Sunday, August 2, 2009

The Continuing Battle Over Health Insurance Reform

The battle over US health care reform enters a new stage while Congress takes its August recess to visit constituents to get their input. So this gives us a chance to pause and take stock of what has happened up to now.

For those who have not read it, I offer a previous posting,
The Continuing Fight Over Health Care Reform as an overview of this issue. It is interesting that President Obama is now starting to refer to this issue as Health Insurance Reform. Indeed there are some commentators such as in this blog from Time, Health Insurance Reform? by Karen Tumulty who speculates on this change in semantics.

The phrase "health insurance reform" is indeed an effort to tailor his message to the concerns of people who have coverage--who are, after all, the vast majority in this country. But one challenge there is that these people--86% of them in our latest poll--are satisfied with what they have. And while you might think that in the middle of a recession, a lot of people would be concerned about losing that coverage, because it is something they get along with their jobs. Our poll found that only a surprisingly low (at least to me) 33% are.

But using the magic of 20-20 hindsight, I now believe we should have called this health insurance reform from the very beginning because the problem we have in the US with health care is first and foremost a problem with our health insurance system. Despite all of the yammering about the fear of “government run health care”, those who want reform actually want the government to tackle the problems surrounding health insurance which is shutting people out of receiving needed healthcare.

The reason behind these problems is an inherent conflict of interest associated with private health insurers. On one hand they are there to serve their policyholders by making healthcare available when needed. But more importantly, they have an obligation to their shareholders to maximize profits. This creates an incentive to restrict or even deny healthcare whenever possible. The more healthcare they can deny, the more profit they make. This is why so much time and money is spent by private insurance companies to try and deny claims from the present policyholders as much as possible along with avoiding future policyholders with preexisting conditions who would be a drain on company profits. Not surprisingly, this has resulted in health insurance companies making huge profits while many sick people were being shut out of getting needed healthcare.

So why not solve the problem directly and replace the private insurers with a public insurer (a.k.a. 'single payer’) like what we presently do with Medicare for those over 65? The answer is that the private insurance companies are politically very powerful and would undoubtedly fight to the death to avoid their demise — a fight that few of our politicians have any stomach for.

But how do the Democrats try to make progress in health insurance reform without going to war with the insurance industry? Essentially, they had to make a deal with the devil. In exchange for keeping the health insurance companies intact in any proposed health insurance reform, the Democrats would get to propose an alternative “public option” to provide a way to keep the private insurers honest.

And indeed President Obama kept his part of the deal. When seeking input on health insurance reform, those who were for a public single payer insurance system that would eliminate the insurance companies were specifically excluded from the conversation.

But when you make a deal with the devil, you take the chance of getting burned! The insurance companies have apparently decided that they like the idea of not having public insurance competition and don’t want that gravy train to end. So instead of cooperating with the proposed public option, they are fighting it with a guerilla tactics like providing talking points for Republican opposition through a so-called "nonpartisan" source of information in the form of the Lewin Group.

The Lewin Group, exposed by the Washington Post as a subsidiary of an insurance company, has been widely cited as an objective, nonpartisan source of information by those opposed to the creation of a public health insurance option.
And while the health insurance companies can hardly admit that they want to squash any public option in order to keep their profits as high as possible, they can mobilize their political base to wage a proxy war on ideological grounds as in the following E-mail ad from the conservative group Americans for Prosperity.
After months of debate in Washington and the usual wheeling and dealing between the politicians and lobbyists, Senator Specter is coming home for a month. Now it’s your turn to talk with him. Don’t miss the chance.

Bring your own signs! Prepare to ask questions!

You can bet our big government opponents are gearing up to turn out their troops. They’ll be shouting for government to take over our health care. They’ll be pushing the job killing, tax increasing cap-and-trade scheme. Already, their turnout operation is in full swing.

It’s up to us to make sure Senator Specter sees and hears our side – the side of freedom, of lower taxes, less government, of making your own health care decisions.
Of course this conveniently ignores two vital facts. One is that nobody is advocating the government takeover of health care — they are only looking for reform in the way health insurance is offered to finally make it affordable and available to all. And as for people making their own health care decisions under the present system, we know that it is insurance companies that have been making the healthcare decisions for Americans — sometimes with tragic results.

Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.

Although some Americans may indeed be satisfied with their insurance, others have learned the hard way after they got sick that their insurance really didn’t protect them from financial catastrophe. But by then it was too late.

One of the concerns raised about the public option is that it may put the private health insurers out of business if they were unable to compete with government run health insurance. But if that really were to happen, why would that be bad? Why is it that the same people who say that government shouldn’t keep companies like General Motors afloat will gladly fight to keep the same health insurance companies afloat who have been getting rich denying coverage to sick Americans?

If indeed the promised health insurance reform turns out not to have a public option, we will then know that President Obama not only made a deal with the devil — but that the devil in the form of the health insurance industry came out the winner. Which would make losers of all the rest of us!

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