Last week, as it has each year for the past decade, the Center for Policy Alternatives, a progressive think tank in our nation’s capitol, convened a meeting of state legislators, advocates, state analysts and savvy resource people from academia and the halls of Congress. They call it “The Summit of the States” and it has become a marketplace of innovative ideas and legislative proposals from across the country, a gallery for the “next progressive agenda” and a peek into which inspirations are building momentum in the legislative arena. This year’s sessions were carried out in an atmosphere charged with the excitement engendered by last month’s great shift in electoral tides. Many first-time legislators who’d benefited from the wave of Democratic victories in previously red states were at the summit, boning up on topics like stem cell research, electoral reform, juvenile justice … and health care.But in the midst of the general optimism over the prospects for hammering out important reforms in the states and nationally, the topic of health care financing stood out as an island of realism, stolidly withstanding all attempts at significant change.It was astonishing to discover that the drift of the session on health care reform was not so much zeroed in on “universal health care” or “health care as a right,” but on the microscopic focuses of “how to make corporations like Wal-Mart pay their fair share of health care costs,” or how some states (like Massachusetts) are making employer-provided insurance the foundation for their health care efforts.What rapidly became clear is that the concepts of single-payer health care or universal health care access are no longer in the middle of the public policy bull’s-eye. They are now further toward the fringe, secondary concerns, even for the progressive community . This is distressing. It is, I suggest, a function of the political punch wielded by the insurance industry, that it has been able to change the focus of the national debate from how to provide health care for all Americans into how to provide medical insurance for more Americans. They have thereby achieved the policy equivalent of transforming a mountaineer’s quest for Mount Everest’s summit into a walk up the La Luz Trail: not an insignificant trek, but certainly not a heroic one … and one that falls completely short of the need.What is beyond dispute is that the American system of financing health care is incredibly successful and lucrative, the best in the world … for insurance companies. What remains undemonstrated is whether insurance companies are good for our health care system.I have come to doubt whether the concept of “insurance” adds any value at all to our provision of medical care. It complicates life for medical care providers–the hospitals, doctors, pharmacists, clinics and labs who actually save lives and restore health, but who have to master the hundreds of billing forms, coverage and drug formularies used to discourage payments. Entire departments of hospitals and full-time clerks in every doctor’s office are devoted to negotiating the complexities of this chaotic system. That in itself adds billions to the cost of American health care, a shuffling of paper which drains resources. In return we get … ?Oh, we get a lot, in fact. We get dropped if we actually develop a chronic condition. We get denied treatment recommended by our doctor. We get drained by the astronomical increases in premiums, co-pays and deductibles the companies are able to levy with impunity if their profit margin dips below double digits.So the resistance to change in our system of financing is, not surprisingly, orchestrated by the insurance industry, primary beneficiary of the current morass. Therefore, we should be forewarned about that industry’s tactic of lowering our expectations from providing care to providing (surprise!) insurance. There is no more classic an example of the tail wagging the dog than the private insurance industry calling the shots on reforming the system, particularly when in New Mexico 75 percent of the health care dollar comes from government and only 25 percent comes from insurance and private pay. Health insurers are the problem, not the solution. Requiring (or alternatively, incentivizing) employers to pay all or a portion of the cost of health insurance is a stop-gap measure, not real reform. That’s a path that will continue to cost taxpayers enormous amounts of unregulated expenditures on behalf of those ill and infirm citizens the private payers choose to exclude (i.e. anyone who costs them money). Health insurance is a trillion-dollar industry in the U.S. It is by far the largest industry unregulated by the federal government, even though Medicare and Medicaid generate enormous profits for the industry every year. Bonanza!By leaving it up to the separate 50 states to regulate the industry, Americans are essentially allowing big insurance to call the shots. If people’s lives and our national treasury weren’t at stake, perhaps we could let the insurers continue in their pleasant pursuit and consumption of tax dollars unimpeded.But this is too important to continue laissez faire. It is time to stop the charade. And we should stop letting insurance companies set the agenda for discussion of health care reform.
The opinions expressed are solely those of the author. E-mail jerry@alibi.com.
