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Fire Departments and Health Care
by Scott McLarty
Imagine for a moment that our public fire departments were privatized.
Imagine that you needed a special insurance policy before calling the fire department in an emergency, or you'd have to pay thousands of dollars out-of-pocket for the firefighters to put out the fire.
Instead of calling 911 for the nearest neighborhood fire department, you'd call whichever fire department is in your insurance plan, even if it's across town or miles away. You might have to call your 'Fire Protection Insurance Company' or 'Fire Protection Management Organization' for approval.
Depending on your fire protection insurance plan, the fire department might tell you they can put out the fire in your living room and bedroom, but not the kitchen or the garage... unless you pay an additional out-of-pocket fee.
An insurance company agent might tell you that they won't pay for a fire department to put out a fire, because your house has a 'prior condition' or is too old or in a high-risk area.
If you don't have coverage and don't want to pay an expensive out-of-pocket fee, you might try to put out the blaze yourself, or just let your house burn. The fire might spread to other houses in your neighborhood. An uninsured neighbor's housefire might spread to your own house.
Imagine that you complained to your US Senators and Representatives that the system doesn't work, that over 45 million Americans can't afford 'fire department coverage' and millions more have inadequate plans, that thousands are losing their homes every year, and maybe your own home has been damaged. And your Senators and Representatives replied that we can't have fire departments that are publicly owned and paid for with our tax dollars because that would be socialism. Even though public fire departments would be far cheaper and save lives and property, moving to a public plan would cause insurance companies to lose lots of money, and we can't have that.
Insurance companies would spend millions of dollars in political contributions to make sure that fire departments remain under their control. They'd hire PR firms and place ads on TV and in newspapers to convince you of the wonderful job they're doing, telling you how public fire protection is a radical idea, un-American, too expensive, inferior in the services they’d provide, etc.
The whole scenario is absurd, you might say. (In fact, it's close to what many Americans experienced before public fire departments were established in the mid 1800s, when homeowners without insurance often watched their houses burn while negotiating fees with fire companies.) Why have a bureaucracy of insurance company middlemen, demanding high fees as gatekeepers for fire protection without actually providing the service itself, when we can have a far less expensive public system that guarantees firefighters will show up in an emergency regardless of who you are, where you live, or what's in your bank account? Any reasonably intelligent human would recognize privatized fire departments as a disaster, a menace to public safety and utterly irrational.
So why do we tolerate a health care system that's run the same way?
Private health insurance companies and HMOs don't provide medical treatment. Instead, they act as gatekeeping bureaucracies that make an enormous profit based on the likelihood that at some time in your life you'll suffer illness or injury and will need medical treatment. They provide cost but no value.
Physicians for a National Health Program notes that "[o]ver 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc." The overhead for Medicare, based on administrative costs but without the demand for profit, is about 3%. Why not convert to a public system, expanding Medicare to cover all Americans, perhaps saving us a third of the cost by eliminating the insurance and HMO middlemen -- a system comparable to our public fire departments?
That's what a Single-Payer national health care system would do. It would guarantee health care and medical prescriptions for everyone regardless of ability to pay, employment, age, or prior medical condition (criteria currently used by private insurance firms and HMOs to limit or deny coverage). Single-Payer would allow everyone to choose their health care provider -- you could visit the physician or hospital of your choice, rather than select from a limited list of those approved by an insurance company or HMO.
We'd pay for Single-Payer with a progressive tax plan. Tax sounds like a bad word, until one realizes that the amount most middle- and low-income working Americans would pay would be far less than we currently shell out for private insurance and HMO plans, and any additional fees when you go to the hospital or clinic or doctor's office would be zero or minimal. That's because HMO-insurance company profits, big CEO salaries and bonuses, and administrative waste would be eliminated. Just as public fire departments have created an incentive for public education and measures to prevent fires, Single-Payer would create an incentive for encouragement of good habits, like a healthy diet, exercise, and quitting cigarettes.
