Oct/Nov 2002
A
Statement of Conscience: "Not In Our Name"
The Bill of Rights Foundation
We
Must No Longer Tolerate a Culture of Violence
Depak Chopra
Murder
for Profit
William Rivers Pitt
Opposing
the President's Call for "Relentless War"
David Krieger
"Diplomacy"
in the Age of the American Empire
Robert Jensen and Rahul Mahajan
The
Middle East: A Human Perspective
Pam Derby
What
Awaits Us in Iraq "Warrior Kings and the Test of True Vision"
David LaChapelle
Free
to Choose: Health Care for All-Oregon: Measure 23 on the Ballot this November
Gerald Cavanaugh
We
Have the Right to Know What's in Our Food
Louis Mincer
Oregon's
Measure 27
Give Oregonians A Choice
Same
News Every Channel, Every Media
Don Monkerud
The
Cult of Greed and the Anesthetization of Democracy
John Darling
Forest
Health & Logging Wealth
Lesley Adams and Joseph E. Vaile
Finding
Balance in the Autumn Season with ayurvedic Practices
Myrica Morningstar
Sacred
Plants
David Crow
The
Movie Mystic
Stephen Simon
The
Thomas Messages
James Twyman
The
Yearly Round
Richard Moeschl
Cosmic
Calendar
Salina Rain
Free To Choose: Health Care for All Oregon
Measure 23 on the Ballot this November
By Gerald Cavanaugh
Oregon voters will finally have a chance to cure the sickness known as the “for-profit health care industry.” The remedy is the Oregon Comprehensive Health Care Financing Act, 2002, which will be on the November ballot. The following essay will describe and explain what this health care financing initiative entails.
In
anticipation of the lies and distortions that “free market” ideologues
and insurance and pharmaceutical company opponents will spew against the measure,
and to reassure citizens concerning the fairness, rationality, and true merits
of the plan, it is perhaps best to approach the issues by clarifying what
the initiative is definitely not about. Bear with me: there is no simple
way to enable citizens to see the virtues of the Plan and to be armed against
the opposing counterfeit arguments.
This Plan is not about socialized medicine. (Although, as Jerry
Seinfeld might say, “Not that there is anything wrong with socialized
medicine.”) What in America is commonly called “socialized medicine”
takes many different forms in democratic, civil libertarian states such as
Great Britain, Spain, Finland, Ireland, Japan, Norway, Denmark, Sweden, and
Italy, among others.
Some of these programs are financed solely by progressive income and payroll taxes with medical costs, such funds being collected and disbursed by a “single payer” government agency: the HCFA-Oregon Plan is such a single-payer mechanism. Other such universal health care systems are financed by these taxes and also by funds from union, employer, and mutual help societies. In some of these systems all the hospitals are publicly owned and operated, and physicians are salaried civil servants; in others, public and private and religion-linked hospitals are available and doctors may or may not be in private fee-for-service practice. The essential point is that health care coverage is universal. In all of them, citizens overwhelmingly prefer their system to anything remotely like the American market-oriented debacle.
In the year 2000, the World Health Organization (WHO) ranked the United States at the disgracefully low level of 37 among the nations of the world in terms of health care for all citizens in regard to such health and medical outcomes as life expectancy, infant mortality, rate of vaccinations, hospital stays, access to a primary care physician, and morbidity rates: America has more sick people than any other industrialized nation. They are the walking sick and wounded because they cannot afford to see any doctor. No wonder that the WHO ranked America even lower (at 59) in terms of “fairness” because too many people are simply left out.
This
initiative is not about government standing between you and your doctor.
Or what treatment may be prescribed—in contrast to today’s too common
situation in which insurance company and HMO junior clerks tell you whom you
may see and what medical practice must be followed. Under this initiative
you, the patient, are free to choose your (willing) health care provider and
it is entirely up to that provider to decide what “medically necessary
treatment” is to be applied. Remember, this is a “single-payer financing”
initiative. All it does is get rid of the 800 insurance companies licensed
to sell health care insurance in Oregon (talk about redundant bureaucracies
replicating each other’s work!). The plan has no provisions con-cerning
anything other than where the money comes from and to which licensed, certified,
or registered health care provider any proper legitimate payment goes. It
will be administered by a democratically-elected, accountable, responsible
Health Care Finance Board and doctors will be allowed, finally, to practice
their profession.
