The slippery slope of market-based medicine
Rose Ann DeMoro
As Gov. Arnold Schwarzenegger recovers from his fractured leg, he has access to the finest medical care California has to offer, as he should. But don't all Californians deserve the same degree of medical attention and health care security?
In a few days, the governor is expected to unveil a sweeping health care proposal, following the leaders of the Senate and Assembly, who already have proposed changes to the state's dysfunctional system.
Yet for all the talk of a "bipartisan" consensus for reform -- following years of inaction despite a worsening crisis -- it appears most options being suggested will exacerbate the problem, retard efforts to achieve genuine reform and further enrich the corporate elite in the health care industry who produced the present shambles.
If your head is spinning from reading all the various ideas being thrown around, here's a Cliffs Notes version. Essentially, all the choices can be distilled into two general areas -- patient-based reform with public accountability, or market-based approaches.
In the market category fall most of the alternatives being swooned over today by the insurance companies and others invested in pure market-based solutions, the politicians who cater to them and those pundits who counsel us to lower our expectations. Among these proposals are laws to force individuals to purchase their own insurance; starting health savings accounts; and expanded mandates that employers provide benefits for their employees or pay into a pool for coverage for those without insurance.
Their common theme is a reliance on commercial mechanisms that created the present crisis by sacrificing quality, affordability and access for private profit. And all these solutions are doomed to repeat that cycle.
Consider the current fashion of the moment, the Massachusetts model. Every adult in that state is required to buy insurance coverage by July or face penalties. Subsidies are provided for low-income residents.
But the plan has gaping holes. Parents are not obligated to buy insurance for their children. Moderate-income or even middle-income adults who would have to spend hundreds of dollars more each month for full family coverage may choose to gamble with their children's health or just cut back on other basic needs.
Further, the plans available to middle-income residents typically have deductibles that can run into thousands of dollars. Consumers are likely to foot the bill for many health care services in addition to the premiums the law would require them to pay. And, in the event of a serious illness or accident, they may find their cut- rate plan abandons them to financial ruin.
Consumers are even likely to lose the choice of a physician because they will be forced to pick among the doctors whose services are covered by the low-cost plan they can afford.
The Massachusetts plan is loved by the health care industry because it transfers huge pots of public money to private health care corporations.
Health savings accounts, marketed as "consumer- directed" solutions because they pair a high-deductible plan with a tax-free personal spending account, are similarly catastrophic. HSAs simply shift the cost of coverage from insurers to individuals, promote rationing of care and do nothing to reduce the number of uninsured.
Rather than reduce the bloated 30 percent of every health care dollar spent on administrative overhead and waste, HSAs actually increase administrative costs with servicing fees paid to the financial institutions that are climbing over each other to grab their chunk of this new lucrative market.
By contrast, consider the approach in every other industrialized nation in the world: either a national health system with public administration and public hospitals and clinics, or a single-payer system, with one entity that pays for all health care services with adequate funding to the private caregiver, hospital and clinic of the consumer's choice.
Poll after poll documents that Americans overwhelmingly support either approach. A single-payer system is not just a dream, it's legislation -- HR 676 in Congress, and a measure in California by Democratic state Sen. Sheila Kuehl of Santa Monica, Senate Bill 840, which was vetoed by Schwarzenegger in September. It will be reintroduced in 2007.
While politicians clamor to come up with inferior alternatives, it will be up to all of us to remind them why this country's inferior market-based plans will simply extend our national disgrace.
Rose Ann DeMoro is executive director of the California Nurses Association. She can be reached at .
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