A faulty prescription for reform

February 25, 2010

— Dr. Steffie Woolhandler is a co-founder of Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance. She is a professor of medicine at Harvard Medical School and co-director of the school’s General Internal Medicine Fellowship program. The views expressed are her own. —

President Obama, at today’s summit and in his proposal earlier this week, has embraced a deeply-flawed bill – the Senate bill – as his model for reform.

That bill would leave about 24 million people uninsured in the year 2019, according to the Congressional Budget Office. Leaving 24 million people without health insurance is neither “universal care” nor even serious reform. As my research team has recently shown, that 24 million uninsured people would translate into about 24,000 unnecessary deaths annually. As a doctor, I find that prospect completely unacceptable.

Sen. Harry Reid, in his opening remarks at the summit, cited our study about 45,000 deaths annually due to lack of insurance (with about 45 million currently uninsured). He also cited another recent study we published showing that 62 percent of bankruptcies are linked to medical bills and illness, and that three-quarters of those bankrupted had health insurance when they first got sick. But when it comes to a remedy, the senator – and the president, I regret to say – offer the wrong prescription.

Their proposal is based on handing over $440 billion in taxpayers’ money to the private health insurance industry, the cause of the problem in the first place. Their rationale is to subsidize purchase of the insurers’ shoddy policies, which are riddled with gaps like ever-increasing co-pays, deductibles and uncovered services. Decades of experience show that the private insurance industry can neither control health care costs, nor give American families the health coverage they need. Many states already regulate insurance premiums and coverage, so merely regulating private insurers is not the solution. Moreover, the Senate plan to send $440 billion into the coffers of the profit-driven insurance industry will give them even more financial and political power to block future reform.

Once the president decided to allow the private insurers to continue to run our health care system, he effectively blocked any prospects for a reform that was comprehensive, universal and affordable. And he immediately faced a series of unpalatable choices in order to raise money to pay for reform, including proposals like mandating that uninsured families pay thousands of dollars for skimpy private coverage, cutting back Medicare coverage and imposing a new excise tax on the health benefits of workers.

What we need is a Medicare-for-All approach, which makes universal health care affordable because it saves about $400 billion in administrative costs every year. It would eliminate the wasteful paperwork and bureaucracy that the insurers impose on our health system and you use those savings to cover the uninsured, and to plug the gaps in coverage for people who now have insurance.

Polls show that the American people support the idea of a Medicare-for-All program supported by taxes. However, the private health insurance industry has hijacked the reform process through campaign contributions and lobbyists. They’ve hijacked Congress and, unfortunately, they’ve hijacked the Obama administration.

These for-profit interests are also giving money to the opponents of the reform process on the right, aiming to steer the whole process towards higher profits for insurers and drug companies, and further and further away from the only workable, rational reform: single-payer Medicare for All.

The American people want an approach that improves care for those with insurance, and the Obama proposal does virtually nothing on this score.

They want a bill that covers all of the uninsured, not half of them. And they want it to be affordable. That means we have to go with single payer.


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When we agree that health care is an essential to life, just as breathing is, then we will have true reform. I agree with the writer. We do not buy rain from private suppliers, but they wish we paid them for rain. We do not buy sunshine from private companies, but they wish they could charge for it. We do not need private health insurers, just equal care for all.

Posted by fred5407 | Report as abusive

Right, like in Canada. Forget about timely health care. Marvel at how the health workers’ unions have hijacked the whole system for their personal benefit. Look at the waiting times. Watch billions and billions of dollars being shovelled into the gaping maw of health care with no discernible improvement in service. By all means, let the government run it, then ask yourself why Canadians increasingly turn to the US system for care, like the premier of Newfoundland did recently for heart surgery. Yeah right.

Posted by Gotthardbahn | Report as abusive

Fred5407 – what rubbish. Food is essential to life but farmers and producers expect to get paid for their efforts. Do you expect to get paid for your efforts at work? I thought so.

Posted by Gotthardbahn | Report as abusive

Gotthardbahn, your argument is equally flawed. Farmers (sugar, cattle, corn, etc.)as well as the oil and gas industry are heavily subsidized by the U.S. government.

Also, according to the Organization for Economic Cooperation and Development, as well as other studies, Canadians are quite happy with their system and get health care that “provides care as good as in the U.S., at a cost 47 percent less for each person.” Of the industrial nations, the U.S. ranks something like 15th in quality to cost ratios.

Posted by Andvari | Report as abusive

No one is talking about providers not getting paid – doctors, nurse practitioners, dentists, and clinics and hospitals will get more payments with a Medicare for All system than the one we have now where millions of people have to pay out of pocket and after layoffs can’t and must default or go into credit card debt or decide to die. What is this rubbish about Canadians en masse wanting to have our system? That is not true. Yes, there is a wait for specialty services, but there is a wait here as well. And for many people the wait is here permanent and fatal due to lack of ability to pay.

Posted by preexisting | Report as abusive