Over My Dead Body
The powerful Senate Finance committee has just voted down two proposed amendments to Obama’s healthcare reform bill; amendments that would have created a public insurance scheme as a key part of insuring some of America’s 47 million uninsured. Sen. Jay Rockefeller’s amendment would have added a public insurance option that would reimburse doctors and hospitals at rates similar to Medicare – a rate that the American Medical Association says is not sustainable. That amendment was defeated 15-8 with five Democrats not supporting it. Sen Charles E. Schumer produced a similar amendment that would have allowed physicians to opt out of accepting patients enrolled in the plan. Payment rates would also be higher than Medicare rates. Both plans would have been self -funding, initially at least. Schumer’s amendment was slightly more acceptable, but was defeated 13-10.
The public insurance option is seen as the real sticking point for Republicans, as they all view it as a prelude to a single payer (i.e. state run) system. They correctly point out that a public health insurer will have an unfair advantage over the private insurer, undercutting them. Eventually, the rising cost of private insurance will force more and more companies to go with the cheaper, public option. A single payer system would almost be inevitable.
Obama has already indicated that Healthcare reform will not flounder on this particular issue, though he still plugs the public insurance scheme at every opportunity. This is because he knows that the issue is more than just a simple insurance one, it is part of the ideological divide in US politics. Democrats favour a strongly socialised form of medicine with, at the very least, a single payer system, if not a single-owner system. Republicans favour the current privatised model.
I note that Democrats often say that they want universal access to healthcare, as if privatised care wishes something other than this. This is clearly a misconception. Both Democrats and Republicans want universal access, the only question is who is going to pay for it. Democrats want the state to pay, Republicans want everyone to be well enough off to pay for their own healthcare. And if Democrats consider Republicans to be dreaming if they think everyone will be able to afford healthcare, Republicans are certain than Democrats are dreaming if they think that the state can afford it…
The plight of the medically uninsured in the US is no laughing matter. But the reality is that the poor of any country will find their access blocked to healthcare, regardless of the system in place. In America, your healthcare access is determined by your ability to pay, but the same is true in countries with public health services. The wealthy access healthcare easily and rapidly, the poor are denied access or severely restricted in their access. These restrictions are given euphemistic names like “waiting lists” and “referral protocols”.
How often have you heard anyone with adequate medical insurance say “I am waiting for my hip replacement”? Normally, they will say “I am going in to have my hip done on Tuesday next week”. They will also know the name of the surgeon performing the operation and often even the name of the anaesthetist. In the public service, you are lucky if you know which hospital you are going to. Public health services are inevitably restricted in both choice and resources. The same is also true for public insurances (and the cheaper private ones, of course).
Admittedly, the uninsured do get access to health services eventually, in a public health system. Usually. Assuming they survive the wait.
I recently sent a referral to a hospital outpatients department for a patient would could not afford private care. The referral came back saying that it could not be processed until a certain investigation had been done. Dutifully, I ordered the investigation from the hospital radiology service, only to be informed that my patient does not meet their criteria for the test! There is only one catch: Catch 22. Joseph Heller must have worked in hospital services at some time…
The ear of the chief radiologist will be seriously chewed tomorrow morning.
The Republicans seem to be having an “over my dead body” moment with this issue of public health insurance. It is a pity, however, that the only dead bodies in reality will be those of people unable to afford healthcare or, worse, unable to access the healthcare they have paid for with their tax dollars.
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Oct 1 09 9:20 am
I do wish that the figure of “47 million uninsured” wasn’t used without qualification. That is a gross figure that includes at least 10 million who are quite wealthy enough to afford cover, but chose not to have it, millions of illegal immigrants, and others. The total of those who want but ostensibly cannot afford insurance (and who are actually citizens or legal residents) is closer to 10 – 15 million. At lot depends on quite how you do your sums.
All those without insurance do of course get health care in emergencies, at publicly funded hospitals. What they don’t get is elective or non-emergency treatment without payment. The quality and availability of such care varies, but in many areas it is probably not that dissimilar to what we get in NZ.
Oct 1 09 9:55 am
I agree with Ed; the true number who can’t afford private medical insurance is closer to 10 million or about 3%.. and even they have access to emergency treatment.
Rather than push for a public option they would be better to celebrate their magnificent private coverage.. and work to make it more affordable. That would mean making frivolous legal suits untenable and affect the trial lawyers.. a powerful funding group for the Dems.
JC
Oct 1 09 10:04 am
Some of the above comments would explain why a recent survey I saw showed only 40% support for Obama’s proposals – oh they survey was of uninsured people.
scrubone´s last blog ..Full Netanyahu UN Speech
Oct 1 09 11:51 am
The crazy thing about the debate is that a fair proportion of the uninsured aren’t just the poor- they are the uninsurable!
Insurance is about the transference of risk from the individual to the insurer. In that process the insurer goes to great lengths to decide if the person presents a risk of making multiple costly claims on their policy.
If the insuree is a high-risk candidate, there are only two real outcomes- they will pay a huge premium to the insurer to compensate them for the high likelihood that they will make a claim, or the insurer will flat-out refuse to insure them.
The idea that an insurer will simply get rid of this risk assessment process and just gives insurance to all-comers is just insanity. What Obama was promoting wasn’t really insurance at all, it was simply a massive money grab for the uninsurable and the poor, that would have resulted in a high level of moral hazard- I can take any risk as the state will pick up the tab.
Giving everyone insurance means that people would no longer have any incentive to manage their personal health risks and the economic consequences of their own poor health.
Oct 1 09 12:22 pm
“I can take any risk and the state will pick up the tab”
is really being marketed as,
“If anything bad happens to my family, I know that the state is there to help out, by making insurance a right of every citizen”
But the result is the same….
Oct 1 09 1:00 pm
Republicans want everyone to be well enough off to pay for their own healthcare.
No doubt Marie Antoinette wanted everone to be well enough off to pay for their own cake, too.
The plight of the medically uninsured in the US is no laughing matter. But the reality is that the poor of any country will find their access blocked to healthcare, regardless of the system in place.
Really? Only if you find not being able to access healthcare at all in the States the same as having to go on a waiting list in NZ. They’re not the same, and pretending doesn’t make it so.
Oct 1 09 2:24 pm
Milt: Only if you find not being able to access healthcare at all in the States the same as having to go on a waiting list in NZ. They’re not the same, and pretending doesn’t make it so.
Actually, as waiting times extend, the situation becomes exactly like the US. In the States, you can only access elective care if you can pay. The poor, therefore, get sicker and sicker until they require emergent care, which cannot be ethically or legally denied on the basis of finance.
This is precisely what happens when the waiting lists extend beyond the natural progressive history of the disease – as almost all waiting lists do. The sole difference is that a small proportion of our poor actually do get some elective treatment.
The solution to both these problems is similar – direct or indirect subsidies to the poor, restricted to healthcare use only. In New Zealand, elective procedures could be purchased directly from private providers by DHBs. In the US, Obama would be better off using the smart card system I suggested in an earlier post.