Essays
In Good, Affordable, Universal Health Care We Trust
by John Clay
We trust our government—federal, state, and local—to protect us from crime, fire, and natural disasters. We trust our government to protect us from hostile nations through US military power. We trust our government to provide good health insurance—for our older citizens through Medicare, for our lower-income citizens through Medicaid, and for our military veterans through the Veterans Administration. It's time we learned to trust our government to provide good, affordable, health insurance for all—through an expanded Medicare single-payer system or through a well-regulated insurance exchange with a public health insurance option. Health care is not something we can, in good conscience, trust to chance or to the profit-driven marketplace.
Fire companies once were for profit only. Two hundred years ago in London, if you couldn't afford fire protection and your place caught fire, nobody came to help. Neighbors with buckets might do their best, but not the trained fire companies. It seems so primitive and far off now. Yet that is what we do today, right here in America, with health insurance.
The result? Nearly 50 million Americans have no health insurance, and those who do have insurance must pay rising deductibles and premiums and fight against denial of claims. Marcia Angell, MD, notes in an interview with PBS.org, that our life expectancy is shorter than that of other industrialized nations, our infant mortality rate is higher, and we get to see the doctor less often. Our health care system, which should be the best in the world given our nation's abundant resources, instead is thirty-seventh best, according to the World Health Organization. Doctors are frustrated, patients are frustrated, and the healthy among us fear what might happen when we need help.
Whether fire protection or health insurance, government does the job better than corporations because government has one job to do, deliver services, while corporations must balance delivery of services against two other jobs, gaining market share and making money. Medicare delivers services far more efficiently than the health insurance corporations, spending only about 2 percent of its funds on administrative overhead while the health insurance corporations spend about 15 percent. For health corporations, higher overhead represents a stronger marketing arsenal and more robust profits. And as we might expect, the more funds spent on overhead, the fewer the funds available for care. To compete against each others' marketing campaigns and to make money, health insurance corporations have to reduce costs by denying claims and raising rates for those who most need treatment; in other words, they limit and ration care. Donald Trump explains the logic of the marketplace in his new book Think Like a Champion: "Business is about making money.... I'm very often surprised by people who think business is something else. They come in with lofty ideas and philanthropic purposes that have absolutely no place in a business meeting. It's a waste of everyone's time."
Underscoring the industry's upside down view of efficiency in which overhead, which for corporations includes marketing and profits, is something to be increased, the industry's term for payment for care is "medical loss". The patient's gain, getting the care they need, is the company's loss. However, a government single-payer system or public option, as demonstrated by Medicare's efficient use of funds, has no such overhead for marketing and profits and thus no need to limit care. The incentive in government-run public health insurance is to provide care.
The insurance companies oppose public insurance of any kind, but they say they support mandated universal coverage in the form of a law requiring all Americans to buy health insurance. Yet mandated coverage alone, without the counterbalance of public health insurance, would not alter the upside-down incentives of the marketplace. It would make insurance universal but neither affordable nor efficient.
We have all been living uninsured or underinsured or in fear of losing coverage or being denied promised coverage. We all know the health insurance industry has gotten rich just as we have gotten squeezed.
Good health care is essential to our ability to fulfill our human potential, and it is essential to the common good of our nation. The good health care we need has slowly been taken away from us by corporate health insurance. Only an expanded Medicare single-payer system or a well-regulated insurance exchange with a government-run public insurance option can bring it back. Let's tell our representatives that we need single-payer health insurance or, at the very least, a robust public option, and we need it now.
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