Hospitals & Asylums
By Tony Sanders
Cincinnati Children’s Hospital Medical Center and the Congressional Institute hosted a Congressional Debate on National Health Care on April 28, 2008 beginning at 2 pm in Sabin Auditorium. The free show was sold out and an estimated 250 guests spilled over into a second auditorium where live footage was projected onto a screen. Members of the audience were given index cards on which they were directed to write a question.
Having released a 100 page report on the same day as the debate titled, National Health Insurance: Compromise to Immediately Achieve Universal Coverage and Progressively Realize National Health Insurance that is Free for All, my question, that was not one of the six chosen, was,
Do you think that a compromise could be reached to pass the National Health Insurance Act, HR 676, if section 104 pertaining to the prohibition of private insurance were stricken, to achieve a universal single payer social health insurance, until a later date when national health insurance, that is free for everyone, would be implemented, whereas private health insurance schemes have never been able to provide a population with universal coverage?
Jim Anderson, the President of Children’s Hospital Medical Center took the podium to the right of the stage. He introduce the forum,
“It is a treat for us to host a health policy forum. This is the second of a set of four debates. Today is the first day of a national week for the uninsured. The US health care system affects everyone. We have more than 10,300 employees at Children’s and have enjoyed rapid growth. Health is certainly an important part of the economy. Experience convinces us that outcomes can be improved. There is growing consensus among all groups that we need to reach reforms. We are looking forward to a substantive and meaningful outcome.”
The debate was moderated by Ms. Romer a National Pubic Radio health, who recently published a book on health care policy and has hosted such discussions before. The panel was divided by the moderator into two teams, Democrats and the Republicans. The debate was structured to begin with a five minute opening statement from both teams, then they would answer selected questions and then at 3:20 both teams would be given five minutes to make a concluding statement. For the Republicans there was Mr. Deal, Mr. Boutany, Ms. Moore-Capito and Mr. Shadegg. For the Democrats there was Ms. Castor, Mr. Berry, Ms. Schwartz and Mr. Becerra. Ms. Romer, the moderator, an enthusiastic student of health policy, said that when asked to do the show,
“It took five minutes for me to agree to moderate this debate”.
Although the Republicans won the toss they deferred the opening statement to the Democrats who are the only party with a viable plan for government reform but are not firm enough in their conviction to take the stand for single payer insurance. They are not able to credibly imbue enough pride in the government health insurance system to sell their plans. Not being firm in their national or social health insurance conviction, that are not voluntary but are cheaper, they have difficulty selling their programs against the empty market capitalist rhetoric in the opposition. Ms Castor walked to the podium and said,
“Democrats are committed to quality, affordable health insurance for everyone. Children’s health has been a focus of debate for the last several years. President Bush’s statement, ‘Americans can go to the emergency room’ is characteristic of the flaws in the system. Since 2001 there are 8.1 million more uninsured – 47 million people are uninsured, 9 million children do not have access to well child visits. Family premiums are up 78% since 2000. Out of pocket costs, co-pays and deductibles are increasing. Bush has undermined the safety net. Estimated solvency of Medicare is down from 2041to 2024. He has prevented Medicare from negotiating for price control. We must improve primary care, prevention and education to keep people out of the emergency rooms. We want to offer new programs for high risk pools and improve Medicaid and S-CHIP”.
Mr. Shadegg took the stand for the Republicans, to shoot down any meaningful reforms by opposing a single payer system, that is fundamental to any reform package, and introducing rhetoric regarding the bewildering array of sub-optimal choices and lack thereof and tax credits that he confuses with cash. The Republican platform, backing private voluntary health insurance, obstructs progress towards either social, less expensive mandated employer insurance supported with tax relief for the poor and unemployed or national health insurance, that is most cost effective using the tax system and does not charge patients for their care, that are the only ways other nations have achieved universal coverage. He said,
“Republicans believe reform needs to be family and patient centered to drive costs down a enrollment up. American must be able to afford health insurance. The chronically ill must have coverage. American health care is the best in the world. Republicans do not want government health care. Individuals should be able to purchase health insurance at the same rate as large employers. Medical liability reform must take place so that money intended for doctors and patients is not diverted to trial lawyers. Health Savings Accounts (HSA) are important and must be up to the patients. Although we believe we have a free market in fact we have little choice in our health care plan. Employers choose our health care plan. We are limited by income. Single payer systems have had disastrous results around the world. Care must be patient centered, not government controlled”.
The panel broke the ice regarding the new prescription drug program. Apparently the Bush administration is stifling Medicare’s ability to negotiate with drug corporations for reasonable prices. Seemingly defeating the purpose of having a single payer. The camps are clear on the issue. The Democrats want better the improved price negotiation that a government payer can provide. The Republicans however jealously defend the market economy although they fail to justify the higher prices. The weakness of the Republican platform is self-evident and the Republicans admit to voting with their constituents. The Democrats are however not well enough versed in social and national insurance to defend their law and win independent voters to their camp.
