Wednesday, August 12, 2009


August 13, 2009

The September issue of Consumer Reports is out. Cover story: "Ratings of 76 Health Plans."
Seventy-six health plans? And those are only the major ones identified in a survey of 37,500 CR subscribers.
Talk about bureaucracy. Most of those plans — 35 health maintenance organizations (HMO's) and 41 preferred provider organizations (PPO's) — operate in individual states; only a few are multi-state or nationwide. Each has its own policies and protocols, each its own billing and payment system, each its own customer service apparatus. It's no wonder that the average health-insurance premium rose 38% over the last two years, due substantially to administrative costs (lobbying included) that comprise around 30% of their budgets.
The CR article reports that 64% of those surveyed were "completely satisfied" with their insurance plan, wryly noting that such a "lukewarm response" is only slightly higher than the satisfaction level for cable TV companies. And as with cable TV, people can't use CR to comparison-shop for a better deal; they're basically stuck with whatever they've got.
The health-care "system" today isn't a system at all; it's a byzantine collection of individual units from providers to insurers, all out there to profit from the third thing that's sure in life besides death and taxes: sickness.
You'd think that with all the red tape people are tangled in (the CR survey rated the billing procedures of every single PPO as fair to poor), they would be clamoring for a simple, unobtrusive insurance system. Today, almost 30% of the people of America are covered by some form of government-funded insurance: Medicare for the elderly, Medicaid for the poor, S-CHIP for children, Tricare for military personnel and veterans. Medicare and the military programs, which are administered by the federal government, are user-friendly and immensely popular — so popular, in fact, that some people don't even think they're government- run; witness the widely-reported story of the man who told Rep. Robert Inglis of South Carolina, "Keep your government hands off my Medicare."
Why not take something that works admirably for people over 65 and extend it to everyone?
What Congress is now grinding out is the usual sausage — baloney, specifically: a hodgepodge of tinkering that leaves the non-system basically intact and has so confused and frightened the public that they're pulling back from these proposals like turtles into their shells. It's not that they've suddenly become happy with their health plans; it's just that they have utterly no idea about how these various thousand-page pieces of work will affect them.
That's why it was so refreshing to hear that Rep. Anthony Weiner of Brooklyn/Queens is introducing two bills into Congress, one to abolish Medicare and the other to extend Medicare to everyone. The first one is a piece of legislative irony you seldom see in the present climate of Congressional nastiness, daring all those public-payer paranoids to dismantle a program their constituents love. The second one is a straightforward single-payer alternative. Weiner had to wait a long time for this — he had to secure Speaker Nancy Pelosi's reluctant agreement to put single-payer on the docket — but it may in fact be a stroke of good timing. Many people, including some members of Congress, are so frustrated by the mishmash that they may take a good look at a plan that's clear, simple, and efficient (administrative costs for the present Medicare program are 3%).
So many of the objections to single-payer are driven not by evidence and common sense but by ideology, and of course by the insurance industry. As Weiner has noted, almost everybody who's privately insured has a single payer right now: their insurance company. There's very little "freedom of choice" involved; employers give few options other than choosing between an HMO and a PPO. The only difference is that their money is going to a business rather than to a government agency.
It's so strange that people and politicians can get so worked up about paying taxes and be so resigned to paying premiums. According to CR, the median annual premium of the individuals surveyed — that's not counting employer contributions — is now $1,829. Why not eliminate the premiums — and the companies that charge them — and tack that amount, and perhaps substantially less, onto a universal Medicare tax?
Once again, as in so many other legislative proposals both federal and state, there is apparently little in the several health-care bills about paying for them. President Obama himself has created his own "read-my-lips" moment by promising "no new taxes" on the middle class. But new programs should always be directly linked to new taxes. All this "creative financing" — cigarettes here, "the very wealthy" there — just leaves everybody, middle class included, with feelings of unfairness. The best solution is the most "transparent": a graduated health tax on income both individual and corporate. Right now, the Medicare tax is flat — 1.45% on all earnings for employer and employee, and 2.9% for the self-employed. Graduating the tax based on ability to pay (and that would include retirees, who presently pay nothing for Medicare Part A hospital insurance) would equitably raise the funds for universal health care.
The intangible health benefit of the current Medicare program lies in its providing not only insurance but assurance. It's guaranteed, and in most cases, it's hassle-free. People can worry about their health rather than their health insurance.
For those over 65, health care has come to be seen as a universal right. Why not extend that right to the population at large?

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