author--Leonard Rodberg
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The President’s Fateful Choice
Sixty percent of all Americans get their health insurance from private insurers, mostly through their employers, with some buying it directly from insurance companies. About half as many — 87 million according to the latest report from the Census Bureau — are covered by Medicare (the federal program for the elderly and the disabled), Medicaid (the joint federal-state program for the poor), the VA, and other public programs.
However, when you look at who pays the bills, you find a very different picture: nearly half of all medical bills are paid by government, largely through Medicare and Medicaid, but also through support for community health centers, the VA, and so on. Private insurance accounts for barely a third of all health care spending. The reason is clear: government covers those who are most in need of medical care, the elderly and the poor, while private insurance covers the healthy part of the population, those who are working.
When Obama decided to tackle health care reform, he could have chosen to build it upon either the public or the private systems. He said he wanted to build on what works, and he could have proposed expanding the public programs we now have to cover everyone (or everyone who wanted that kind of coverage). These programs work, and they work well. Instead, he chose to base his program on for-profit private insurance, the part of our health financing system that is most expensive and deficient. He chose the private path, and, as Robert Frost said, that has made all the difference. No plan that rests on multiple weakly regulated for-profit insurance companies can possibly achieve the goals he has set out and still claims his plan will achieve.--snip--
The Public Alternative
The alternative that Obama might have chosen is the public route to real health care reform, using Rep. John Conyers’ Expanded and Improved Medicare for All Act, HR 676. This plan is straightforward. It would expand the existing Medicare program so that everyone would be covered via automatic enrollment, just as seniors are automatically covered now when they turn 65. It would provide comprehensive benefits, much improved over the existing Medicare program, which has deductibles and co-pays that keep many seniors from getting the care they need. It would allow free choice of doctor and hospital, which would remain independent, as they are now. A public agency would process and pay the bills, and the system would be financed through a progressive tax.
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Conclusion
Private health insurance is a defective product that needs an expensive fix. By building his program on private insurance, President Obama has tied himself to a system that is too expensive and is unlikely to achieve the goals he has set. It will not lead to universal coverage and cannot contain costs going into the future.
On the other hand, an expanded Medicare for All system can provide comprehensive services while costing no more than we now spend, and it provides real mechanisms for containing costs. Should a private mandate plan be passed, the problems of the health care system will not go away. Real health care reform will continue to be essential. As costs continue to climb faster than incomes, health care will absorb a larger and larger fraction of our national livelihood. At some point, we will have to move to a unified public mechanism for funding health care that will be truly sustainable.http://www.tikkun.org/article.php/nov_dec_... emphasis added
