February 21, 2020
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Affordable, functional health care

The health care reform bandwagon is rolling in Washington. Committees in both houses of Congress are at work on health care reform, and many politicians are saying “now is the time.” But meaningful reform is about a lot more than getting a few more people “covered.” It must also be about reining in the out-of-control cost, making sure health care is affordable and accessible to everyone and assuring that the right number and types of health professionals are there to care for the millions who are doing without decent health care.

Some in Congress want to require every American to buy private health insurance as a way to reach the goal of universal coverage. But private for-profit insurance is the wrong way to finance a universal system of health care. Contrary to their branding efforts, health insurance companies are not really in the health care business. They are financial services companies. Their business model resembles those of banks more than those of health care companies.

As if they were trying to prove this, when Maine enacted legislation some years ago requiring insurers to accept anybody who applied (guaranteed issue) and charge all policyholders in the same class the same premiums (community rating), most health insurers withdrew from the state. Anthem, Maine’s only remaining for-profit insurer offering policies to individual policyholders, is now asking for permission to raise premiums between 17 and 34 percent above their already high levels.

Health insurers lack the capacity to control underlying medical costs. They also lack the will to do so, as their profitability is closely linked to their cash flow — the more money they process, the higher their opportunities for profits.

They maximize profits by “managing risk,” that is, by avoiding insuring sick people and by denying the claims for payment of people they do insure. That is not an aberration but a core part of their business model. That business model is fundamentally incompatible with the goals of a humane health care system.

America needs a system that does not rely on the insurance industry to provide basic health care. We need a system more like Canada’s. Even though there is some minor grumbling by a few Canadians about waiting times for some discretionary services, their system is enormously popular. No Canadian faces crushing health care bills or bankruptcy due to unexpected medical costs. Canadians proudly view their health care system as being “the highest expression of caring for each other.”

We already spend almost twice as much per person as the Canadians. That should be enough to provide high-quality health care to all Americans. Sixty percent of the total costs of the dysfunctional U.S. health care system is already publicly financed. This figure includes huge tax subsidies that now amount to more than $250 billion a year for the purchase of private insurance, but only if it is a fringe benefit of employment.

Only a simple tax-based system administered by an independent national health care trust fund is capable of controlling overall health care costs. The fund would negotiate standard, reasonable and timely payments with all health care providers. No exclusions, no denials, no hassles. Everyone would have access to guaranteed health care. Instead of wasting time arguing with insurance companies about payments, doctors and nurses could focus on providing services to patients. A publicly financed, privately delivered system would also make the real costs of our system more visible and make true accountability possible.

It is time for the American health care system to return to its roots — driven by mission rather than money. There are proposals in the Congress that would begin to move us toward that goal and rescue our failing health care system. They are the Conyers bill, HR 676 in the House, and the Sanders bill, S 703 in the Senate. Rep. Chellie Pingree is already a co-sponsor of HR 676. We urge you to contact Rep. Mike Michaud and ask him to join her as a cosponsor of HR 676, and Sens. Olympia Snowe and Susan Collins to urge them to cosponsor S 703.

In that way, we can join every other industrial country in the world in making access to affordable health care a right.

Phil Caper is a retired physician and former health care policy adviser to Sen. Edward Kennedy, D-Mass. Joe Lendvai is a retired audiovisual producer and small-business owner. Both live in Brooklin.

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