A majority of Americans have told opinion
pollsters (read the
opinion poll results here) that they
want good health care to be a right enjoyed by everybody--rich or poor.
Americans have said they wouldn't mind paying higher taxes to make it so.
Americans want single-payer universal health care (which, by the way, would
cost LESS than what is now spent on health care because it would eliminate
insurance company profits and the enormous administrative waste that a
multiple-payer system imposes on every hospital and doctor's office.) A
February, 2009 poll found that, "When given a choice of the current system or
one 'like Medicare that is run by the government and financed by taxpayers,'
voters overwhelmingly chose the latter. A solid majority (59%) say they would
prefer a national health insurance program that covers everyone, over the
current system of private insurance offered to most through their employer."
It is bad enough that the politicians
(fronting for the corporate elite they serve, and with backing from the
elite-controlled mass media) have
ruled out single-payer, which they most
certainly
have done. But it is worse than that.
They are planning to introduce reforms that will make our health care system
even worse than it already is. In the name of providing health care for all,
they are implementing reforms that actually aim to reduce health care for the
masses.
There is method in their madness. First,
they want Americans to feel insecure so that we will be easier to
control, and not having
health care when one really needs it makes one feel very insecure indeed.
Second, they want everybody to be enrolled in a health insurance plan in order
to more directly control and restrict how much care people can get. They don't
want people without health insurance getting their care at the emergency room
of a hospital where more dollars might be spent on their care than the elite
want. The elite intend to use health insurance as a means of limiting health
care, by providing poor Americans with health insurance policies that severely
restrict how much care they will pay for. This is already happening in
Massachusettes, where the state now
requires everybody to purchase health insurance and offers a "public option"
policy to compete with private insurers, similar to what Obama's proposed plan
would do. Here is how The New Ledger
on March 26, 2009,
reported on the reality behind the hype:
"First, it [the state] expanded subsidies for low-income (below 300% of the federal poverty line) residents to obtain health insurance. While this sounds like a valuable benefit being provided to indigent Massachusetts residents, the funding for those subsidies was primarily pulled from the state’s so-called “free care pool,” which had provided medical and mental health services to poor Bay Staters at locations ranging from community clinics to emergency rooms, regardless of their insurance status. As an ironic result of this program, more poor residents had access to subsidized insurance, but fewer could afford care when faced with a deductible and coinsurance – meaning the amount the patient had to pay up front before insurance kicked in, and the percentage of treatment costs past the deductible that fall on the policyholder. The burden of paying for service the Health Care Reform Act placed on the state’s indigent population, combined with the draining of resources from facilities that had previously cared for the poor free of charge, left a larger number of poor Massachusetts residents without access to care than before the system was ostensibly “reformed” to help them gain more affordable access to care."
Massachusetts, while expanding health insurance coverage to poor people, is dismantling the hospitals and health care services that provide health care to those people. The details about how this is being done are described in the Boston Globe August 10, 2009 Op-Ed by Ellen Murphy Meehan, titled "The state's fraying health safety net," which I have copied below. Meehan writes:
"In our state and around the nation, poor whites, African-Americans, Latinos, and Asian-Americans get their care at certain hospitals - the hospitals in their backyard. These hospitals have been the state’s partners in providing care for those who have gained coverage under reform. Despite this unique role, the hospitals have been abandoned and are compelled to deliver care with fewer resources...healthcare reform will fail in its objectives if it serves to dismantle healthcare services for the disadvantaged that it was designed to serve."
Meehan describes the true effect of healthcare reform but writes that it was "designed to serve" the poor; had she told the truth--that it was designed to ration health care for the poor but not the rich--her article would probably not have seen the light of day.
The corporate elite has given the
politicians and mass media the job of persuading the American public to view
cuts in our health care as a positively good thing: no mean task. How are they
going about it?
They are telling us that the problem with
our current health care system is not just that some people lack health
insurance, but that "health care expenses are out of control" and something
has to be done to contain and eventually reduce them: "bend the curve down" as
they say.
The message is that we need to ration health
care. Thus, after President Obama's grandmother died following hip
replacement, he told a
New York Times Magazine interviewer,
"Whether, sort of in the aggregate, society making those decisions to give my
grandmother, or everybody else's aging grandparents or parents, a hip
replacement when they're terminally ill is a sustainable model is a very
difficult question." This interview gave Op-Ed columnists a green light to
start talking about the wisdom of rationing health care spending "at the end
of life," when a disproportionate amount of health care dollars are spent. How
much is it worth, really, to extend Mother's life a few weeks if she has a
terminal illness? Which is more important, keeping Dad alive past the age of
88, or paying for a new elementary school?
