Bitter medicine - Page 2

Health care reform groups fear the cure may be worse than the disease
Illustration by Danny Hellman

Yet other groups fear this cure would be worse than the disease, sending millions of new customers into a private insurance system that simply doesn't work, and compounding existing problems.

"We're still pushing for a national single-payer bill," Dr. James Floyd, a health reform researcher with the nonprofit group Public Citizen, told the Guardian. "While we're open to other options, we haven't seen anything [in proposals by Democratic congressional leaders] yet that is acceptable."

That position has plenty of support among the general public and reform-minded organizations, for whom single-payer continues to be the holy grail.

The current proposal "doesn't change the system one bit," said Leonard Rodberg, a member of Physicians for a National Health Program, who works in health policy. "These bills are requiring that people buy insurance, but there are no numbers about how much the insurance would cost. And if the cost of the insurance is still too high, you can remain uninsured."

And as negotiations center on the government-run insurance option, the concept of scratching the status quo and offering free Medicare-like health care to every American instead has fallen to the wayside.

Rep. John Conyers (D-Mich.) got 84 co-sponsors for his single-payer bill, HR 676, and hearings were held in June to explore the option. But congressional leaders then took it off the table. The reasons why seem to be as much about political will as they are about campaign contributions from the insurance industry. As one high-level congressional staffer told us, many lawmakers won't back a single-payer system in part because they "don't want to have to respond to being accused of being a socialist by the right wing."

Then there's the insurance lobby. "They spend hundreds of millions," the staffer said. "They lobby Congress, and they provide millions to campaigns. They have Fox News. But the single-payer movement is growing leaps and bounds."

Rodberg said the insurance industry would love to see a mandate to buy insurance approved at a time when insurers are losing customers because the economy is shedding thousands of jobs each month. "This is a bailout for the insurance companies," Rodberg told us. "But there's absolutely nothing in this legislation that will control costs, because it just leaves it to the insurance companies and the market."

Dr. Jim G. Kahn, president of the California Physicians' Alliance and a professor at UCSF with expertise in health policy, told us he believes the proposed bill falls short of the goal of comprehensive, universal coverage. "'Universal' was recently redefined by [Montana Sen. Max] Baucus as 95 percent — i.e., 15 million uninsured," Kahn told us via e-mail. "Reaching even that level will be hard, due to the complexity of enforcing an 'individual mandate' on families with only modest income (and hence no subsidies). And in eagerness to reach that level, more and more people will become underinsured, with inadequate coverage and a further boost in already high medical bankruptcy."

Medical debt contributed to nearly two-thirds of all bankruptcies in 2007, according to a study in the American Journal of Medicine. The majority of those afflicted were solidly middle-class homeowners at the start of their illness, and most had private health insurance.

Health Care Now, a hub for single-payer grassroots groups, is planning a large rally in Washington, D.C., for July 30, the anniversary of the founding of Medicare, on which many single-payer plans would be based. "Single-payer is the only plan that would truly be universal and contain costs," said Katie Robbins of Health Care Now, arguing that the current plan pushed by congressional leaders "doesn't protect us from the ills of the insurance-based system as we know it."

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