Universal health care, much as we need it, won't happen until there's a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
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What should Congress do? The new Democratic majority is poised to reduce drug prices by allowing -- and, probably, requiring -- Medicare to negotiate prices on behalf of the private drug plans. But it should go further, and force Medicare to offer direct drug coverage that competes on a financially fair basis with the private plans. And it should end the subsidy to Medicare Advantage, forcing H.M.O.'s to engage in fair competition with traditional Medicare.
Conservatives will fight fiercely against these moves. They say they believe in competition -- but they're against competition that might show the public sector doing a better job than the private sector. Progressives should support these moves for the same reason. Ending the subsidies to middlemen, in addition to saving a lot of money, would point the way to broader health care reform.
It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.
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National health insurance sounds very attractive, until you talk to people who are currently in this type of plan. For example, when HillaryCare was in the forefront of discussion in the early ninety's, I happened to be in Germany, which has a national health plan. This plan was the model on which HillaryCare was being considered so I thought it might be interesting to get the perspective of people who were in that plan. Overwhelmingly, I was told that it was a farce and that anyone who could afford to was opting for private insurance. This was because a national health care plan in fact subjects partici-pants to long waits for care, even for critical care, i.e., MRI's, CAT Scans and necessary surgical procedures.
Closer to home, we have Canadian Health Plan to look at and it's documented that many participants have had to wait for critical pro- cedures, even so far as dying before the procedure was approved. In fact, Ottawa has recently passed legislation allowing private insurance as an alterna-tive because of the limitations posed on people by the National Health Plan. Why do you suppose that may Canadians cross the border to seek health care at their own expense when they have access to the Canadian Health Plan? I have had personal conver- sations with many Canadian citizens who tell me that their national plan leaves a lot to be desired.
I understand that there is an urgent need to find some means of providing for those people who can-not provide for their own insurance, however, I am unwilling to subject the millions of people who have health insurance and are quite happy with it to a plan which would cover everyone but ration vital health services, i.e., a national HMO.
According to many, there are apprx 44 million uninsured individuals in the U.S., however, this figure includes several million who choose not to insure themselves for whatever reason they choose. There is also the issue of having to provide health services to people who are in this country illegally. If you doubt this, just do some research as to the effect that requiring that public health care facilities in those cities and states close to the Mexican border has had on those jurisdic- tions bottomline. In fact, in Los Angeles, where I lived for about 63 years before moving to Idaho in 2003 has had several hospital and emergency closures due to budge-tary limitations.
Be very careful for what you wish, or you may live to experience the failure of such a plan.
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