This initiative will not drive doctors from the state. One of the most
common lies about other advanced countries’ so-called “socialized
medicine” is that the doctors in such systems are unhappy and wish they
could practice in America. In fact, those doctors in general are happier and
have higher professional morale than do their American counterparts. There
is no shortage of highly-qualified doctors in those “socialized medicine”
countries, nor is there a “brain drain” of doctors from the advanced
industrial nations to America. Yes, well-qualified, English-speaking doctors
from India and Pakistan, for example, who intern in America would love it
if we allowed them to stay but that, of course, is a different matter and
the American Medical Association is dead set against any such competitive
pressure.
This plan will not be prohibitively expensive. Quite the contrary.
Even with universal coverage for all Oregon residents, every objective analysis
of the single-payer financing mechanism unequivocally concludes that such
a plan will in fact cost less than the current systemic mess. There have
been at least ten of these studies, including a 1991 Physicians for a National
Health Program report, a 1993 Congressional Budget Office study, a 1998 Economic
Policy Institute analysis, and three recent statewide studies for Massachusetts
(2000), Maryland (2001) and California (2002) prepared by an independent consulting
firm, The Levin Group.
How
can this be so? Look at the numbers: Combined administrative costs of for-profit
insurance companies and providers ranges between 25% and 50% of every medical
dollar. Since private insurance companies and for-profit HMOs have as their
first duty the care and feeding of their shareholders, with their executive
officers running a close second or, apparently, even first, devotion
to net profits all too often means denial of services and deferment of payments.
“Provider costs” are those entailed when doctors and hospitals have
to hire thousands of clerks to handle all of the demands and delays of the
insurance companies. In San Diego, the director of clinics for the poor
has to spend $165,000 every year just for clerks whose sole job is to determine
who is eligible for various programs.
In contrast, the single-payer Medicare system spends between 2% and 3% of
medical program outlays on administrative expenses such as overhead, salaries
and computers. Think about it. Administrative burdens are lower for Medicare
than for private insurance plans because Medicare bases eligibility for benefits
mainly on age and offers a single, basic benefit package. Unlike private plans,
Medicare does not pay insurance commissions or most sales and marketing expenses—and
these, too, are costly. In seeing how the single-payer approach to health
care financing is so much more efficient and inexpensive, citizens must understand
that, except in a universal single-payer system, administrative costs can
be staggering. Medicaid, for example, which has an “income and assets”
requirement (which must be checked and rechecked continuously) has a higher
administrative burden than does Medicare, based as it is only on age. Even
so, the combined administrative force of both Medicare and Medicaid totals
just a bit more than 4,000 employees, one employee per 9,500 beneficiaries.
Now that is efficiency and cost effectiveness.
Beyond the reductions in administrative expenses, there are other significant cost containment and cost reduction factors. The initiative emphasizes preventive care and enables patients to have a close relationship with a primary care physician which not only contributes to personal health but also cuts down on the ruinous costs of emergency care, which for many Oregonians today is the only time they see a doctor. The Plan also has provisions for continuous education on health, diet, medical, and life style issues, all of which programs are demonstrably effective in improving health outcomes and facilitating cost reduction.
Take the current prices on prescription drugs, please. And then think, “Buying in Bulk.” This initiative will create a prescription drug market of over 3.5 million Oregonians. Instead of charging whatever they think they can get away with, as they do today, pharmaceutical companies will have to sit down and bargain with our health care agency on fair prices for their commodities, just as they now do in places like Canada, Mexico, and Western Europe.
The initiative also envisions cost controls on the purchase and construction of capital equipment and medical facilities to insure that taxpayers’ money is spent on what patients really need. Similarly, there will be oversight concerning the reliability and cost effectiveness of modes of treatment so that, for example, the present practice of paying for new and more expensive drugs with no real clinically proven enhanced benefits will end.
In short, as the 1998 Economic Policy Institute analysis concludes: “Even more important, with the single-payer system, greater efficiency and improved cost containment would become possible, leading to sizable savings in the future. The impediment to fundamental reform in health care financing is not economic but political. Political will, not economic expertise, is what will bring about the important change.”
One
other important point: The anticipated financial outlays in this Plan are
based on federal projections of health care expenditures in years to come.
