Single Payer Health Care

If you are one of the super-rich and have given in to the various stereotypes, you probably don’t know it is broken.  If you are one of the 46 million Americans who are uninsured, you know it is broken.  If you are one of the god-knows-how-many others who are under-insured, you know it is broken.

If you have had a significant medical procedure recently, and are waiting, anxiously, to find out how much they are actually going to charge you for all of that attention, you know it is broken.  If you have had a significant procedure and have already learned how much it cost, or how much they say it cost and are therefore charging somebody, you know it is broken.  If you have been informed that you were only covered for a pitifully small amount of the total, you know it is broken.

If you have made efforts to assert that it was your impression that you were covered completely and found yourself on hold or talking to a very well-trained functionary, a lot better-versed in the small print of your insurance contract than you are, and just a bit offended by the idea that you can’t believe that anyone would expect you to pay that amount of money, you know it is broken.  If you are, for some truly bizarre reason, aware of how small an amount the insurance companies are glad to settle for after all of the tough talk, you know it is broken.

If you know how many people at the doctor’s office are there just to deal with the insurance companies, you know it is broken.  If you know that there is at least one health care/insurance executive with a billion dollars in the bank, you know it is broken.  If you have listened to a primary care doctor at 3 o’clock in the morning trying to pry insurance information out of a person in pain, doing her best to explain that it is the patient’s pocketbook, as well as the patient’s increasingly painful medical condition, that they are seeking to take care of, not wanting the patient to go to the wrong emergency room because their insurance was an HMO instead of a PPO, you know it is broken.

If you have had to pay for your prescription drug because the only one that works is not on the list that the insurance company picks up the tab for, in spite of letters and phone calls by your doctor and you, with endless, seeming hours, on hold, you know it is broken.  If you are young and healthy, you may not know it is broken, but you are being told now, and almost no effort whatever will confirm that disquieting fact.

In the US, we pay almost twice per capita for health care compared to other industrialized nations, and a very serious chunk of the population, I think we can all agree 46 million qualifies for such a description, has no insurance whatever.  In today’s world, amidst the wealth for which this country is famous, that is broken, sadly broken.

So let us begin to say it as it needs to be said and do it as it needs to be done: FIX IT, TODAY AND FOREVER.  Some of us were converted decades ago. We have watched as the engine of opposition flexed its muscles to destroy what edifices of change the great among us were able to construct.  The noble efforts to FIX IT throughout that long period of time have been unsuccessful.  Today, universal, single-payer healthcare advocates are overtaken by a withering array of emotions from hope to disgust, from encouragement to dismay, from a fevered energetic happiness to anger, bold and unrepentant.  The state of the disaster and the feasibility of its correction have been made manifest.  As one more powerful voice, Paul Krugman, arrives, late and, to be frank, without sufficient excuse, more and more uninvolved citizens have their well-edited explanations for uninvolvement, snatched from their hands, torn up in their faces, and dumped into the nearest trash can.

All now must know this:  We have, at this instant, described as the whole of our healthcare system, everything we need, to do everything we want.  There may be some whose world view does not allow for an all-inclusive healthcare system.  There may be parts of the wealthiest among us who reject equality of access.  It has been a foreign notion for so long. But it is certainly what the overwhelming majority of Americans want.  Those opposed are simply unable to appreciate the staggering good that everyone else will immediately be the beneficiaries of.

Make no mistake.  This nation has at its disposal all of the doctors and all of the nurses and all of the hospitals and all of the x-ray machines and all of the MRI’s and all of the money for drugs and research and all of the ambulance services and medivac helicopters to take care of everyone.  We have it all right now.

Classic economic theory dictates that the efficient allocation of resources can only be achieved in the embrace of the free market.  This may be flawed theory.  There are certainly instances where the market achieves extraordinary efficiency and bounty.  Without question, however, there is one instance where the free market, were it in fact to be permitted, does not achieve anyone’s articulable goal, and that is in the provision of healthcare.  It is an elemental truth that the insurance industry makes more money, the more it denies care.  The sick and infirm require the expenditure of resources.  To the extent that expenditure can be avoided, the bottom line of any insurance company is enhanced.  Therefore the incentives of the market resist the fulfillment of an essential and expressed societal value, the alleviation of suffering.

What then must we do?  One thing only.  We must relegate the health insurance industry to the scrap heap of history.

When it takes its place there, it will leave behind the wherewithal of this noble vision.  It will leave behind between fifteen and thirty percent of its revenues now spent on profits, and advertising, and executive salaries, and paperwork.  With those funds, care will be given to the entire population.   If a doctor prescribes it, you get it.   You go to the doctor of your choice and no insurance company or other bureaucracy has anything to say about it.  This is not a dream that suggests some theoretical efficacy.  It is precisely the way a very substantial proportion of medical care is delivered in this country right now. It is known as medicare, and it provides healthcare to millions of Americans with a miniscule 2-3 percent of funds paying for all of the paperwork generated.  It is these savings in administrative costs that will allow the incredible expansion of care that pulls everyone into the system and leaves no one out of it.  It is the fact of the size of the enterprise which makes it all possible and yet impossible.

Healthcare is about 1/6th of the American economy.  That means that the health insurance industry controls, and reaps profit from, over a trillion dollars of revenue every year.  Is it possible to imagine the resistance such a juggernaut will mount to the idea of its demise?  The $300 million public relations effort orchestrated in 1994 to defeat a presidentially-sponsored measure that would have allowed the industry to continue doing business is only the most minor suggestion of the lengths to which it and its stewards will go to insure that the proposal of universal, so-called single-payer, health insurance never breathes a healthy breath.  Add to that resistance the supercharged, 14% profits of the pharmaceutical industry, whose life will be spared but whose way of life will be rearranged forever, and a proponent’s cause for chagrin is no mystery.

But it is right, almost literally beyond argument right.  And it is smart.  And it is efficient.  And it will save inestimable sums of money, and countless American lives as its bounty stretches out before us for as long as our minds can imagine.  FIX IT TODAY AND FOREVER.

How does one defeat an unfathomable fortune on the fields of politics?  How do we battle such forces when those allied against us include all that speaks or writes or broadcasts?  What will be the advertising budget for the defeat of single-payer?  What will be the price of support?  How short will be the careers of those journalists who give these ideas their due?

Lest there be uncertainty, the battle is titanic.  It is the civil rights movement, and it is the women’s suffrage movement, and it is social security, and it is revolutionary, and it must be conceived as revolutionary.  It will take every kind and manner of organization.  It will require every sort of commitment, and discipline and sacrifice.  It will die without imagination and energy.

To say that this is the beginning of the struggle for this country’s sense of decency is to ignore decades of efforts by patriots with a stunning vision of one particular facet of justice, that all who live have the right to be free from preventable and treatable disease.  That these ideas have never penetrated this nation’s consciousness as they are beginning to at this moment, however, is the suggestion of the beginning of something.

For such a beginning to find traction in the deranged, befouled politics of this moment, it will be necessary for the most famous of our sons and daughters to find their way to the battleground, to lift their voices as they have never done before, to allow their images to become synonymous with, and symbolic of, a liberty that this nation has not yet been allowed to imagine.  If these words are anything, they are a call to the most talented, and the most fortunate, to give some part of themselves for the whole health of us all.

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