Finally, They Ask Who's GETTING Health Care

The Globe reports:

People with robust [sic] health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

All right, let's give the reporters credit. Never mind the logical impossibility of health insurance plan being "robust" if you can't actually use it. (The operation was successful, but the patient went broke?) Also, forget about the fact that this only becomes news when it affects middle-class people, the kind who thought they were already well insured.

Let's be happy that finally, it's front-page news that the Massachusetts individual mandate to buy health insurance is failing to deliver actual health care to a large and growing number of people. The key word here is "failing." This is not a model for national health insurance. It's an object lesson in what happens when the hospitals, insurance companies, and doctors all design a health plan without the slightest thought for its effects on actual patients.

Feeling Ill about Health Care Debate

Following the health care debate is enough to make you sick.

Here in Massachusetts, supporters of the state's mandatory health insurance plan talk about how many people now have insurance and how much money that's going to save the hospitals and the state treasury. Critics mostly talk about the cost of the plan and how, soon, paying for those who can't pay for themselves will drive the state to the poorhouse. Some point out that businesses are providing their employees with health insurance plans that don't meet the minimum standards set out in state law, and daring the state to catch them.

All this is beside the point. The goal should not be to provide people with health insurance but to ensure their right to health care. Plans that cost low- to middle-income households a lot of money up front--plans with a high deductible, to use the industry's bland euphemism--insure coverage without care. And that leaves people just as sick as they were before, just a little poorer.

At the federal level, besides using Massachusetts as a model (!), Obama is doing the usual liberal dance: offering something that makes him feel good but doesn't do the job.

• "President Obama will sign a presidential memorandum today to extend benefits to same-sex partners of federal employees, administration officials said last night, but he will stop short of pledging full health insurance benefits," reports the Boston Globe.
• "A key Senate committee voted yesterday to expand a children's health insurance program to cover an additional 4 million uninsured children," but that still leaves many uninsured, and it says nothing about what happens to children when their parents fall ill.
• The current debate is over whether the federal plan should include a "public option." Proponents say that a public plan would give people more choices--which is only meaningful if the choices are any good, and if they differ in significant ways. They also say competition from a public plan would force private insurers to find ways to cut costs. Critics say the public plan could get a public subsidy and put private insurers out of business.

"In response, Senator Charles Schumer, Democrat of New York, has proposed setting ground rules for a public plan that would force it to compete on a level playing field with private insurers." In other words, get rid of the main reason for having a public plan in the first place, its ability to serve huge numbers of people at low cost!

Schumer is no different from the leader of his party in this respect. President Obama has done all but take a blood oath that his plan is not a "Trojan horse" leading the way for a single-payer system. That's exactly what's wrong with it! Single-payer means everybody gets health insurance as a right, the same as the right to vote or the right to a public education. The fact that the Democrats are falling all over themselves to rule out a single-payer solution is what's so sickening about what passes for a health care debate.

If This Were Reform, It Would Have Different Friends

I've written before that the main problem with the Massachusetts mandatory health insurance plan is that it mandates coverage--but not care. Are we about to see that problem made larger on the national level?

"Lobbies backing health reforms," today's Boston Globe headline screams. "Insurers change their tune from 1993-94 debate." But the article makes it clear that insurance companies are getting involved only so they can protect their own interests, not those of the patients who need the care. It quotes Karen Ignagni, the president of "the nation's largest health insurance lobbying group":

"Strategically, industries have choices if they're at the epicenter of the discussion about a certain part of the economy," she said. "They can sit and wait for others to develop proposals or take the bull by the horns and look at what are the issues that are troubling the country, what are the issues that need to be resolved to help improve the productivity of the country. . . . It's not an altruistic strategy, it's a realistic leadership strategy."

And the insurance companies certainly do have a dog in this fight.

The insurance industry, meanwhile, could gain or lose depending on which reforms are adopted: Offering tax credits or subsidies to help pay for private coverage for the uninsured could bring insurers millions of new customers; but if a reform law also lets people choose a public Medicare-style plan, private insurers could lose business.

As they should! Here is an early warning signal that the Obama administration may become the third term of the Clinton era. To stop this backsliding in its tracks, check out Health Care for America Now. For the solution we really need, see your doctor: Physicians for a National Health Program.

Too Soon to Declare Victory on Health Care in Massachusetts

If you believe the papers, the politicians, or the pundits, the Massachusetts plan to make sure everyone has health insurance--by forcing them to buy it for themselves--is a great success. The uninsured don't believe it, however. Neither do low-income people in Somerville, where I live. Neither do I.

According to the Boston Globe, "The number of uninsured adults in Massachusetts fell by almost half last year." Proponents of mandatory health insurance said "that not only are more people getting coverage, but that only a fraction of taxpayers contested the health insurance mandate."

Sounds like great news, right? It does--until you look at who supports mandatory health insurance and who doesn't. People who already have insurance favor the plan by 71%. Not surprising: it doesn't cost them anything out of pocket, and the taxes needed to fund the plan haven't kicked in yet. But a majority of people who don't have health insurance yet--the people the plan is theoretically supposed to benefit--don't support it, according to a study by the Massachusetts Dept. of Revenue.

In Somerville, where I live, we recently surveyed 537 mostly low-income residents or employees. We asked them what should be the top priority of CAAS, the anti-poverty agency where I work. Keeping housing safe and affordable was the $1 priority (not a surprise, given the high cost of housing in our area). English literacy and finding a job, or a better job, were essentially tied at #2. "Access to health insurance" ranked #3. The people who need health insurance the most are telling us that the Massachusetts plan is still a problem and not yet a solution.

What do they know that policy makers don't know? I have suggested in the earlier version of this blog:

1. Too many people will have coverage without care. The affordable plans people can purchase hardly cover anything. There’s a huge “deductible,” a payment people have to make up front each year before the insurance policy pays a dollar. If I go to the hospital for a week, sure, I’m covered after the first day. But if I go to see my doctor or dentist, or if I have to buy prescriptions or eyeglasses, I’m the one who’s paying. How many thousands of Massachusetts residents will be insured but never get any more health care than they have now, under this plan?
   
   
   
2. Too many people still won't have health coverage, period. For some desperately poor people, or even people with a decent income but a lot of expenses, there’s no plan on the market that can really be called affordable. Massachusetts graciously exempts them from the mandate. But that means they won't have health insurance, the same as before!
   
   
3. The plan penalizes the poor and subsidizes the corporations that sell health insurance. The mandatory plan has teeth because the tax collectors can fine you up to $912 if you don't buy health insurance. "You think you're too poor to buy health insurance?" they are saying in effect. "Well, how would you like to pay the state and get no health insurance, instead?" The money that we are forcing the working poor to pony up for health insurance they can't use and can't afford is going straight into the pockets of the big health insurers. We are robbing the poor and giving to the rich, and patting ourselves on the back while we do it!
   

We don't need to be forced to buy health insurance from for-profit corporations. What we need is a "Medicare for all" system that efficiently provides high-quality care to everyone, regardless of the ability to pay.