No Bebop

Health care reform has been getting a lot of attention lately, no doubt because the president campaigned on it and won a decisive victory. But a secondary impetus behind the current interest in the topic is the slow awakening of certain sectors of the economy that helped bring down health reform during the Clinton administration.

The business world, which pays the freight for health care for its employees, has noticed in recent years the annual increases in health care costs (and therefore health premiums) of 7 percent going back decades. This has driven a nearly year-round orgy of shopping around for cheaper policies, the cost of which falls heavily on the enterprise — current ward of the government General Motors’ health care costs have been estimated to add $1,500 to $2,000 to the price of every car. Clearly, all the other auto companies with significant U.S. facilities must have a similar burden, and of course it can’t be limited to just autos — every company is scrabbling to cut their health insurance premiums.

The continual changing of health providers, in turn, creates morale problems among employees. The new insurer often has a different list of approved doctors and hospitals, so people getting chronic care occasionally get their favored doctors and treatments yanked out from under them. Pharmacy coverage gets shunted off to mail-order companies instead of the corner drugstore. And of course, new policies almost always have higher co-pays, higher premiums and stricter rules about what they will and won’t cover. Oh, and while I don’t have statistical backing for this, can anyone really doubt that continuing cost increases in medical coverage are a part of the reason why ordinary wages have been pretty much stagnant for a decade?

These trends have been evident to the ordinary wage-earner for quite some time, to politicians with their platinum-card health care policies not so much, probably because of campaign contributions from Big Pharma, big hospital chains and big health insurance companies. This is a bipartisan phenomenon, I’ll grant you, but it has been the Republicans, going back to the failed Clinton reform battle, who have operated in near-complete denial of the problem. Like their denial of other problems, like global warming and the recession, their fake happy talk and scare talk of “government-run health care” isn’t having much effect.

Thank goodness for GOP pollster Frank Luntz, who has distributed a fresh set of talking points to the Republicans to help them serve their real masters and defeat reform while pretending to be engaged in finding solutions. Not surprisingly, there’s not a useful policy proposal anywhere in the memo, just the usual attempts by Republican spinmeisters to rewrite history and the dictionary. Joe Conason does a nice beatdown of the memo at Salon, and you can follow the links to get the flavor of Luntz’s Orwellian healthspeak.

More troublesome is the fact that the supposed good guys in the Democratic caucus are trying to pre-game the system, as was reported this week when advocates for single-payer health care were conspicuously disinvited from a health care reform hearing led by Sen. Max Baucus (D-Mont.). They were reduced to causing a disturbance in the hearing. You can get the lowdown from Ed Schultz’s show here:

Now, I will state up front that I understand why politicians fear talking about single-payer. It’s the most radical possible reform, goring the oxen of Big Pharma, private sector health insurance companies and hospital chains. It tramples on a lot of “free market” shibboleths that are not only closely held beliefs of many Americans, but more to the point have made a lot of doctors a lot wealthier than they would be by simply opening an office and treating patients.

Ever notice how a local hospital quits practicing medicine in a certain realm, like pediatrics, but just down the road there’s a pediatric practice whose partners consist of all the pediatric doctors who used to work at that hospital? It’s more lucrative for the doctors, who charge specialist rates instead of hospital rates and who also share in the practice’s profits, which used to be the hospital’s profits. And as hospitals lose practices that are profit centers, they get stuck with the least profitable procedures, for which their prices have to go up to compensate. This kind of profit taking, however, comes out of everyone’s pocket in the form of higher insurance rates.

So yeah, I’m not one of those persons who thinks Obamacare is going to skip from the current clusterfuck of conflicted priorities, widespread non-coverage and profit-taking to a shiny happy system like the one in France, which is rated no. 1 in the world by the World Health Organization. (We’re no. 37.) By the way, those of you brought up with the scare stories of right-wing jabberers and corporate think tanks about “socialized medicine” should take a look at France. All of the health care providers are private enterprise. As depicted in Michael Moore’s “Sicko,” French doctors even make house calls. It’s just the health insurance that’s been nationalized.

And that’s a big point. I know people who have worked for health insurers. Ever hear of “subrogation?” This is where the insurer determines whether it’s really responsible for a particular claim and, if not, shunts it off to anybody else they can think of. While this is a legitimate function, it’s frequently abused by insurers who have been known to simply review a claim, check to see if the claimant has insurance anywhere else, and then forward the claim to that entity. Did you know that your injuries in a car crash aren’t compensated by your health carrier but your auto insurance company? And yet car insurance firms frequently forward injury claims to health insurers.

This kind of thing is why 30 percent of health care costs in the United States are administrative costs — shuffling paper, arbitrating disputes between insurers, or between insurers and denied claimants. The simple act of fostering “competition” raises the costs of health care for everybody. The only thing worse is when health insurers are colluding instead of competing, as is currently alleged in a lawsuit between competing hospital chains in Pittsburgh.

By contrast, the administrative costs of Medicare and the Veterans Administration health plan are somewhere in the realm of 2 percent. There’s no subrogation, because there’s only one place to go to get paid. There’s no bantering over pre-existing conditions. Medicare and the VA are single-payer health insurance plans.

Anyway, political pressures as described above will keep Congress from passing a single-payer health plan on the first try. Nevertheless, single-payer advocates need to be heard, because they represent a model of health insurance that has been proven to work in all of the major Western democracies — all of whom pay less and get better outcomes from their health care systems.

Essentially, what Democrats are considering now is whether to establish a publicly operated health insurance plan in competition with private health insurance providers. The hope among people truly concerned with reform is that this approach will allow them to dodge some of the political opposition to reform up front, and that over time the public plan will prove to be superior, so people will choose it over private insurance and employers may even shunt their employees to the public plan. The idea is to get to single-payer by attrition.

But I don’t think for a minute that the big opponents of reform will be fooled by this, so they will attempt to keep such a plan from being created, or failing that, will make Congress cripple it to the point that no one will want to belong to it. This is why single-payer advocates need to be in the mix of people planning reform — without them, there is very little reformers will have to wring concessions from the opponents of reform. And we’ll still be stuck with pre-existing conditions, 46 million uninsured, and “networks” of approved care that don’t include your family doctor. So read up on those Luntz talking points and tell anyone invoking them that we won’t get fooled again.

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