This "don't waste money on keeping old
people alive" theme is couched in oh-so-rational rhetoric. But it is in fact
shockingly despicable. Let us be clear about why, exactly, it is despicable.
It's not that rationing health care,
per se,
is wrong. It is undeniable that society has only a finite amount of wealth to
spend, and we have more needs than just health care. So one way or another, by
explicit or implicit decisions, we will limit how much we spend on health care
in total and for different categories of people, and this means rationing.
The question is not whether to ration health
care, but when to do it. The time to tell somebody, "We're sorry but we, as a
society, can't afford to pay for health care that could keep you alive or make
your life more enjoyable, because we need that money for something more
important," is AFTER, not before we have begun telling people, "We're sorry
but we, as a society, can't afford to pay for your multiple mansions and your
yacht and your Lear Jet and your personal team of physicians and your personal
chefs and fitness trainers and butlers and chauffeurs and maids and nannies
and pilots etc. that make your life so enjoyable, because we need that money
for something more important." Until the latter rationing has kicked in, it is
just morally reprehensible to advocate the former.
One way they are trying to introduce overt
health care rationing in Massachusetts was revealed by the
Boston Globe
on July 17, 2009, when it reported that a state commission including key
legislators and Governor Patrick's administration "wants private insurers and
the state and federal Medicaid program to pay providers a set payment for each
patient that covers all that patient's care for an entire year and to make the
radical shift within five years. Providers would have to work within a
pre-determined budget, forcing them to better coordinate patient's care, which
could improve quality and reduce costs." (As if "improving quality" would be
as likely as "reducing costs"!)
Another way they are trying to persuade
Americans to support reducing our own level of health care is by telling us
that it is important that health care reform legislation not increase the
federal deficit with increased health care spending in the federal budget.
Thus the Republicans make a big deal about asking the Director of the Budget
Office if Obama's health care plan will increase or decrease federal spending
on health care, and when he replies, "increase," they say, "Aha! It is going
to cost Americans even more than the already bloated cost of health care."
What they don't mention is that true health care reform, meaning a
single-payer system, would reduce the overall cost of health care by
eliminating the insurance company middle man, so that the rise in federal
taxes to pay for it would be more than offset by the reduction in premiums
people now pay to private insurance companies.
Related to the aim of reducing medical care
for the masses is the theme that electronic medical records are good for
patients. No doubt there are some advantages to patients (and doctors and
hospitals) in converting medical records to electronic files that can be
shared easily within and between institutions. My medical record is presently
mostly electronic, and it is a convenience to me to have it readily available
to all of the doctors I see, even when they are in different buildings. There
is another advantage of electronic medical records: they can more easily be
used for medical research to learn what treatments work better than others.
Privacy protection is a challenge, but that might be a solvable problem.
These pluses, however, are not the main reason that the elite are advocating
making medical records electronic. Their chief motive here was revealed by a
Boston Globe
editorial July 21, 2009, which I have copied below because it illustrates
elite health care propaganda so nicely. This editorial supports the state
commission's proposed radical shift to paying a set amount for the year for a
patient (i.e. "accountable care") and
explains why electronic medical records are important to make it work: "One
carrot [to persuade providers to make the radical shift] will have to be tax
credits or outright subsidies to speed up doctors’ and hospitals’ adoption of
electronic medical records. Such records are crucial to the coordination that
accountable care organizations should be able to provide." Electronic medical
records will be used, in other words, to ensure that no patient gets more care
in a year than the predetermined set amount.
Beware of health care reformers who speak of
"cost cutting," "accountable care," "electronic medical records," "end of life
health care costs," "rationing care" or "making sure everybody has health
care" when they don't speak about the importance of making sure that
everybody--rich and poor alike--has equal status (and I don't mean "some are
more equal than others") when it comes to the amount of health care they are
entitled to in our society. For many of us, our very lives are at stake.
The fight for good health care for all is fundamentally a revolutionary fight
for real democracy and equality. The reason we don't have good health care for
all is very simple: the ruling corporate elite doesn't want us to have it;
they want to keep society very unequal, they want to make sure real power
stays in their hands, and they want us to feel so insecure that we will be
easily controlled by them. These are the same reasons our government wages
unjust wars and
supports Israel's ethnic cleansing and so many other morally wrong things.
