Written by LAMAR HANKINS   

Freethought San Marcos

Why health insurance reform is an essential government responsibility

Sixty years into the health care-for-all debate, some people continue to call health insurance reform socialism. If, by socialism, such people means that the control and operation of the health care system will be done collectively by and through the government, the proposals now before the Congress are not socialism. Even the public option, Medicaid, and Medicare are not socialism. None of the proposals before the Congress place the government in the position of providing health care. Of course, health insurance companies do not provide health care either. They merely pay for health services provided by mostly private parties, such as physicians and hospitals, with money collected from individuals and businesses. But for most Americans, the health insurance corporations do control access to health care.

Our representatives (or a majority of them, at least) and most Americans have concluded that the present private health insurance system is a colossal failure because too many of our citizens do not have access to adequate health care. With nearly one-third of our population without any health insurance or with health insurance so inadequate that they are one major illness away from personal bankruptcy, it is clear that our present health insurance system does not work well. These nearly 100 million Americans cannot afford adequate health insurance, which Medicare provides to seniors, those with renal failure, and some people who are disabled.

The health insurance market is a failure. Sadly, people blinded by the ideology of free markets as the solution to all ills are willing to sacrifice the lives of others for their ideology. And the lives of others are being sacrificed. The American Journal of Public Health reported two months ago that about 45,000 people per year in the U.S. die because, without health insurance, they cannot pay for health care.

The values I grew up with and try to live by compel me to conclude that people’s lives should be more important than ideology. With respect to health insurance, the free market is a failure. I will listen to anyone’s ideas, no matter what they are called, if they work, but the free market has failed us in this instance.

Research published in several medical journals concludes that “The Canadian single payer healthcare system produces better health outcomes with substantially lower administrative costs than the United States (healthcare system).” In Canada, as most readers probably know, the provincial governments collect taxes (and some collect modest insurance premiums) and pay the health insurance costs for their citizens, much as health insurance companies in the U.S. are supposed to do, except that all Canadians are covered without regard to pre-existing medical conditions. In Canada, there are federal standards which must be followed by the provinces.

But in America, our health insurance companies will not provide health insurance for most pre-existing conditions. Yet, our health insurance companies enjoyed record profits this past year (as well as throughout the past decade) and the largest such companies are preparing to raise their rates by incredible amounts. The five biggest for-profit health insurers–UnitedHealthGroup Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp.– reported profits for 2009 up 56 percent from 2008.

Anthem Blue Cross (owned by WellPoint), the largest health insurance provider in California, plans to raise rates for individual policyholders by 39%. Anthem is requesting a rate increase in Maine of 23% and 50% in Indiana, with double digit increases in eight other states already being sought. Health and Human Services Secretary Kathleen Sebelius warned last week that rates in at least six states could go up by as much 56 percent. Exorbitant increases in insurance premiums, refusal of coverage for pre-existing conditions, and denial of claims by existing customers are all evidence of a broken system. The health insurance market is not working for a substantial segment of the population. In such circumstances, the government is the only hope for America’s families.

The health insurance companies are doing what they are supposed to do–make as much profit from our cancer, heart attacks, broken bones, prostate problems, asthma, and strokes as possible. But the American people have seen that making profits has not been the solution to our health insurance needs.

This is why the public options that already exist in this country are so popular–Medicare, VA health services, and Medicaid. These programs have provided affordable health care to millions of Americans. Now the rest of us need access to equally good programs so that we cease being the victims of the corporatization of health care in this country.

The simplest way to compel the health insurance corporations to alter their practices so that most Americans can receive adequate health insurance is to allow anyone to buy in to Medicare. But as most people realize, Congress–under the influence of corporate lobbyists–seldom seeks the simplest solution to social and economic problems.

Current proposals to provide meaningful health insurance reform provide that those who like their present health insurance coverage can keep it. Such reform would make available affordable coverage through subsidies and tax credits to those who need help for whatever reason, whether a job loss, inadequate income, or excessive insurance premiums that exceed a certain specified level relative to their income.

