Medicare is the best (and only) Public Option

Dropping the shell of a once strong public health plan from the evolving health reform bill could be the best thing to happen to Progressives - and to the nation. But our trade-offs could take very divergent paths.

One way to go is the Medicare expansion path. Since Medicare is the largest single-payer health care program in the US, is beloved by many (strong voters) and boasts similar success rates in cost containment seen in our peer nations who aren't nearly as stupid and greedy as us, we'd all win if Medicare - espeically a fixed, de-bloated Medicare- was expanded to younger age groups.

The other trade-off path we may face is to expand Medicaid, the Other white meat of federal public health programs. Medicaid is a multi-payer, not single-payer, model and thus costs more administratively than does Medicare. Which is a big deal, in $$$.

The differences in coverage, patient demographics and finance mechanisms are also significant and I'll address that with links in my next post. So stay tuned and watch for this in tomorrow's newsday: If Progressives get the Medicaid expansion approach as a trade-in for a real public option, we'll fail to control spiraling health care costs without strong governmental regulation and...horrors!...price controls. Ironic that the Repubs would even consider that path, but their blinding fear about Socialized Medicine may cause them to.

The truth hurts, but not as much as doing nothing in health reform will.

Here's my recent OpEd in the ABQ Journal, in case you missed it. Comments welcomed!

More later,
Terry

We traded abortion for the public option.

Yep, we can thank the ConservaDems for this one, too.

Apparently these are our choices in the U. S. of Amorality: access to basic public health care for mostly everyone or access to abortion for women with private health insurance.

Dems in the House chose the former this past weekend.

Socialism has it's costs when applied in a clumsy, pro-Capitalist way. But I believe the trade was worth it, not for the least of all reasons being: that's all we were gonna get.

Call me a floor mat, call me naive, but I do think there's more to come of this health reform stuff once we crack the door open this year with a decent public plan.

I'm impressed and hopeful about the way the nation joined in the debate for "socialized medicine", even if only to learn that most of our neighbors, family members and co-workers harbor vitriolic anger toward poor people, sick people and people of color while enjoying the public dole on their Medicare, Social Security and warfare missions. Ah, contemporary American irony.

But alongside this vileness was amazement, disgust and...fighting back from many sane folks who've been watching health care systemic failures from the bewildered sidelines. This sleeping giant is now awake, and they're not gonna sleep through health catastrophes anymore after the show they witnessed this Summer.

Sounds like the birth of a real movement, to me. Yes, Virginia, we can have universal access to abortion and to other basic health care services at the same time.

But only in a modern, pluralistic democracy.

Hangin' with the Tea-Baggers

"Absolute chaos"; doctors as "slaves" if we reform health care.

The "moral values" of fat industry profits and Big Insurance salaries.

I couldn't make this stuff up, but that's some insight among the audacious claims from the panelists and crowd at the Albuquerque Tea-Baggers "Health Care Town Hall" on Wednesday evening at CNM's Smith Brasher Hall.

Yes, it's come to this: 50-60 working class-looking folks and 5 wealthy specialty docs and business consultants, sitting in a government building spewing hatred toward "the government" and lies about health reform.

There were no family medicine docs or health systems experts on the panel, of course, but the crowd didn't seem to mind the irony of being told how to work against their own economic interests to preserve our broken health system status quo that rations access to essential medical care by arbitrary social categories like employment, income, race and ethnicity.

Care to tell the Alb. Tea-Party what you think about this? http://albuquerqueteaparty.com/

By the way, they spent much time lamenting their "small crowd", lack of youth activists and inadequate media attention, but that's where the similarities to Progressive reformers ended on Weds. night.

Fear about health care access "as a human right" dominated the many tearful comments by a majority of elderly, overweight, white folks, some with limps. All with health insurance or Medicare, I presume.

Is US Labor propping up Big Insurance...again?

What a sad irony, an "historic mistake", but that's the $64 million question as US Labor opposes any taxation of employment-based health insurance benes in the current health reform debate.

The drive to continue excluding employer-based health insurance from taxes actually subsidizes our current corporate health coverage scheme and empowers Big Insurance profits and a non-system of care that is rationed by employment status. Is this what we really want out of health reform?

While perhaps historically correct, tying health insurance benes to employment may now be, ironically, the nail in the coffin of a real Public Health Plan - something that Labor also says it wants.

Can we have both a strong Public Plan and subsidized employment-based health insurance, or are they logically incompatible? A new Center for Budget and Policy Priorities report says we can, but only under certain conditions. Labor should listen, this time.

If not, we’re all in trouble.

And I mean ALL of us - not just those of us lucky enough to have union jobs . We’ll fail to reform health care in the US if we compromise away a strong universal public plan so that Big Insurance can get more tax-payer windfalls for the dwindling numbers of amply-employed but still painfully underserved by Big Insurance.

This time, the failure may be stamped with the Union Label unless we tax the health care rationers and the employers who feed them. Or we can kiss guaranteed, affordable care for all, goodbye. That appears to be our choice now.