Obstacles to Real Universal Health Care
Why can't we get a Single-Payer/Medicare For All system? Because the profit-making health insurance and HMO industry holds svengali power over most Republicans and Democrats in Congress and the White House, thanks to campaign contributions. According to the Center for Responsive Politics, the amount of such contributions was over $46 million in 2008. Sen. Max Baucus, chair of the Senate Finance Committee, thus declares that Single-Payer is "off the table." Barack Obama once supported Single-Payer, before he launched his bid for president. Now he favors a plan that would leave the insurance industry in charge.
There's a small number of Senators and Representatives who support Single-Payer. Rep. John Conyers (D-Mich.) and Sen. Bernie Sanders (Ind.-Vt.) have introduced Single-Payer bills in the House and Senate (HR 676 and S 703). Most are Democrats. Presidential candidates Cynthia McKinney (Green) and Ralph Nader (Independent) promoted it during their campaigns in 2008, as did Dennis Kucinich before he was eliminated in the Democratic primaries. But the White House and most members of Congress have followed Sen. Baucus's lead and don't want it discussed. They don't want its merits compared with the health care reform plans that capitulate to insurance and HMO demands. The health of insurance industry profits takes precedent over the health of the American people.
On March 5, a White House policy summit on health care initially excluded Single-Payer advocates until complaints led to last-minute invitations for Dr. Oliver Fein, president of Physicians for a National Health Program and Rep. Conyers. On May 5, a health care hearing sponsored by the Senate Finance Committee featured private insurance industry representatives, the Chamber of Commerce, the right wing Heritage Foundation, the Business Roundtable, and Blue Cross Blue Shield, but no Single-Payer supporters.
The hearing was interrupted by eight protesters who demanded public discussion of Single-Payer. The eight were arrested. Among them were Russell Mokhiber of Single-Payer Action and Kevin Zeese, former Maryland Green candidate for the US Senate and currently Executive Director of the Campaign for Fresh Air and Clean Politics. (Read Mr. Zeese's account of the protest)
Such actions might be the only way to focus public attention on Single-Payer. In past generations, it took strikes, massive and sustained street demonstrations, and political campaigns outside the Democratic and Republican parties to win the eight-hour day and 40-hour week, an end to child labor, civil rights for African Americans, and other reforms. As more and more Americans learn about Single-Payer, how they're getting cheated under the status quo, and how the alternative proposals from Democrats are designed to sustain insurance company profits through mandates and subsidies, the demand for Single-Payer will reach critical mass.
Polls have already demonstrated widespread popular support for a national health care program that guarantees universal coverage. In 2008, the US Conference of Mayors endorsed Single-Payer as have thousands of physicians.
The recent economic crisis has made Single-Payer even more urgent. Its enactment would provide relief for businesses large and small, since it cancels the high expense and administrative burden of employer-based health care benefits. It would relieve municipalities and school boards from having to bear the cost of providing health insurance to employees, reducing budgets and lowering local property taxes.
Many business leaders understand that Single-Payer is the best proposal economically, but they're reluctant to support it. Why?
Dr. David Himmelstein of Physicians for a National Health Program has an answer. Dr. Himmelstein attended "a health care forum a couple of years ago sponsored by the Business Roundtable. And the moderator asked the audience -- made up primarily of representatives of big business -- to indicate their preference of health care reforms. And the majority came out in favor of single payer. Why then is the Business Roundtable opposed? Himmelstein put it this way: 'In private, they support single payer, but they're also thinking -- if you can take away someone else's business -- the insurance companies' business -- you can take away mine. Also, if workers go on strike, I want them to lose their health insurance. And it's also a cultural thing -- we don't do that kind of thing in this country'" ("Top Ten Enemies of Single Payer," by Russell Mokhiber, Common Dreams, April 16, 2009). In short, business leaders don't want to lose leverage over their employees and they fear creeping socialism.
Cheerleaders for Obama or Serious Advocates for Health Care Reform?