Mr. Berry spoke in behalf of the Democrats,
“The VA, Department of Defense and Coast Guard negotiate for lower drug prices. Medicare is however prohibited form negotiating lower drug prices. Drug prices have risen 75% over the last ten years, more than 3% more than the annual cost of inflation. Why can’t Medicare negotiate in behalf of consumers?”
Mr. Deal responded in behalf of the Republicans,
“Are we going to give private enterprise a chance. Costs are much less than expected for the MMA. Top drugs are not offered at the VA, they use generics”.
Mr. Berry (D) retorted,
“Medicare’s administrative costs are one sixth that of private insurers. Why not go to the market and say ‘you can have the best price?’ Yet we pay three to four times as much as other countries”.
Ms. Moor Capito (R) answered,
“The Democratic Chairmen sponsor and a Medicare for All Act that would force all people to use Medicare”.
Ms. Schwartz (D) caved in,
“We are looking for a variety of solutions. We have a lot of good ideas”.
Mr. Becerra (D) emphasized,
“We want an American solution to the problem”.
Mr. Boustany (R) introduced himself,
“I am a cardio thoracic surgeon. I saw people who couldn’t be seen elsewhere. A doctor patient relationship is key”.
Mr. Shadegg (R) concluded,
“The more people who leave private insurance, the higher the premiums are”.
The first question was, why can every other industrialized country cover everyone but we can’t?
Ms. Schwartz (D) began,
“We have to work out a way that gets health care to everyone. The Republican solution sends people to the marketplace. If insurance is too expensive people don’t get treated in a timely fashion. We must come up with a better solution”.
Mr. Shadegg (R) responded,
“Americans are different, they are more individualistic. Republicans want people to choose what is wanted. We will put cash in the hands of the people and they can choose the private plan they want. We want more risk pooling”.
Ms. Castor (D) explained,
“Say you have a chronic condition, you can’t find an insurer even with the Republican tax credit”.
Mr. Shadegg defended his plan,
“High risk pools allow people with pre-existing conditions to buy health insurance at the same rate as other people”.
The second question was, our system pays specialists high sums but leaves primary care, and pediatrics in the cold, medical students go into high paying specialties leaving shortages in needed areas, does the federal government have the objective to correct shortages in primary care? There is clearly a problem
Mr. Boustany (R) opened,
“This is a serious problem that I have asked the GAO to look into. There were 139 training slots for cardio-vascular only half of them were filled. Nursing shortages also manifest as the result of a shorter of educators. I have introduced a plan to make it easier for nurses to teach”.
Ms. Schwartz (D) closed,
“I am the mother of a physician, an internist. We have to cover the cost of training in our health insurance system. We have to make changes in the reimbursements to redirect dollars from specialists to encourage providers to treat chronic conditions and improve health outcomes”.
The third question was, what incremental steps can Congress take to achieve universal health coverage and should children be first?
Mr. Becerra (D) said,
“We must approach the aging population. We have the best technology, the best minds. But first we must take care of the kids”.
Mr. Shadegg (R) responded,
“We want patient centered care. We are reliant upon one pooling method – employer. New pooling mechanisms go a very long way”.
Ms. Schwartz cut in,
“The first step is to care for the children”.
Ms. Moore-Capito (R) was supportive,
“S-CHIP started in a Republican Congress when I was a state legislator on the health committee. Our hearts are with our constituency when we vote”.
The fourth question was, who will pay?
Mr. Shadegg (R) began,
“No one should go without health care. What we want to do is risk pool to cover the cost of the chronically ill and poor as these programs were designed to do”.
Mr. Deal (R) weighed in,
“There is a lot of money in these programs, $2,400 per person. We could get more for our money”.
Ms. Castor (D) argued,
“There has been a huge cost surge since Bush took office. People with private insurance are getting less. We want a comprehensive wellness program through the country. There is going to be a comprehensive solution”.
Ms. Schartz (D) suggested,
“An electronic medical record system is estimated that it could save $160 billion a year. There are methods to improve care without cost increases”.
Mr. Boutany (R) lamented,
“There are inherent flaws in Medicare, Medcaid and S-CHIP and they don’t get access to a doctor. We good preventative care – smoking cessation, obesity counseling. Real competition will drive costs down. Choices should extend across state lines. The people are not in control”.
The fifth question, would you push for children’s health legislation in the first hundred days of the new Congress?
Mr. Berry spoke in behalf of the Democrats,
“All four of us support extending and expanding S-CHIP”.
