Can we have universal health care?

...The Obama version of the plan presents Americans with three choices: "keeping the insurance you have," signing up for new competing private insurance plans created through National Health Insurance Exchanges that form new pools of enrollees, or enrolling in a new Medicare-style plan...

...But Obama's plan as now outlined lacks effective, credible cost controls imperative to a universal system...

...THE OBAMA PLAN Obama 's plan tries to address these concerns through a model of "guaranteed affordable choice" adapted from the work of Jacob Hacker of the University of CaliforniaBerkeley...

...In response to media questions about launching an expensive health program at a time of mounting deficits and shriveling revenues, "I ask a different question," Obama explained...

...At the same time, some major sectors of U.S...

...The Massachusetts plan imposes an individual mandate to purchase insurance that requires onerous payments for often limited coverage...

...For-profit insurers have become increasingly unpopular, with approval ratings lower than even the much-despised tobacco companies...

...While promising that "nothing would be off the table" in weighing reform possibilities, Baucus recently held a Senate Finance Committee hearing that excluded any advocates of singlepayer health care, He also recently declared, "We are Americans...

...lack of coverage follows from that...

...The sharp increase in unemployment is rapidly adding to their ranks...

...A mandate signals government coercion...

...health outcomes at vastly higher costs but to the uniquely dominant role that for-profit entities occupy in the American system...

...Per-capita health care spending reached $6,697 in 2005, more than 40 percent higher than any other nation...

...With the current economic crisis deepening anxieties across the United States, Americans want to be certain that their health coverage does not contain any loopholes that are revealed by insurers precisely at the moment they most need coverage...

...If this provision can pass both houses, it will set off a high-stakes struggle...

...Thus, administrative savings generated by a single-payer option could provide the funding needed for a universal health plan and prevent health care from being ensnarled in rivalry with other crucial priorities, such as Obama's public-works "stimulus" program and clean energy efforts...

...It's not something that we can put off because of the [financial] emergency," Obama has declared...

...On the positive side, the Obama plan also offers a public, Medicare-style option that some advocates of his proposal view as the potential incubator of a single-payer system, if sufficient numbers of Americans gravitate away from private insurance...

...They have increasingly shifted production and other vital corporate functions outside the United States, significantly reducing their stake in the fate of the U.S...

...To America's north, Canada, which substitutes a single public entity in each province for the insurance industry, spends about 12 percent on administration...

...we're different from Canada, we're different from the United Kingdom...

...In fact, the medical profession has gone through a stunning change in perspective because of the intrusive and costly bureaucracy imposed by private insurers...

...Healthcare reform is very much linked to the broader economic issues that the country is facing," Todd Stottlemyer, president of the National Federation of Independent Business, which fought the Clinton plan, told the LA Times...

...But it is a valuable starting point for discussing what is likely to succeed, and what is likely to fail, in health care reform...

...In contrast, the Catholic League branded Sebelius "an enemy of the unborn" for her pro-choice views...

...Nonetheless, the overall situation is in many ways propitious for health care reform: a committed president, Democratic majorities in both houses, and a public angered by corporate bailouts and feeling reciprocally entitled to government assistance aimed at ordinary citizens, all occurring against a stark backdrop of rapid economic decline and uncertainty...

...The compelling need to rid the U.S...

...However, private insurers have taken the AMA's place as the most potent barrier to fundamental reform, and this immensely complicates Obama's reform agenda...

...But she is not viewed by the for-profit insurers as anti-industry...

...Moreover, Robert Kuttner, in his recent book, Obama's Challenge, thoroughly demolishes the credibility of the focus groups and polls conducted by the Herndon Group...

...Although Obama would defer a mandate for adults until premiums are brought under control, such mandates will eventually be necessary to make the plan work...

...This is part of the emergency...

...First, the healthinsurance industry has virtually bottomless lobbying resources and a rich trove of campaign contributions to influence politicians of both parties, making the passage of any meaningful reform without their approval extremely difficult...

...credited with steering the bill through the House, was later rewarded with a two-million-dollar job as director of the drug industry's main lobbying group...

...Similarly, economist Dean Baker declares, "Basically, anyone who is not serious about controlling health-care costs is not serious about providing universal coverage...

