - about 3 percent.
Unfortunately, the for-profit insurance companies have been infiltrating Medicare in the form of "Medicare Advantage" plans, substantially raising costs when compared to traditional Medicare.
A single-payer "Medicare-for-All" system is embodied in a bill currently in the U.S. House of Representatives, H.R. 676, sponsored by U.S. Rep. John Conyers, D-Mich., and cosponsored by 93 other members of Congress. Its features are: automatic enrollment for everyone; comprehensive services covering all medically necessary care and drugs; free choice of doctor and hospital, who remain independent and negotiate their fees and budgets with a public or nonprofit agency; processing and payment of bills by a public or nonprofit agency; promotion of job growth and the entire U.S. economy by removing the excessive burden of health care costs from businesses; coverage for everyone without spending any more than we are now.
The growth in health care costs must be addressed if any proposal is to succeed. Single-payer offers real tools to contain costs: budgeting, especially for hospitals, planning of capital investments (to avoid wasteful duplication and concentration of expensive technology), and an emphasis on primary care and coordination of care. Mandate plans offer only false hopes: competition among for-profit insurance companies, computerization and chronic disease management. Competition among the shrinking number of for-profit insurance companies has already failed to contain costs and, in the absence of single-payer and reformed primary care (so that everyone has a primary care home), computerization and chronic disease management will raise costs, not lower them.
Business leaders are well on their way to understanding how the current system makes their businesses uncompetitive with businesses in industrialized countries that have cost-effective health care systems not based on profit.
Finally, the most important group is patients. We are all sometimes patients. All patients must rise up and remove the foxes from the henhouse.
Foxes are not evil, but their nature is such that they must not be allowed in the henhouse.
February 2010
"Healthcare apartheid and quality of life for people with disabilities"
Margaret Nosek, Ph.D.
The sizzling debate on healthcare reform has very little to do with me as a
person with a significant physical disability, yet it fuels the fire in my belly.
I am well insured because I work and supposedly have access to some of the
best healthcare in the world, yet I continue to receive, and suffer from, some
services that are second-class for several reasons. Our current system is best
prepared to deal with acute conditions; those of us with multiple chronic
conditions are mostly left on our own to manage a bevy of specialists, each
with their restricted, though extensive, knowledge and limitations in their
practice. Trying to find a generalist who has knowledge of wellness in the
context of disability is like trying to find a tofu burger at a Texas barbecue.
There is nothing in the current system of medical education that prepares
physicians on how to keep people like me well. As a result, when I go to see
my internist with concerns about a seemingly common problem, for example,
stomach pain and fatigue, it’s just so easy for her to say ‘‘That’s to be
expected with such an extensive disability.’’ Aside from being an easy out,
disability can mask possibly serious symptoms. The system lacks incentives
to look deeper into a seemingly simple but potentially complex problem and
consult with my other specialists to rule out, identify, and treat.