Mr. Boutany (R) argued,
“In my time as a surgeon Medicare patients had a hard time accessing care. The system is not working. Let’s create better access”.
Mr. Deal (R) explained,
“We have already extended S-CHIP. S-CHIP is designed to help children whose families make less than 200% of the poverty line. Some states insure adults and other people. Before going up the scale lets cover the lower end of the income spectrum. Covering people above 200% got us off track”.
Mr. Becerra (D) apologized,
“We did everything we could to address concerns of the Republican party. Three times is passed and three times it was vetoed by the President. Would Republican have supported its passage if we didn’t address their concerns?”
Mr. Boustany (R) opined,
“We need to enroll the children in S-CHIP and Medicaid. I have talked with pediatricians and primary care doctors. Children are going to the emergency room.”
Mr. Shadegg (R) argued,
“People don’t get the best care under Medicare. They want cash”.
Mr. Becerra (D) despaired,
“The Republicans favor the rich. Tax subsidies are difficult for families making less than $30,000 a year. Tax credits don’t help people who aren’t rich”.
The sixth question was, should Congress mandate all Americans to purchase at least catastrophic coverage?
Mr. Shadegg (R) began,
“Republicans do not like a mandate. The poor cannot afford to buy health insurance. Helping Americans get care is better than a mandate. We want to give a tax credit, cash money, to buy health insurance”.
Ms. Schwartz (D) replied,
“We want to get Americans the best coverage. It is unconscionable not to cover kids. We already pay for people who don’t have health insurance. We want to get all Americans insured”.
Mr. Becerra (D) went to the podium to give the closing statement of the Democrats.
“First let me thank my colleagues from the other side of the aisle. It has been nice to get on the road with them. We know the greatest reason for bankruptcy is medical bills. We know we are the only industrialized nation without universal coverage. We believe children are the start. We think there are many ways to do these things. We think bi-partisan support will guarantee everyone access to quality affordable health care. More Americans are not covered by their employer. More Americans are not getting preventative care. No parent wants to see a child die before them. There are more children without access to health care. We can get there on a bipartisan basis”.
Mr. Deal (R) gave the closing speech for the Republicans,
“Thanks. There are different opinions. Health care is one of the great problems of our time. My mother nearly reached 100 but she died a couple of months ago. She would always ask me I had fiddled with her Social Security and Medicare. S-CHIP is as laudable as it stays in its parameters to help the poor. Both parties have made mistakes. The only way to make change is to deal with liability reform. This is an issue that affects all of us. We are all potential consumers of health care. We aught to encourage life style changes. The monumental system does not however provide much room for flexibility. We have to update and modernize. The people of the USA must have access to the best health care”.
There is a long standing political impasse between the parties since before Clinton proposed to achieve universal health coverage by mandated employer benefits in 1994. The Democrats want change so the nation can achieve universal coverage, but they are stymied by the hot air of the Republicans regarding tax credits that won’t benefit the needy and free choice amongst a myriad of inferior products, about which information is imperfect. Democrats are trying to go it alone and ignore the precedence of other developed nations that either have social insurance system that mandate employer health insurance premiums or even more efficient national health services, completely reliant upon taxation No state in the United States has ever achieved universal coverage, the only meaningful goal, we must therefore look to our neighbors for guidance.
Until the United States has achieved universal coverage the class struggle between the rich and poor, in a private health insurance system, will lead poor Brits to live longer than rich Americans, and the United States will continue to lag behind its more politically capable peers, in health outcomes. The Republicans are however not impossible to convince, their rhetoric can be culled to find the justification for the reforms that they oppose. States heavily subsidize risk pools so that people with chronic conditions can buy insurance at the same price as others, if they are employed at all, government programs cover most disabled people. Private insurance fails to provide for risk pooling and only the healthy can afford it. To be progressive the Democrats must insure the poor first, before embarking on more ambitious schemes. Talks break down on the critical issue of single payer insurance that is a requirement for either a social or national insurance scheme. The Democrats must defend single payer health insurance as the method with which a comprehensive electronic record system will be implemented.
It is good that the political parties take the time to debate national health insurance. Voluntary private health insurance is an archaic and corrupt theory that has failed. As the most expensive health care system in the world the United States medical establishment can afford the technology and education to provide quality care. The American system is however undermined by the enormous bureaucracy needed to sustain a complex system of private health insurers that is more interested in profit than keeping the population healthy. There are only two options for reform, social or national insurance. Reform is needed immediately and single payer insurance is a given in both viable systems. Children’s health will probably be the experiment in universal coverage.
Sanders, Tony J. National Health Insurance: Compromise to Immediately Achieve Single Payer Universal Coverage and Progressively Realize National Health Insurance that is Free for All. Hospitals & Asylums. 100 pgs. April 28, 2008. www.title24uscode.org/nhi.htm