Acceptable reform will help small businesses with insurance coverage for their employees. And seniors will receive improvements in their Medicare so that preventive care is fully covered, their drug costs don’t end because of the exclusion (called the donut hole) after their prescriptions exceed $2830 a year, greater access to community and home-based care is provided, insurance company gouging for Medicare Advantage programs is ended, and better efforts are made to expose and correct fraud, waste, and abuse among Medicare service providers.

For those with private health insurance plans, adequate government reform will require that at least 80% of insurance premiums are spent on health care, not insurance company overhead and profits. And all preventive care should be covered. Incentives should be provided to physicians to serve under-served areas, particularly in rural parts of the country, and to provide primary and geriatric care, practice areas where we have a shortage of doctors.

Worthwhile health insurance reform will assure that health insurance companies are subject to our laws prohibiting price-fixing and collusion in the marketplace. To accomplish this, the anti-trust exemption should be abolished.

The Republican position on health insurance reform seems to be that these matters should be left up to the states. This position has appeals to states’ rights voters, but it is virtually without merit. Except for Massachusetts, few states have even tried to fix the private health insurance mess and are unwilling to tackle the problem in a meaningful way. Since the states won’t do it, it is left to the federal government to make the system work for all Americans.

A public option–like Medicare–will rein in the health insurance corporations’ abuses or they will lose business because they don’t provide an adequate product. In recent polling in Nevada, Illinois, Washington, Missouri, Virginia, Iowa, Minnesota, and Colorado, independent voters polled said that they want a public option by ranges from 56% in Missouri to 69% in Illinois. Democrats support the public option by overwhelming majorities. Only Republicans don’t seem to care that the system is broken and needs public competition or reform to correct the imbalances and abuses in the private system.

Many of us understand the United States as a cooperative venture among our people, a kind of social contract, which underlies our system of government and is reflected in the preamble to our Constitution:

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

There is nothing in the Constitution about the private market model and that model does not represent how the American economy has worked throughout our history. From its beginning, Americans have accepted this proposition: If the marketplace cannot or will not provide a good or service needed by the people, the people have the right to satisfy that need through their own cooperative efforts, whether through private cooperation or through cooperative government action.

As proof, look at all the credit unions, consumer cooperatives (providing housing, water, electricity, telecommunications services, child care, health care, food, books, and funeral services), producer cooperatives (owned by people who produce products, such as farm crops, cattle. milk, crafts and other artistic products), worker cooperatives (businesses owned by workers, including employee-owned food stores, bakeries, restaurants, taxicab companies, sewing companies, timber processors, and other industrial manufacturers), and government cooperatives (businesses, cities, and state governments have banded together to purchase goods and services that they need in order to lower costs, improve services, and increase competitiveness).

While all of these kinds of cooperatives are vital to the economic health of the nation, they exist alongside profit-making businesses that offer the same or similar goods and services. Cooperatives usually exist where the private market has failed to provide people something they need, at a price they can afford, and on terms they find acceptable.

Our government as a kind of cooperative venture operates under different rules and structures from those followed by either the private, market-driven sector, or the cooperatives sector. Government usually provides streets, roads, and highways; fire and crime protection; schools; libraries; recreational facilities; airports; sewer services, garbage collection, and recycling services; water, electrical, and gas utilities; low-income housing and a range of social services, including health care and health care insurance for the elderly, children, the disabled, those with special medical conditions, and the military (TRICARE and VA).

It is the government’s responsibility, acting on behalf of the people, to make our society work for the people’s benefit when the socioeconomic system has become dysfunctional. When that dysfunctionality results in the unnecessary deaths of tens of thousands of Americans each year, that responsibility becomes an imperative.

For nearly 100 million Americans, having meaningful health insurance reform will do more than almost anything else at this time in our history to assure that the promises of that preamble are fulfilled. It is time for Congress and the President to give us a government of, by, and for the people, not of, by, and for the giant corporations who now control access to the health care system.

© Freethought San Marcos, Lamar W. Hankins

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