...The bailouts brought to the surface the normally invisible stream of government subsidies and support flowing daily to Corporate America...

...Even America's leading cheerleader for "outsourcing" U.S...

...He would also extend subsidies—estimated at about $100 billion in the first year—to those unable to afford insurance on their own...

...Presumably, Baucus was referring not to the much poorer U.S...

...Half of all personal bankruptcies are caused primarily by medical expenses...

...This calls into question the commitment of businesses to Obama's reform plan, according to political scientist Marie Gottschalk of the University of Pennsylvania...

...This secession from U.S...

...HCAN contends that polling and focus groups conducted for its predecessor, the Herndon Alliance, show that the GAC plan is more popular than the single-payer plan, with the "keep the insurance you like" feature resonating particularly well...

...Workers' out-of-pocket health care spending soared 87 percent since 2000, according to Families USA, going from $135 to $248 per month for family coverage...

...With the Republican cohort slashed to fortyone (pending the result in Minnesota) by the 2008 election, the surviving handful of GOP moderates (for example, Olympia Snowe and Susan Collins of Maine, and George Voinovich of economically devastated Ohio) could feel intense pressure to break ranks and yield the two votes needed to end a Republican filibuster...

...While insurer-driven excess administrative costs account for about 31 percent of all U.S...

...Doctors are no longer the primary barrier to health reform, as when they blocked Roosevelt and when they mobilized a grassroots campaign to trounce Harry Truman's reform proposal in the late 1940s...

...At a time of massive government outlays for various bailouts and a much-needed public employment program, the health care system wastes somewhere between $350 billion to $400 billion (the estimate of Harvard Medical School's Steffie Woolhandler) of all spending on excess administrative costs imposed by private insurers...

...DIMENSIONS OF THE HEALTH CARE CRISIS To evaluate the Obama plan and the nature of the battles it will generate, we first need to grasp the scope of the health care crisis...

...The combined profits of the nation's largest insurance companies and their subsidiaries increased by over 170 percent between 2003 and 2007...

...Postscript.' As we go to press, Kansas governor Kathleen Sebelius has been nominated by President Obama as secretary of Health and Human Services, which will be a central post in the fight for health care reform Sebelius is a former insurance commissioner who once blocked the sale of Kansas Blue Cross/Blue Shield to an out-of-state firm...

...There is reportedly a strong likelihood that the Kennedy and Baucus plans will be merged, although neither office responded to inquiries on this point...

...workers and communities by many American-based transnationals carries staggering implications, as Jeff Faux explains in The Global Class War: "The CEOs and principal owners of corporations who have disconnected, or are in the process of disconnecting, their fate from America's have no interest in paying more taxes to make the society they are abandoning more competitive...

...They desperately want assurance that they will have access to quality care, regardless of their employment situation...

...An Indiana University poll, released in April 2008, showed that 59 percent of U.S...

...Obama's call for reducing health care premiums through the spread of information technology and enhanced management of chronic diseases are perceived by health specialists as desirable for improving the quality of health care...

...However, the insurers will continue to claim a major role...

...Obama has estimated that his new plan will require about $100 billion to get off the ground, but disease management sometimes proves to be costly, and the expanded use of information technology has not yet yielded clearcut savings...

...As Obama himself stated, "If I were designing a system from scratch, I would probably go ahead with a single-payer system...

...Passage of his bill would set off a perpetual tug of war between insurers' ever-rising premiums and the increasingly expensive goal of universal coverage...

...As Marcia Angell, M.D., of Harvard Medical School states, the goals of universal coverage and cost controls are inextricably linked: "Though well-intentioned, plans like these [Massachusetts and California] all have the same fatal flaw...

...The pharmaceutical corporations, with legions of lobbyists and plentiful campaign contributions, will align closely with insurers, as Big Pharma fears that reform would bring government-negotiated prices...

...THE POST-BAILOUT CONTEXT In addressing the multi-dimensional health care crisis, Obama seemingly faces a much more favorable political context because of the controversial $750 billion bailout of major investment banks and insurers like AIG...

...The Obama plan also suggests regulations insisting that insurers devote an overwhelming share of their income to the provision of care...