The struggles against all of these injustices are fundamentally the same
struggle for real democracy and equality.
Boston Globe editorial:
How to pay doctors
Ideally, this shift in incentives will mean that a patient, for instance, will leave a hospital with enough discharge support so that she won’t be re-admitted a week later. Or, a primary-care physician checking an overweight patient for a strep throat will have enough time to talk to the patient about exercising more to lose some pounds. A well-crafted “global’’ payment system should pay for such preventive measures in ways that fee-for-service does not.
Boston Globe Op-Ed
By Ellen Murphy Meehan
August 10, 2009
AS NATIONAL policy makers fashion a healthcare bill modeled in no small part
on Massachusetts’ landmark health reform law, they need to address a major
flaw that has emerged here.
Three years into our healthcare experiment, health coverage gains have been
remarkable. Medicaid enrollment is estimated to have grown from less than 1
million before the reform law to 1.2 million in 2010, and altogether, in
Medicaid and private plans, more than 428,000 have gained coverage. Families
and individuals who had never had health coverage have access to health
plans and services that were previously unattainable.
At the same time, however, hospitals that serve the largest proportion of
those newly covered and low-income populations have seen their state-funded
payments diminish or be eliminated. By receiving lower rates, they have
helped to subsidize health reform. But the consequence of their diminished
rates is financial losses and the prospect of the loss of critical services
for poor and disadvantaged populations.
By design, the state’s landmark health reform was supposed to “true-up’’
Medicaid rates, raising them closer to cost than the current 60 percent to
70 percent reimbursement of cost, a critical step since Medicaid enrollment
growth has been a key component of health reform. Instead, as health reform
has been implemented, rates have declined for many hospitals, and special
payments for hospitals that serve a disproportionate share of low-income
patients have been eliminated - long before the current recession began.
That is the core issue surrounding Boston Medical Center’s lawsuit against
the state - a grave concern that other safety-net hospitals seek to compel
the Commonwealth to address.
In Washington now, as in Massachusetts in 2006, who will pay for this
coverage is hotly debated. In Massachusetts, officials took the federal
Medicaid disproportionate-share payments designed by federal law to support
hospitals that serve the needy and built them into expanded Medicaid and
subsidized Commonwealth Care coverage. But this has left those hospitals,
located in the state’s poorest urban communities - Lawrence, Holyoke,
Brockton, Boston, Fall River, Cambridge, and others - with no compensation
from Medicaid for the vast amount of care they deliver at rates that are
still well below cost.
In our state and around the nation, poor whites, African-Americans, Latinos,
and Asian-Americans get their care at certain hospitals - the hospitals in
their backyard. These hospitals have been the state’s partners in providing
care for those who have gained coverage under reform. Despite this unique
role, the hospitals have been abandoned and are compelled to deliver care
with fewer resources.
Healthcare for these populations is largely separate and it is rapidly
becoming unequal.
A word of caution to the Obama administration: Policy makers looking to
Massachusetts as a model for national health reform had better keep a
watchful eye on Boston Medical Center’s suit, and reconsider the wisdom of
redirecting scarce Medicare and Medicaid disproportionate-share dollars away
from hospitals that serve the poor. Expanded coverage must go hand in hand
with financially stable providers. In the worst-case scenario, coverage
that’s financed by eliminating the payments that underpin healthcare
services to the disadvantaged is a roadmap to rationing of care.
Many of us who have advocated for universal coverage applaud the dramatic
gains and successes of Massachusetts’ health reform law. It shows that
innovative policy can overcome longstanding obstacles. Our experience also
shows, however, how carefully and cautiously the redirection of scarce
dollars must be made. The role of hospitals in poor communities is
especially important in our society, but they have not been treated fairly
in Massachusetts, and the gross inequities are becoming more apparent.
While we recognize that the present fiscal crisis means we must focus
attention on bottom-line numbers, Massachusetts really needs a policy based
on substance and the reality that people are directly affected by the plight
of safety-net hospitals. The Boston Medical Center suit points out that
healthcare reform will fail in its objectives if it serves to dismantle
healthcare services for the disadvantaged that it was designed to serve.
Ellen Murphy Meehan is a healthcare consultant and executive director of the
Massachusetts Alliance of Safety Net Hospitals.
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