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Stones & Bones / volume 10 number 8, August 2008 DOSE OF REALITY The United States is in dire need of a program of affordable health care for all its citizens. Notice that I use the term “affordable health care,” not “affordable health insurance.” Health care and health insurance are not the same thing: health care is the actual delivery of health services, whereas health insurance is merely a mechanism to pay for health care, and most insurance pays for only a fraction of the cost of health care. In this country we rely heavily on private industry for health insurance, despite the fact that this industry absorbs a sizable fraction of the health care dollar, expending it on high administrative costs and shareholder profit. Too little of the money passing through the private insurance industry actually goes to pay for health care. The most promising milepost on the road to affordable health care for all Americans is the introduction of HR 676 in the House of Representatives in January 2007. This bill, titled “United States National Health Insurance Act” (or the Expanded and Improved Medicare for All Act), was introduced by Rep. John Conyers (D-MI). Initially with twenty-five co-sponsors, the bill has gained increasing support in the House, and it now has ninety-one co-sponsors. (Except for one Independent, these sponsors are all Democrats.) Furthermore, HR 676 has picked up support elsewhere, and just recently received the backing of the US Conference of Mayors and other organizations. Among them is United Academics AAUP/AFT local 4996, the union representing the faculty of the University of Alaska Fairbanks. Most proposals for health reform, such as those of presidential candidates John McCain and Barack Obama, fail to address the real problems of America’s dysfunctional health care system. HR 676, by contrast, does not pussyfoot around: it goes right to the heart of the problem—too much reliance on the private health insurance industry. The bill basically calls for elimination of that industry by establishing an effective single-payer health care system operated by the federal government. A laudable aspect of the bill is that it provides every American with all medically necessary health care services. These include primary care and prevention, inpatient care, outpatient care, emergency care, prescription drugs, long-term care, mental health services, dental services, vision services, hearing services, and chiropractic services. In short, it provides all the health care services that are essential to the well-being of Americans. HR 676 eliminates all deductibles and cost-sharing, thus removing any need for co-insurance or any other form of cost-sharing by beneficiaries. This is an important provision that truly makes health care available to everyone, regardless of financial condition. Under HR 676, no longer will the United States ration health care on the basis of the ability to pay. The need for freedom of choice is much touted, and the bill takes care of that by giving every patient the option of choosing whatever health care he needs from any licensed clinician anywhere in the United States. In another advance toward taking health care out of the marketplace—a proper move because health care is not a suitable commodity for the marketplace—HR 676 requires that all providers of health care be nonprofits. All for-profits will be required to convert to nonprofits, and the bill has a provision for compensating the for-profit enterprises for the actual appraised value of converted facilities used in the delivery of health care. Along the same line, HR 676 basically eliminates for-profit health maintenance organizations (HMOs) by classifying them as for-profit insurance companies, and private insurance companies are prohibited from selling policies that duplicate the coverage provided under the act. Another cost-saving provision of the act is to establish global payments to hospitals, nursing homes, and community or migrant health centers, thereby reducing the administrative costs of such institutions associated with fee-for-service payments. For physicians and other clinicians, payment will be on the basis of a negotiated fee schedule, and that will greatly reduce the hassle and expense of billings and collections typical of our health care system. This will be a great boon to physicians of course, and it will allow them to spend more time on what they want to do: serve their patients. They will no longer have to bill patients for services and then try to collect. Also, the program proposed by the act will establish a formulary of prescription drugs, promoting use of generics where feasible, and purchased in bulk at prices negotiated with suppliers in a fashion currently conducted by the Veterans Administration health program. The result will be a substantial overall reduction in the cost of drugs. The plan for funding the program HR 676 proposes seems fair and equitable. In essence it involves a progressive income and payroll tax plus a small tax on stock and bond transactions. Additional funding will come from federal monies currently appropriated for existing health care programs such as those that serve the indigent and uninsured. Clearly, this is an excellent bill that does all the right things to create an affordable single-payer health care system. One remarkable and highly practical aspect of the proposal is that it calls for establishment of the single-payer health care system over a period of fifteen years, putting it into effect slowly so as not to disrupt the economy of the country and damage the livelihoods of individuals. The new program will be so efficient that many insurance company employees, clerical and billing personnel, and others will lose their jobs. The bill calls for them to receive first priority in retraining and job placement, and also makes them eligible for to receive unemployment benefits for two years. In short, HR 676 is a dream bill, and I find it highly encouraging that this proposal is gaining support from many quarters—not, of course, from the insurance and pharmaceutical industries, which will deploy every lobbying propaganda trick they know to prevent the American public from getting truly affordable health care. The public benefits immensely, and in the long run the whole of American industry does too, as many American industrialists are beginning to realize. To compete in the global marketplace, they need the efficiencies of a single-payer health system. You can read the full text of the bill at: www.thomas.gov/cgi-bin/query/z?c110:H.R.676: Neil Davis is a retired geophysicist and author of several fiction and nonfiction books. His most recent book is Mired in the Health Care Morass. More on health care issues can be found at his blog, http://healthcaremorass.blogspot.com. Neil can be contacted at neildavs@mosquitonet.com. | ||
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