Al's Opinions

It has been written of President Franklin D. Roosevelt that he would first decide what he wanted to do or accomplish. Having decided that, he would then see how close he could come to accomplishing it. He was lauded for following the course of a realistic and practical politician.

There's another side to this approach to governing. If you can not achieve all of what you want to achieve, is it worth while working on something that achieves only a part of what you want? I apply this question to the health plans promoted by several Democratic and Republican politicians: Clinton, Schwarzenegger, Nunez, Romney, and others. These plans all amount to an effort to fix or improve our existing system of providing health care to Americans. Although the supporters of these plans are sincere in wanting to do something to improve a poorly functioning system, I think they are like applying band-aids to a severely injured individual who needs surgery to stop internal bleeding.

The essence of the Clinton-Schwarzenegger-Romney plan is to require all employers (of more than just a few employees) to provide subsidized health insurance for their employees. If an employer wishes, he can instead pay money to the State which will be used to subsidize health insurance to those individuals who are not covered by an employer. There are differences among them as to how much the non-insuring employers should pay, whether all persons are to be required to purchase insurance, and what coverage the insurers are required to provide. Basically, they are all attempts to make a system, originally designed by some employers to attract skilled and expensive workers, provide affordable health care for everyone. These plans are attempts to make a system which was never intended or designed to provide universal health care provide it.

In spite of my criticism, the C-S-R plan does amount to doing something. It won't provide universal health care. It may provide universal health insurance, which is not the same thing. Experience with private for-profit insurers shows that having insurance does not necessarily guarantee having adequate health and medical care. My question is, is it worth while doing?

One can argue that enacting a plan that provides good medical and health care to every American is not politically possible at present. Too many people will argue against it with arguments about "big government," bureaucratic control of medical decisions, inefficiency of government, and the like. I argue that, in spite of the difficulties, our political leaders should try for a universal health plan and not an almost universal insurance plan. The President should be committed to it and should use his press conferences and other unique opportunities to speak to the American People to explain why a universal health provider plan is better than any insurance plan. And that means that we need a President who is committed to the idea of universal health care. The candidates among the Democrats who are committed to this goal have been discarded by the primary voters. There is no hope, in this generation at least, that a Republican candidate would be so committed.

Perhaps, in the end, we will have to accept, for the time being, a half-measure or a band-aid. Winston Churchill once observed that the "American People will always to the right thing, but only after trying all the alternatives."

Labels: Arnold Schwarzenegger, Hillary Clinton, Massachusetts plan, Mitt Romney, univeral health insurance, Universal health care, Winston Churchill

Today (St. Stephen's Day, 2006) blogger and writer Ezra Klein writes in the Los Angeles Times that the days of our present broken health care system are numbered. The present system is based on providing subsidized health insurance as a perquisite of employment. Employers are beginning to abandon the system because of the rapidly increasing cost of health insurance.

What are the alternatives? Klein lists two models:

1. Extend Medicare to provide coverage for every American. Congressman Pete Stark of California favors this approach.
2. Establish a legal requirement for every person to buy health insurance and require insurance companies to provide plans at reasonable cost. This is the essence of the Massachusetts plan. In addition, Massachusetts provides financial assistance to low income residents who otherwise can not afford health insurance.

Both of these models are institutions that are currently in operation. Medicare has existed since the mid 1960's. The public knows how it operates. It is a popular program. It's good, if not perfect. The Massachusetts plan has only recently begun to operate. It is too early to assess its performance and popularity with the public. I have written elsewhere that I regard the Massachusetts plan as something like a band-aid applied to our existing broken system. It has the advantage or disadvantage, depending on your point of view, of keeping the private insurance industry in the profitable business of supplying health insurance to healthy, young people.

Mr. Klein has a critical view of a plan put forward by the private insurers:

The most compelling evidence that resistance to reform is futile, however, is
coming from the insurers themselves. Cognizant that Congress and the nation are
tiring of the current dystopia, the insurance industry recently released its own
plan for universal healthcare.It's a bad plan, to be sure. Its purpose is more
to preserve the insurance industry's profits than improve healthcare in this
country. But the endorsement of universality as a moral imperative, and the
attempt to get in front of the coming efforts at reform, mark the emergence of a
distinct rear-guard mentality within the insurance industry. Their game is up,
and they're turning some of their attention to shaping their future rather than
betting that they can continue protecting their present.

Mr. Klein mentions three elected officials who propose to support changes in our present health care mess. Pete Stark, a Representative from California and probably the new Chairman of the Health Subcommittee, favors a "Medicare for all" solution. Senator Ron Wyden of Oregon has assembled a coalition of "union leaders and corporate chief executives" to put together a plan similar to the Massachusetts plan that would rely on existing private insurance companies to provide health insurance. Governor Arnold Schwarzenegger of California recently vetoed a bill passed by the State Legislature that would have established universal health insurance as the plan for California. However, he now says that he wants to work with the Legislature and others to create a universal health care plan for the State.

Mr. Klein sees the acceptance of the failure of the present system as a hopeful sign. There is recognition of the need for health care to be universally available to all regardless of income. One way or another, he feels, we will find our way to something that is better than what we now have. It will be better in that it will be less expensive and will provide better care for everyone. We Americans spend more per person on health care than any other nation on earth, but the results of our system measured in life expectancy and infant mortality are rather poor in comparison with the results in other industrial nations.

I am not as optimistic as Mr. Klein. Big Pharma and big Insurance are too big and too profitable to succumb without a terrific struggle. We saw what they could do in 1994 when they defeated President Clinton's attempt to achieve universal health care. It may be that, for the time being, we will have to be content with a plan like that of Massachusetts that keeps big Pharma and big Insurance as profitable entities. Governor Schwarzenegger, for example, has slhown his disdain for the Medicare or the Canadian models because they both involve a change of funding from private insurance premiums to public taxes. The fact that most individuals will have actually less out-of-pocket expenses under a Medicare or Canadian type of system than at present doesn't convince either him or his hard-line Republican allies that the change should be accepted.

Labels: Massachusetts plan, Pete Stark, Ron Wyden, Schwarzenegger, Universal health care