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Miller: U.S. Needs a Holistic, Cradle-to-Grave System of National Health Care

In the 15 years since Congress gave up on universal health care, about 300,000 Americans have died from the lack of health coverage alone, using the government’s own data.

Added to the tragic death toll is the economic toll. More than a half-million individuals and families declare medical bankruptcy every year; most of them have health insurance. Actually, they thought they had health insurance because they pay for insurance. People learn the hard way that when help is really needed for a catastrophic health crisis, private insurance does not protect them from financial ruin.

We stand again as a nation at the same fork in the road on the path to improve access to health care for all of our neighbors and family members.

One choice is the fork that brings us together to weave a safety net. This fork is the Medicare-for-all approach; everybody in, nobody out. Imagine a cradle-to-grave, holistic system based on public health, prevention, wellness, a medical home for everyone and — according to the Congressional Budget Office — doing all of this while saving money. This is the single-payer choice.

Then there is the other fork: forcing everyone to have insurance by building on the current broken system. This is the déjà vu path. Choosing this path continues corporate rationing, procedure-based sickness care, out-of-control costs and obscene CEO and executive compensation. During the last debate on universal health care, Congress fell for industry promises of savings through an expansion of managed care. After a year or so, all voluntary “savings” were gone and the bad old days of skyrocketing costs were back.

Secret Bailout

It’s bailout fever now; every corporation and industry wants theirs. Some are out in the open like Wall Street, American International Group and the automakers. One big corporate bailout is secret, disguised as a uniquely American way of doing business.

I’m talking about the for-profit corporate sickness insurance industry. An industry that takes in money, lots of money, much of it from us, the taxpayers, and in return pays for as little health care as possible to maximize profits for their investors.

It is strange to listen to the Members of Congress criticize the Big Three automakers, when at the same time they not only continue to support, but even propose expanding the for-profit, corporate health insurance industry. At least automakers make something. They have the capability to retool and build better and more efficient cars, light rail, solar panels or even better mousetraps.

Strategy for Passage

There are two issues on the table. First is the fate of the various “reform” bills as they continue to be introduced and move through Congress, and second is the strategy for actually passing reform this year. Watching the same mistakes that killed the Clinton-era reforms being made again — by Democrats and Republicans — is painful.

There are three health reform choices being proposed this year. One choice is the completely public option, universal, single-payer social insurance, which the president and Congress are trying very hard to keep “off the table.” The middle ground has an insurance mandate with an individual choice of either private, likely for-profit, insurance or a public insurance plan, for example, buying in to Medicare. The third option provides the least choice, a mandate to buy private insurance.

This is where strategy matters. By leaving the universal, social insurance option out of the debate, it is easier for the industry, media and some Members of Congress to paint the mixed public-private plan as an extreme rather than what it is — the middle ground. And while not ideal, the mixed plan is a place for Congressional compromise.

Why are powerful people afraid to give us the right to choose a public plan? Are they afraid we will learn that more than $1 billion every day is wasted on insurance overhead? Or that more than a trillion dollars bleeds from the health care system every two and a half years — money not spent on health care but on insurance administration, advertising, marketing and corporate profits?

In surveys of the American people, Medicare is always ranked as the best and most popular government program. If Congress fails to enact a universal social insurance plan, enrolling in Medicare or a new public program must be a choice for the uninsured and underinsured.

If we are lucky, we will see real courage from Congress this year. Every Member knows that sooner or later, because of the economics, the United States will join the rest of the developed world and create a national health plan. This is privately conceded even by the biggest insurance industry boosters on Capitol Hill. Without real reform, there will be more tinkering at the edges until the tsunami of medical costs finally forces the government to do the right thing.

During these challenging economic times, we have the chance to complete the promise of full social insurance. Universal access to health care has been deferred for 74 years since it was stripped from the Social Security Act of 1935 — and that is long enough.

Carol Miller is a rural and public health activist who lives in a small village in Ojo Sarco, N.M. Miller has public service in Washington, D.C., in both Republican and Democratic administrations, including the Clinton Health Care Task Force. In 1994 she was the health reform policy adviser for the National Rural Health Association and the New Mexico secretary of health.

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