Why won't some major unions, like Service Employees International Union (SEIU) and liberal advocacy groups like Families USA, support Single-Payer? (SEIU president Andy Stern and Families USA executive director Ron Pollack participated in the Senate Finance Committee hearing described above.) It could be their long alliance with Democratic Party leaders. The behavior of such groups during the Clinton Administration illustrates my point. Bill Clinton campaigned in 1992 on a promise of universal health care, but after taking office he introduced a reform plan that would have herded Americans into coverage under the top five or six insurance firms. The latter were well represented at the Jackson Hole summit hosted by Hillary Clinton and Ira Magaziner in early 1993, while consumer advocates weren't invited.
The Clinton 'managed care' plan that emerged from the summit was a bureaucratic monstrosity filling over a thousand pages, a gift on a silver platter to those very insurance companies. Medium and small size insurance companies, which were behind those Harry and Louise ads critical of the Clinton plan, would not have been able to compete. President Clinton eventually acknowledged that the plan didn’t even cover all Americans.
Instead of supporting Single-Payer plans offered by Paul Wellstone (D-Minn.) and Jim McDermott (D-Wash.) in 1993, many unions and liberal organizations that had previously favored national health care endorsed the Clinton proposal. They wanted to show support for a new Democratic administration that had replaced twelve years of Republican rule. They didn't want to jeopardize their newly won access to the White House, so they ready to set aside their own agenda.
Rather than winning influence when they invested their support in the Democratic ticket, these unions and liberal groups had purchased their own acquiescence to a president more responsive to major corporate lobbies. (Such acquiescence, combined with an expert public relations strategy, also explains why Hillary Clinton still wins praise as a champion of health care reform, and why the Clinton plan still gets labeled, erroneously, 'universal health care.') Under Bill Clinton, the Democratic pledge of national health insurance, a plank in the party's national platform since 1948, was canceled.
Current enthusiasm for the Obama Administration and the new Democratic majority in Congress poses a similar danger. The Democratic goal is to make health care affordable -- within the context of the market. If publicly financed health care is to be considered at all, it must only be an option in competition with other, private heatlh insurance options, inevitably balanced with public subsidies to ensure continuing profits for the private insurance providers. Thus on April 28, several congressional caucuses (Progressive, Black, Hispanic, and Asian and Pacific American) declared their support for the "public health insurance option" that would be "part of comprehensive health care reform legislation", but shied away from endorsing the Conyers-Sanders Single-Payer bill. MoveOn has created a video ad promoting the Obama plan and critical of insurance lobbies, ignoring the participation of insurance companies in the crafting of the plan.
The goal of Single-Payer is to make high-quality health care a right for all Americans, replacing for-profit health coverage and rendering the market as irrelevant as it is to fire departments.
For those of us who understand that health care access, like fire department service, must never be based on corporate profit margins, there are lessons to be learned. We can't rely on the Democratic Party. We can't trust major liberal organizations or unions that have been compromised by politics allegiances. Groups like AMA and AARP that rely on insurance company contributions and ads in their publications will always oppose Single-Payer.
We can't trust most of the media, either, since commercial and public broadcasters like NPR accept insurance and HMO money in the form of advertising contracts and underwriting. The result has been a near blackout of accurate information, sometimes any information at all, on Single-Payer in news about health care reform.
Leadership for real universal health care is coming from groups like Physicians for a National Health Program, the Healthcare-Now Coalition, and Single-Payer Action. Politically, the leaders are independents, the Green Party and other noncorporate alternative parties, and Democrats (perhaps a few Republicans, too) frustrated with their own party's retreat on health care and other big issues.
As businesses lay off employees and cancel health benefits, this is the best time for a mass education effort on Single-Payer. It's our best opportunity to persuade Americans that for-profit health insurance and HMO coverage are a lunacy of the same rank as privatizing fire departments, and that legislation to sustain for-profit health insurance firms and HMOs is as nefarious as multi-billion-dollar taxpayer-funded bailouts for financial corporations and their CEOs. No other industrial democracy in the world tolerates the rule of private health insurance bureaucracies. Why should Americans?
originally published at OpEdNews.com
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