Kate’s Kitchen Table

I was waiting in a long line in the post office yesterday.  One poor clerk was working the desk and was being besieged by patrons with multiple packages, a mass mailing, and a pick-up of a certified letter that didn’t seem to be anywhere.  The wait seemed endless.  An elderly gentleman in front of me – obviously old enough to be enjoying his Medicare benefits – huffed and said, “And NOW they want to take over our health care!”

I stopped myself before publicly arguing with this old fool, but I wanted to tell him that while he’s enjoying his government-run health insurance, many other people would give their eye teeth to have whatever he had – even if it was inefficient.  It’s  a damn sight better than nothing.  I just figured he was a Republican, and left it at that.  And If you only know one thing about politics, know this  – if there is one thing that the Republicans are really good at, it is the “sound bite”, the succinct summing-up of any debate in three words or less.

 Rationing!  Death Panels!  Illegal Immigrants! Government Takeover!  The lies and disinformation campaign have controlled this debate for almost a month now.  Liberals, Progressives, and just plain Democrats that want health care reform have been stunned silent by the sheer numbers of people the other side has gotten to believe this.  They’ve even got elderly Americans believing that the Medicare that they love and revere so much, is NOT a government-run healthcare program.  I am losing faith in the intelligence of the American voter. 

What’s worse than the lies from the other side is the amount of time we are spending to tell the American people what health care reform is NOT, rather than what it is.  Is it any wonder that support for an Obama health care plan seems to be dwindling?  Nobody knows just what it is.  The administration MUST do a better job at letting Americans know what they are buying and what they can expect.  Any of these explanations must include the debunking of the more insidious health care myths – the ones that all of us seem to accept without question.  First and foremost of these is “The U.S. has the best health care in the world.” 

According to every agency that keeps statistics on health care about the only areas where the United States is tops are in financial indicators.  We are ranked #1 in how much money per capita we spend on health care (over $7,000 per year in 2008 – twice that of ANY other country), number one in the percentage of personal bankruptcies caused by health costs (50% in 2006), we have more medical equipment per capita than any other industrialized country in the world (MRI machines, CAT scanners, x-ray machines, etc.), and the highest rate of health management support workers (business managers, administrative workers, etc.) to providers (doctors, nurses, and pharmacists). 

What we do not have are outcomes.  Of 48 surveyed nations, the U.S. ranks 47th in life expectancy in the world (just below Costa Rica), 43rd in infant mortality (lower than Cuba), and 24th in the probability that you will die before the age of 60.

The fact is, our “best” and wonderful system of medical care is only available to those who can afford to pay.  From 2000 to 2006, overall inflation has increased 3.5%, middle-class wages have increased 3.8%, and health care premiums have increased 87%.  The family share of premiums plus cost sharing have been rising faster than inflation, causing access problems for some.  Current estimates are that about 47 million Americans – about 17% of the population – is uninsured.  Four out of five of the uninsured are families, and about two-thirds are low-income workers.  The most often cited reason for lack of health insurance is cost (over 50%), followed by lack of a job (24%).  Less than 10% of the uninsured are those that just don’t purchase it.  These chronically uninsured do not count those people that will face insurance gaps – temporary loss of coverage, usually due to unemployment.  Looking over the last two years, about 82 million Americans younger than 65 experienced a significant gap in insurance coverage.

This does not include the underinsured population – the Americans with insurance who find that the coverage is not adequate.  Several organizations estimate that about 16 million of the insured do not have sufficient coverage to protect them from crushing out-of-pocket expenses.  Of all the personal bankruptcies that were filed due to medical expenses, 75% of those were by individuals that had health insurance.  Finally, more than 40 million adults stated that they needed but did not receive one or more of these health services (medical care, prescription medicines, mental health care, dental care, or eyeglasses) in 2005 because they could not afford it. 

The most important feature of any health care reform legislation must be to provide universal coverage and health care access to all Americans.  Many proposals that the Republicans and “blue-dog” Democrats say that they can affirm are health INSURANCE reforms, not reforms to health care.  Eliminating denial of coverage for pre-existing conditions and prohibiting dropping an insured individual from coverage because they are sick are great ideas – but they do not improve access.  They are also a red herring.  No, they won’t deny you coverage with a pre-existing condition, they’ll just charge you three or more times what anyone else pays.  Insurance co-ops again will not improve access because they must compete within an industry model that only makes money by denying coverage.  A non-profit entity still has to cover its expenses and insurance reform does nothing to lower cost.

The only thing that is guaranteed to provide universal coverage, adequate access,  and lower costs to consumers is a public plan option.  Immediately, consumers would see savings over 20% due to less overhead costs.  More enrolled would mean lower costs as the risk would be spread through a larger population.  It would be Medicare for everyone – but younger working people would pay additional premiums.

It is time that we realize that it isn’t good enough to have the most expensive best health care in the world – that more and more citizens do not have access to. 

(sources:  World Health Organization, Center for American Progress, U.S. Census Bureau, National Center for Health Statistics)