On health care politics, why not demand the best?

Posted June 22, 2009, at 7:12 p.m.

Why is Barack Obama dodging a single-payer option? Care would be publicly funded, but privately delivered. People would go to the doctor of their choice. Obama recently answered: “If I were starting a system from scratch … a single-payer system could … make sense. [Now] we are entrenched in the current system. We don’t want a huge disruption.”

Our health care system is broken. Under our system, health care expenditures are projected to skyrocket from 18 percent of GNP to 34 percent by 2040. Starting from scratch is the practical course. Decades ago corporate health care giants falsely assured citizens that competition would slow health care inflation. Now they promise to cut costs and compete fairly — as long as they get subsidies and regulators treat them gently.

Health care is a right, not a commodity to be bought and sold on markets. Treating it as a commodity impoverishes us both morally and economically. Health insurance is at best a means to an end, just like banks. Neither banks nor insurance companies produce usable goods. Health insurance companies do not and should not compete over which can deliver the best bypass surgery. Since neither delivers direct benefits, the size and rewards to both, as to any middleman, should be as limited as possible.

The U.S. economy is in dire straits in part because unregulated banks went from channeling capital to marketing bets on the future of their own and others’ loans. Private health insurance is a speculative play on the health of each of us. One recent New York Times letter provocatively asked: “Why would any educated society rely on a health care system that has a stated fiduciary responsibility to extract as much money from its customers while giving them as little care as possible?” It meets that responsibility to shareholders by avoiding those deemed likely to need care and denying as many claims as possible.

This debate is trapped in a vicious circularity. Single payer is a nonstarter because Obama and Sen. Max Baucus deny it the visibility they afford corporate health care plans. Corporate interests use our money to buy ads telling us that government-funded health care means federal bureaucrats micromanaging doctor-patient relations and waiting lists.

Public health advocates have demonstrated that public systems give patients more choices with fewer shortages than corporate health bureaucracies provide. Longevity is greater. Health care consumes less domestic GNP and citizens lose less time wrangling with bureaucrats. Unfortunately the public health advocates lack the resources to gain access to our media or money-drenched political process.

We don’t break this vicious circle by dwelling on the obstacles, a self-fulfilling prophecy. Let’s fight Obama’s demand that we do health care quickly. It must be done right — after all voices are heard. Let’s take lessons from unions’ best corporate campaigns. These involved not only workplace organization but also pressure on institutional stockholders and board members.

Some hospitals and hospital associations endorse the current system. What if we told the nonprofit hospitals seeking charitable contributions how their stance might affect our giving? What if the many nurses and doctors who are repelled by corporate health care not only demonstrated, as many bravely have, but also asked their patients to write, call, e-mail friends, papers, politicians? Can we pressure local and national media to cover single payer fairly? Here in Maine, we should follow and publicize the money trail. How much is Sen. Olympia Snowe receiving from these titans and to whom is she responding? There are more modes of interconnection and ways to convey displeasure than any of us can imagine, but once we start the process can build on itself. That Baucus and Obama even mentioned single payer reflects some progress.

Finally, we should demand the whole enchilada. Some reform advocates argue that a public option alongside the corporate plans is the best we can get. I worry that such a program will become a costly dumping ground for the most ill unless there are strong, well-enforced rules on corporate cherry-picking and the public option has full, immediate freedom to market itself and negotiate with health providers. But whoever is right, advocacy of single payer is vital both to assure the best public option and to continually remind citizens of the burdens corporate health insurance imposes on any health system.

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In my June 9 column, I should have said abortion rates declined more slowly under George Bush. Abortions also became more concentrated among low-income and minority women. (For details and interpretation, see www.GuttmacherInstitute.org).

John Buell is a political economist who lives in Southwest Harbor. Readers may reach him at jbuell@acadia.net.

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