Many Roads to Divide and Conquer Healthcare

Have you noticed throughout the healthcare reform debate that most everyone seems unable to see the forest for the trees? We get hung up on illegal immigrants, abortion, the disabled, the poor, the pre-existing conditions crowd, the young, the old, the military, the employed, the self-employed, the government-employed, retired union members, small businesses, and large businesses. So much minutia, so little time. What if didn’t have to be like this?

As we know, there’s a plan for everything. Over 65 or disabled? There’s Medicare and perhaps CLASS. In poverty? There’s Medicaid. Slightly over the poverty line? We’ve got an Exchange for you. Eligible child? Try S-CHIP. Employed? Let’s hope your employer offers one of the 1,300 high-cost private health plans. Self-employed or unemployed? Good luck with that, try the Exchange. Got a pre-existing condition? We’ve got a risk pool with a waiting list that you can’t afford anyway. Work for the government? You’re in luck – it’s got the widest selection of health plans available in the US! All this complexity and division puts patients themselves at a decided disadvantage.

Providers like hospitals and physicians actually have to get paid in the middle of this mess, and some of them have figured out how to game the system by exploiting the out-of-network and cash price loopholes. Most just muddle through with a giant administrative staff and aging accounts receivable. Others like Big Pharma and the medical device industry have used it to make a windfall. Most of all, though, the private insurance industry wins. Under all current legislation, they will continue to win. In fact, Republicans just submitted their 8-months-too-late “cost control” plan to completely hand over the healthcare industry to private insurers (fair access and prohibiting recissions are so last year, apparently.)

Meanwhile senators suddenly discover that private insurers don’t actually spend $0.87 per premium dollar on claims, like they’ve said. For individual and small business plans, it can be as low as $0.66. That means fully one-third of members’ premiums are not being spent on their care. Compare that to Medicare’s $0.97 spent per premium dollar; even adjusting for fraud and abuse, it couldn’t come close to the waste of private insurance.

We all know there’s a simple solution to this complexity and cost. It’s called single payer or Medicare for All. It was soundly smacked down at the beginning of this debate, and Kucinich’s state single payer amendment in HR 3962 is still in the balance as of this writing. Maybe just maybe the public that was initially so afraid of the supposed lack of choice (completely ignoring the plentiful supplemental plans that would have been offered in conjunction with it) is now seeing the lack of change AND choice that the current bills represent. We’ve been divided and conquered. Is it time to let Kucinich’s 4-page evolutionary amendment trounce the thousands of pages of House and Senate “survival of the sameness?”

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