It's time for a full-court press to detach health insurance from employment in the face of a changed economy.

Please consider these Health Econ & Labor History basics before screaming at me for Labor heresy:

1. Our current employment-based system of health insurance is considered by most health and labor economists to be a “historic mistake” – one that is not working for most of us, even those who are insured. It rations care by class, race and income level and offers the poorest quality of care in the industrialized world for those it miraculously "serves", and makes a huge profit for shareholders while doing so.

2. US Labor pushed for employment-based health insurance after WWII , and employers agreed in order to enable a healthy, productive industrialized workforce amidst labor shortages.

3. Our economy is no longer industrial nor is labor in short supply, and it ain’t gonna be any time soon, at least not in poor or diverse states like NM. This is not necessarily a bad thing in a pluralistic society; in fact, it’s considered a good thing by many. Either way, it’s what we got.

4. Insurers and other administrators have driven health care costs uncontrollably high, despite their consistent exclusion from taxation when offered through employment contracts.

5. As a result of the above four points, demand for a Public Health Plan for all of us has finally emerged in the US – the only industrialized country to NOT consider health care a basic human right in this way - to produce affordable, universal access to health care, backed by the government because that's what they're there for and do best. (Just ask your local government Fire Fighter.)

6. A functional and universal Public Health Plan requires demand, among other basics, to regulate costs and access. When Big Insurance is subsidized by being excluded from routine taxation like that of other employment benefits, it will drain demand away from a Public Health Plan and cause it to fail.

7. Spineless ConservaDems in Congress want a Devil’s Deal in health reform to appease their corporate backers, so we may get EITHER continued subsidies for Big Insurance via untaxed employment health benefit rations OR a strong Public Health Plan for all of us.

This health care fight is about our social values, and about making choices for the change we need.

Here’s our first big one…will Labor side with people or corporations in health reform? We can’t have both this time, in this economy and with our people getting expensively, unjustly sicker.

When will we stop making historic mistakes in US health care and finally enact a Public Health Plan that puts Big insurance on the sidelines where they belong... and puts Labor on the side of all workers?

An open letter to Sen. Bingaman about the shameful AMA and bait/switchy 'co-op" plans

Dear Sen.Bingaman's DC Staff-

Thanks for making time for our NM Alliance for Retired Americans unscheduled visit last week in DC. Our 400+ statewide and 3.5 million national members appreciate yours and Senator Bingaman's hard work for real health reform.

We want him to keep it up, and know that we're doing our part out here. Especially as the ground is getting weak with corporate interests, including the AMA, who shamefully opposed the creation of Medicare in 1965. They made a historic mistake then and they are making one now by opposing a strong Public Health Plan. Our Senator must not follow their lead and enable this mistake again...we need a strong Public Health Plan now.

I'm an epidemiologist and former NM DOH worker, but I'm now helping to lead our local NM ARA because health reform can't wait any longer. New Mexicans are dying in discriminatory patterns, and it's nearly all preventable with a sound Public Health Plan.

I've made a career of analyzing local health access and financing trends here in NM and I can tell you, first hand, that the co-op option will have no teeth to place corporate health insurance interests where they belong for the health of the people: ultimately, in a supplemental role.

We don't trust fire fighting or policing to corporations, so why should we trust them with health care gate-keeping and disease prevention/management? There is no science to back this fatal error up, just money and smoke and mirrors. International comparative health systems research bears this out time and again - the US is the biggest rationer of the poorest quality of care of all our national peers.

Please tell the Senator to be strong for our people, and we'll do the same.

Love,
Terry

The Doctor did it.

Making corporately-financed health care irrelevant requires us to accurately define our enemies - the enemies of health care access as a basic human right.

In addition to Big Insurance, Big Business and others who profit from illness and healthcare rations, one enemy especially stands out because he/she's also a needed friend and ally. Really...??

The American Medical Association opposes a public health plan because it would threaten their profits. They opposed the creation of Medicare in 1965, too. Shame, shame on them, as Medicare is the most effective public health plan of all time and is responsible for lifting our country out of unequal illness and poverty patterns, and prolonging the quantity and quality of life in the US in equitable ways. According to the NYTimes the other day,

"The A.M.A., with about 250,000 members, is America’s largest physician organization. While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress."

You bet they are.

That's nice, but the current market-based system doesn't work for anyone who is not a doc.

Let me be more specific....our absence of a primary care infrastructure - itself a product of "private markets, as they are currently" - makes people sick, at much profit to treatment providers like medical specialists and high-end medical technology designed for over-killing (literally).

Let's be clear about who the AMA serves - it ain't primary care docs, but specialists. And they don't want the change we need in health care reform.

Nothing is simple about the politics of US health care, and our docs shouldn't be contributing to this profitable confusion. Tell the AMA (1-800-621-8335) - and Sen. Bingaman - how you feel about the status quo "private market" system that fails us all in fixable ways.

Be strong,
Terry