U.S. needs a new health care debate
Health care in America. Ain’t it a wonderful thing, how we all feel so secure as we go through life, thankful that we live in the richest nation on earth and can rest assured that if we get sick, we will be cared for by that same nation whose wealth we have helped create?That, in case you didn’t recognize it, was extreme sarcasm.Our nation has ceded control of its health care systems to corporate interests, mainly the insurance industry and business-minded practitioners, who see their main job as one of making money rather than taking care of people.This deplorable situation is most clearly shown in the fact that more than 45 million people, more than 15 percent of the U.S. population, have no health insurance, meaning they have no access to basic health care.The second insidious outcome of this situation that the health care industry, which has been dubbed the “medical-industrial complex,” has conspired to drive the costs of health care ever skyward, to the point where it is impossible to afford health care with health insurance.This has become a vicious cycle of neglect that has injured an unhealthy percentage of our population, as is generally acknowledged by a growing number of critics.Which brings us to the point of this column, which is to examine two recent developments at opposite ends of the country. In the state of Massachusetts and the virtual city-state of San Francisco, Calif., laws have been passed this year that are said to be attempts at reform, and have been labeled “universal health care” initiatives. In both cases, however, the only “reform” has been the goal of forcing everyone to get health insurance.In Massachusetts, the new law requires that all state residents obtain a minimum level of health insurance, and the enforcement mechanism is the state’s income tax return check. If you don’t do it yourself, the state will withhold the necessary amount from your tax return check and buy the insurance for you. For the poor, the new law includes a provision for a subsidy to help pay insurance premiums, representing a little help from the government.In San Francisco, it is generally the same deal, and in both cases the business community is to be forced to kick in some of the money that will end up in the pockets of the medical-industrial complex.The San Francisco program is estimated to cost $200 million initially, though no one has said where the costs might go over time, or where the money is to come from over time. To start out, the state and the city both have plans to tap into existing medical assistance funds to help defray the costs. The problem with all this is it does nothing to get at the basic problem, which is this: If health care is left to business, business will place its own needs above those of the patients, who by definition are outsiders in terms of profit margins, stock dividends and other aspects of finance.There are those who believe that these efforts are part of a broader scheme of “reform” that will bring this entire question into sharper focus, perhaps in time for the 2008 presidential battle.Other observers have noted that the health care conundrum has basically been ignored by policy makers since the early 1990s, when the Clinton administration’s half-baked efforts at “reform” went down in flames. That effort, by the way, also did nothing to get at the basic structural problems of the crisis, but rather was little more than a plan to further enrich the insurance companies. I was interested to discover, during research for this column, that the health care industry is in financial trouble. Corporate health care is losing money, at a rate of about 5 percent a year as of 2004. It seems people are putting off visits to the doctor or the hospital for financial reasons – rising deductibles and co-pay amounts on top of rising prices in general, that sort of thing – and the resultant drop in demand for health care services is pinching the hospitals and doctors.One offshoot of this decline is that more than 400 emergency rooms have closed in the last decade and a half, further tightening the availability of health care for the poor and uninsured. This is exacerbating the cycle of neglect, to the point where analysts for the Standard & Poor’s fiscal think tank are predicting that things can only get worse.Will all this lead to true reform? Will it force U.S. policymakers to see that the only way out of this is to create a “single payer” health care system where the government- meaning the taxpayers- is in control of everything from costs to availability?I don’t know. We have examples of how such a system can work already in the form of Medicaid for the aged and the poor, the Veterans Administration health care network for the military, and the taxpayer-funded health care provisions enacted by Congress to make sure our national elected representatives have the best health care system in the country today.The questions are out there, the information is available. It remains for us, the voters, to make sure the next election cycle shines the light of day on these issues so that answers can be found. John Colson can be reached at firstname.lastname@example.org
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