...Unfortunately, initial indications are not very encouraging...

...The potential for for-profit insurers to use highly sophisticated marketing techniques to attract younger, healthier patients and to employ denials and delays in treatments for older or sicker patients...

...HCAN did not respond to Dissent's request for a response...

...A free choice of doctors is far more appealing to most Americans than a free choice of insurers...

...Sebelius would be 'a very smart choice' for health secretary...

...business have abandoned their former roles as leading "corporate citizens" of the United States and instead pursued what might be called a "secessionist" strategy...

...HCAN promises to promote "a bold new solution that gives you real...

...An inability to restrain costs, thus compromising universal care...

...choice and a guarantee of quality coverage you can afford: keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan...

...As Kuttner puts it, "Universal social insurance signals government help...

...However, it is also clear that many reformers will be working to make the public program an embryonic form of single-payer system, so this is sure to be a central arena for conflict...

...At the same time, he has made it clear that vast expenditures for the bailouts and for public-works programs will not lead him to defer action on health care reform...

...Subsidies stop at about the $60,000 income level for a family of four...

...Gottschalk points out that employers have succeeded in forcing their workers to absorb skyrocketing insurance premiums...

...Republican leaders responded to Kristol's message by repudiating all reform initiatives and even engaging in "reverse lobbying," with GOP congressmen pressuring business groups to terminate any support for reform...

...Further, leaving private insurers in place largely forfeits the massive savings in excess administrative costs that could help to fund universal health care and other priorities...

...The fastest growing component of health care is health insurers' administrative costs...

...How can we afford not to...

...However, the Democrats maintained both internal discipline and an uncharacteristic thematic unity in the battle for adequately funding the SCHIP health program for children, perhaps a sign that they have learned some lessons from the 1993-1994 debacle...

...The new health insurance plans are intended to hold down cost increases by existing insurers...

...Kennedy, although approaching sainthood in the hearts of many liberals and progressives as he simultaneously battles cancer and wages a fight for health care reform, is reportedly leaning heavily on the dismal Massachusetts state plan signed into law by Mitt Romney...

...health spending, total administrative costs for the public Medicare program are just 2 percent...

...The Obama approach calls for initially limiting the individual mandate to purchase insurance to children and then extending it to adults once costs are reduced through such measures as information technology and better management of chronic diseases, such as diabetes and high blood pressure...

...However, the Herndon Alliance/HCAN finding seems to conflict with a CBS poll conducted in September 2007 that found that 55 percent preferred "having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers," compared with 29 percent who chose "keeping the current system where many people get their insurance from private employers and some have no insurance...

...However, Obama and his team, along with many reformers, have concluded that private insurance must remain at the heart of even a reformed system, given what are considered "political realities...

...Obama's proposal pointedly calls for an end to the widely hated practice of insurers disqualifying people because of "preexisting conditions...

...system of such unnecessary administrative costs gained additional weight as Obama felt pressured by the recession to defer the rollback of Bush tax cuts for those earning over $250,000...

...They would like to be able to choose their own doctors, now impossible under many health plans...

...Eventually, these struggles could erode insurers' legitimacy and exhaust all alternatives short of a single-payer system that dethrones the insurance industry...

...Obama has outlined a plan for universal coverage, cost restraints, and extensive choice for American health consumers, along with new regulations on for-profit insurers...

...WHICH WAY CORPORATE AMERICA...

...The resulting bill infamously banned the U.S...

...Meanwhile, Billy Tauzin (R-LA...

...It's that simple...

...By avoiding the risks of a direct collision with the tremendous power of the health insurance industry, the Obama plan fails to address the problem of effective cost controls needed to sustain coverage for all Americans...

...Baucus, now working on a plan similar to Obama's concept, gained lasting notoriety among Democratic colleagues during passage of the Medicare Part D bill drafted by drug lobbyists, when he and John Breaux were selected by the Republicans as the Democrats with whom they wished to negotiate...

...In the context of enormous fiscal demands on the U.S...

...At the same time, they will fiercely contest the public component of Obama's plan, which they describe as unfair competition to the private insurers, and which Senator Mike Enzi (R-Wyoming) dismisses as second-class "Medicaid for all...

