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By Millie Priebe
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Private insurance companies strongly oppose government run insurance plans. It would not be a level playing field; it’s not fair for private companies to compete with the government’s ability to purchase drugs in bulk and have significantly lower administrative costs
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Rep. Earl Blumenauer, along with State Sen. Alan Bates and Dr. Mike Huntington of Physicians for a National Health Program, spoke at a health care reform panel at the First Unitarian Church on April 16.
Congressman Blumenauer led by noting the 36-year effort to provide health care for everyone.
“We sent to Bush two bills for children’s health care and he vetoed them,” Blumenauer said, adding that President Obama signed the Children’s Health Insurance Act, signaling a new era of change: “More is happening; the floodgates broke on the 20th of January.”
“We extended COBRA benefits … We have a broad challenging agenda. Not since FDR has there been a more challenging, more ambitious” agenda: Climate change, health care, foreign relations, tax reform, economic crisis are the five key issues of priority of Obama’s administration, and health care is number one. In his first 30 hours, Obama signed administrative rules or bills encompassing these, reversing anti-science and human rights abuses of the Bush administration.
“Despite the election of Obama, which will bring much change, politics is intensely polarized. Only a few Republican representatives voted for progress.”
On the health care issue, Blumenauer is optimistic.
He says all parties “agree that everyone has insurance in the coming health care reform. The Democrats want to expand Medicare and Medicaid. The Republicans want to expand private insurance, or alternately want a ‘public’ plan encompassing both. We have reached those who opposed reform before. We’re at a breaking point; the health insurance industry now will take all people, even the sick. We’ve changed direction; the next 2 months will see different proposals. 
“I disagree that we have the best health care in the world. The average health care statistics are low. We have a non-system. We have been asked to keep our eye on the ball, attention to costs and efficiency, using health technology. The path we are on now is not sustainable. Oregon has a special role in the health care issue and a model for efficient, quality care. If the national arena would do what Oregon wants to do, there would not be a crisis.
“I have co-sponsored two bills, including Pete Stark’s HR 193 — a public plan similar to that of the senators’ own health insurance, available to all residents who may opt out if the individual has a group health plan, and modified Medicare. We want honest competition. There is pressure from those who are happy with their insurance now. This bill can actually pass. HR 676 won’t.” And I support Wyden’s Healthy Americans Act.
“The hope is that people focus on what to do to carry the message foreword. There are many important things that we can’t discuss now. But some things make a difference: Prevention, end of life care with use of machines, and communication of doctor and patients. I hope that together with a full court press that this administration can do something real and educate the public about the reform that we want.”
State Senator Bates, who is a physician, discussed some of the reasons for the high costs of health care. He said that other countries have 70 percent primary care physicians and 30 percent specialty physicians. Here in the United States, it’s the opposite, with 30 percent primary, and that’s growing smaller every day, while the specialist percent is growing.
“We need incentives for more primary physicians, more nurse practitioners,” Bates said. “It is costly to wait till the end of life for treatment. We need a form available electronically for end of life directions, a living will. This will lower costs.”
Current legislation in Oregon is HS 2009, a public plan. He mentioned that the cost of a cigarette is exorbitant in terms of costs of health care. ‘Real drivers’: 60 percent of costs are behaviors of people: obesity, cigarettes, and alcohol and drugs. We need a public health prevention program.
The problem with U.S. health care: The United States spends the most per person than any country in the world — 50 percent more than other countries, but ranks 37th in quality of health care. The United States ranks 23rd in infant mortality, 20th in life expectancy, and 50th or lower in immunizations. We spend more than $7,000 per person on health care, enough to provide care for everyone. But 48 million have no medical insurance and many more are underinsured. And about one-third of total funds for medical care is spent on overhead, billing, marketing, profits and obscene executives’ pay. Medical costs for individuals are the most common risk for bankruptcy.
Generally there are three types of reform: Private insurance with new regulations, Public option, and Single-payer.
Private insurance
1. Private insurance, the current primary mode of financing, is to be overhauled. The efficiency of competition and choice of consumers (patients) assures quality, and only the profit motive can achieve this. The insurance industry wants a government mandate for all to purchase insurance, ‘heavily regulated’, limit costs of premiums and drugs, relaxing pre-existing conditions requirements, control of rising costs of medical equipment, overlap of testing. ‘Full scale renovation’ also includes emphasis on prevention and savings in technology costs and the use of technology to consolidate health records. Expansion of Medicaid and health care for children, CHIPS. These reform plans were written two years ago but shared only among the industry. The surprise announcement of these was revealed to the public by the industry on May 5th after the Senate hearing on health care reform. Any additional government intervention is ‘socialism’ and out of place in the free-market system of the US. Supporters are the insurance and pharmaceutical companies, the Chamber of Commerce and other business associations and conservative Congress persons. This retreat from long held practices is a response to the increasing desire of Americans for government help in the escalating problems in health care and its costs. Critics note that the industry incorrectly uses the word ‘socialism’ for choice of private medical care and government financing. “Socialism’ actually refers to medical care that is both financed and delivered by the government.
Public insurance option
2. The term ‘public plan’ is ambiguous. Until recently it referred to single-payer or other types of government run programs. Now it refers also to the compromise ‘public option’ choice for Americans to either join Medicare (a public plan) for low income and seniors and disabled, or keep the private insurance they now have if they can afford it, with mandatory membership. Proponents say Americans want choice, and many are happy with insurance they have. The private sector should continue to play a role in providing health care. Representative Blumenauer and Senator Merkley support a public plan. There is a growing minority of support for this, having obtained standing in the debate, among liberal legislators.