Moreover, the funding level for the Plan has also been scrutinized and accepted
by expert economists using conservative state revenue projections. The initiative
mandates a balanced health care budget and includes guidelines for provision
of care that requires conformity to the budgetary constraints. In other words,
the financing of the Plan is empirically well-founded, prudent, and sufficient
to cover the expected costs.
This Plan will not place an excessive burden on small business. The payroll
tax paid by employers is a graduated tax, from 3% to 11.5%, based on total
wages paid, that is, in general, the smaller the business the lower the
tax. A small business employer with a worker earning $7.00 an hour will pay
only 21 cents an hour on such a wage or $33.60 a month for a full-time worker.
Most small business people want to be able to afford health insurance for
their workers but less than one-half of them can do so. This initiative will
allow all of them to provide for their workers, with the proven concomitant
increases in worker productivity and morale and reductions in personnel turnover. All
businesses will pay the tax and thus no business can gain a competitive advantage
by not insuring its workers.
Those
business people who already provide health insurance will be relieved of the
yearly grind of selecting and administering employee health plans—the
premiums of which have been rising at double digit rates for years—and
their own costs will be lower, while they and their families will also be
covered. Finally, this payroll tax is also a business expense and thus a deduction
from business income for tax purposes.
This initiative will not be a heavy income tax burden on individuals.
In the first place, those whose taxable income is less than 150% of the Federal
poverty level—for a single person, this is about $14,000, for a family
of four, about $30,000—are exempt from the tax. Only after individuals
and families have exceeded this level will the graduated tax begin to affect
them and that will start at a 3% rate. The richest 5% of Oregon’s
taxpayers may pay as much as 8% of taxable income but, in any case, their
payment is capped at $25,000. With the federal tax deduction the actual outlay
would be about $15,000. At an Oregon taxable income level of $312,000,
that is a bargain. (Your taxable income in general is 60% of your gross income.)
And
keep in mind that this tax, whatever your income level, will replace your
current health insurance premiums, your co-payments and deductibles, your
prescription drug costs, and, if you have such benefits, your dental and vision
care premium costs. The vast majority of Oregonians will be far better off
financially, as well as having excellent health care coverage, when this Plan
is adopted by the citizens.
All of the preceding will certainly not answer every question concerned citizens
may pose. It is to be expected that this initiative will generate much heated
discussion, and one may hope that much light will be thrown on the issues
in the process. But, given the domination of our political system by powerful
corporate interests seeking to maintain a status quo that primarily benefits
themselves, and given a corporate media that most often selfishly serves those
interests, citizens must work hard to get an objective picture of reality.
For the entire text of the initiative visit the website of the grassroots
organization behind this ballot, www.healthcareforalloregon.org. See also
the excellent website of the “Physicians For a National Health Program”
at www.pnhp.org, and that of the Public Citizen Health Research Group, www.citizen.org/hrg.
I close with two necessary caveats: Do not be fooled by the propaganda against the Canadian health care financing system, such lies and distortions most often used as a club by opponents of single-payer reform in America. Ninety percent of Canadians support their system and resist efforts by profit-seeking interests to move it toward an American-style system. Similarly, be very skeptical about stories concerning the British National Health Service which, according to certain American economic interests is facing collapse. As the capitalist market-oriented periodical, the Economist, wrote recently: “Prime Minister Blair must preserve the two things that the National Health Service has done very well. One is delivering near-100 percent health coverage for the population. As several countries, most notoriously the United States, are discovering, this universal coverage is more easily said than done. In systems that depend largely on private insurance, it is especially hard. The second is the NHS’s basic cost efficiency: it delivers health care of high quality at far lower cost than other rich countries have managed.”
Oregonians should seize this opportunity to make universal health care a reality. After all, we want to live in a decent society, one in which the answer to the question, “Am I my brother’s and sister’s keeper?” is YES!
Gerald Cavanaugh is a member of Health Care For all-Oregon and Physicians for a National Health Program. Health Care Meltdown: Confronting the Myths and Fixing Our Failing System by Dr. Bob Lebow, is a splendid explanation of what this struggle is all about, and how to solve it. Send $19 to JRI Press, 5398 N. Cattail Way, Boise, ID 83703-1778, or call (208) 853-3087.