Private insurance companies strongly oppose government run insurance plans. It would not be a level playing field; it’s not fair for private companies to compete with the government’s ability to purchase drugs in bulk and have significantly lower administrative costs.
On the other hand, single-payer advocates note the failures of these plans in several states. The government pays for Medicare and Medicaid both of which covers people with more illness which costs more, and thus is more expensive for taxpayers. Private insurance would lose money with those. Instead they insure the healthier people whose medical costs are less. The cost difference per capita of public and private insurance is a subsidy to the private insurance companies.
Single-payer insurance
3. Single-payer is managed by the government and paid for by a progressive tax and a payroll fee. The underlying moral value is that everyone has a human right to health care, and 89 percent of physicians believe that people should have care even if they cannot afford it. This is Medicare for all, one group health insurance plan, one risk pool, automatically covering everyone, no matter his or her employment, for all medically necessary care, choice of physicians and hospitals and other health care providers, more illnesses covered, emphasis on prevention, efficiency using medical technology and records. A single-payer plan eliminates private insurance except for low priority medical procedures such as teeth enamel and cosmetic surgery. For patients, there is no paper work, small or no fees for service, no premiums, no deductibles, no co-pays.
All but the top 5 percent will pay much less in taxes than they now pay for health care costs. Guidelines for hospital budgets and salaries for physicians, who do not bill patients, save costs of bureaucracy and time for more medical service. Minimal administrative costs of 3 percent, rather than the corporate 20 percent to 30 percent, save more than $300 billion. This savings is enough to pay for the 48 million uninsured and the tens of millions more who are under insured.
Single-payer is preferred by 59 percent of physicians and 60 percent of Americans. In spite of the public support of single payer, only a few Democratic legislators support the two single-payer bills: Representative John Conyers’ HR 676 and Senator Bernie Sanders’ S 703.
Opposition: Blumenauer and Merkley, private insurance companies and most of our legislators oppose this plan. Generally, their reasons are ‘unfair competition with private insurance’ mentioned above. Other reasons to oppose single payer: A human right to health care is not valid; the label of ‘socialist’ is a concern for many; fear of lower quality health care. In fact, quality can be affirmed scientifically, and philosophical concerns are by nature debated without end.
The question raised for Blumenauer about campaign finance reform is relevant. His view of postponing work on campaign finance reform and concentrating on urgent issues today is perennial on both sides of this dilemma. “If people choose to work on this, if we layer on interests and not focus on two or three issues it is less likely that any of them will pass. We have to choose our priorities.”
Legislators want to be re-elected, of course, and all receive contributions from health insurance and drug companies: Massive amounts from their exorbitant profits. And millions more is spent on information to influence Americans, and defeat single payer or public option. That is the relevance of the outcome of the health care debate ultimately.
Single Payer Action recently had a meager donation campaign goal of $30,000. Equitable reform is off the table and the sick and poor are on the floor under the table picking up the crumbs dropped by Health Care For-Profit.
Health care debate far from over
Representative Blumenauer’s appearance is evidence that the health care debate is taking on more importance. There are large single-payer rallies around the country. In the past health care had been a faint issue early in presidential campaigns. But as the elections drew near health care receded and by Election Day there was no talk at all. Since 1973, as the working class and middle class real incomes fell, the burden of health care costs rose and the voices of Americans have become louder. For them this issue was big long before it became big for Congress. It was not the recession that put the issue at the fore.
Think tanks, advocacy groups, action groups, insurance companies, medical organizations, unions, have issued opinions and ad campaigns. Talk show hosts entertain guests and text messages. The insurance companies have made concessions, plans and promises because of the advocacy, letters to Congress, and challenge. There are compassionate Congress persons leading others for passing legislation.
Loud voices, many letters, calls and emails, clicks on blogs, canvassing, planning, rallies, marches, donations, speeches, protests like the Baucus 8, make a difference as you know. Recall the abolitionist movement, civil rights marches and protests, Vietnam protests and rallies, union strikes, and health care victories here in Oregon. California in 1994 and Oregon in 2002 had the first two, and only, state single- payer bills on the ballot. Though defeated it was progress on the way to real reform. Rights are not given to us. We fight for them. This is a pivotal time for health care reform. Hard work is needed now. There are many important issues today but health care will be overhauled soon, perhaps by the end of the year, and the outcome has huge consequences for Americans. This is a significant time in history.
At the health care hearings of the Senate Finance Committee in May not one ‘stakeholder’ on the panel represented single-payer. Eight single-payer activists, beautiful and strong, were arrested for boldly demanding a single-payer representative on the panel: We will be satisfied “only when the people who are living in the park and the people living on Park Avenue have the same quality health care. Single payer now!” Chairman Senator Baucus used the term ‘deeply’ six times: “I deeply, deeply respect your views.” “deeply respect”, “deeply in mind”, care deeply,”and “care deeply” again (emphasis his). He pounded the gavel repeatedly — 21 blows, to justice. He was a sad spectacle. From deep within his soul this ancient feeling of human empathy unconsciously flowed out of his mouth while his shadow side ordered the police to lead away eight voices of compassion. This is history! We are looking at it! The massive surge in support, media coverage, dialogue is a sign that it will have an impact for a long time.
Millie Priebe is a local health care activist.
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