...Kristol stressed the importance of denying the Democrats the chance to enact a historic benefit to middle-class Americans, akin to Social Security and the post-World War II GI Bill...

...Two leading forces in the health insurance industry—the 1,300-member America's Health Insurance Plans and Blue Cross/Blue Shield—have stated that they would accede to the elimination of pre-existing conditions in exchange for a requirement that all Americans be covered by an insurance policy...

...The Medicare-style public plan could then become a "dumping ground" for costlier patients, thereby driving up costs for the program...

...Working Americans are acutely aware that they are struggling for survival without the same solicitous government attention to their economic and physical health...

...According to the New York Times, "Karen M. Ignagni, president of America's Health Insurance Plans, said Ms...

...DEMOCRATIC LEADERSHIP ON HEALTH In Congress, the development of the Obama plan will include such key players as Ted Kennedy (D-MA), chair of the Committee on Health, Education, Labor, and Pensions, Max Baucus (D-MN), chair of the Senate Finance Committee, and the HHS secretary...

...But the hard-right majority of Republicans in the Senate appears ready to wage an all-out war against any plan proposed by Obama, following a presidential campaign in which John McCain and Sarah Palin invoked the specter of "socialized medicine" against the Democrat's health proposal...

...This design would have considerable public support: a 2005 Business Week poll found that "67 percent of all Americans think it's a good idea to guarantee healthcare for all U.S...

...They offer no workable mechanism to control costs, mainly because they leave the private insurance industry in place...

...Thus, Obama's plan can easily be portrayed by its opponents as the imposition of an expensive new cost rather than the extension of a desperately sought social right...

...Yet despite this astronomical level of spending, health care outcomes in the United States ranked an appalling thirty-seventh overall in World Health Organization figures...

...The for-profit insurers will work to circumvent new regulations that could force them to provide treatment for all potential enrollees and limit their administrative overhead...

...However, HCAN got off to a rocky start with those who promote a single-payer system because of its insistence that Americans prefer keeping private insurance...

...INSURERS REPLACE AMA AS STATUS QUO DEFENDERS Düring the Great Depression, the American Medical Association's fierce opposition forced Franklin Delano Roosevelt to drop health care from his landmark Social Security Bill for fear of seeing the entire package defeated...

...In 76 percent of these cases, the family breadwinner initially had insurance coverage...

...THE OPPOSITION Any substantive health reform plan is certain to face filibuster threats in the Senate, where the vast majority of Republicans are hard-line conservatives from the South who view universal health care both as a dire political threat to their party's future and potentially harmful to dependable sources of campaign funding in the health insurance, pharmaceutical, and for-profit hospital industries...

...At this writing, Obama has not designated a health-reform point person to replace Health and Human Services nominee Tom Daschle, who withdrew from consideration after information about his nonpayment of income taxes and ties to the health insurance industry surfaced...

...In short, they want health care as an inalienable right of all Americans...

...The rest of the Senate majority—apart from progressives like Russ Feingold of Wisconsin, Barbara Boxer of California, Bernie Sanders (Independent) of Vermont, Sherrod Brown of Ohio, and a handful of others—has hardly been alert or principled on health care issues...

...PAYING FOR REFORM Obama has proposed modest tax increases for employers and workers in cases where the employer does not currently offer coverage...

...The Republicans may follow the kill-at-allcosts game plan offered during the Clinton health care fight by neoconservative writer William Kristol, who highlighted reform as "a serious political threat to the Republican Party...

...Some experts expect that the insurers will attempt to turn the public program into a dumping ground for high-cost patients and will easily manipulate new regulations on other pernicious practices, triggering a new round of battles with health consumers and Congress...

...Until the Wall Street crash, Obama had been counting on the repeal of those cuts for the richest 1 percent to supply much of the funding for his health care plan...

...Grudgingly forced to concede the need for reform, the majority of Republicans in 2009 will be promoting "market-based," "consumer-driven" proposals along the lines of McCain's campaign plan...

...Some forty-seven million Americans were already lacking health insurance before the economic meltdown...

...Thus, the success of cost-shifting and the attractiveness of the secessionist approach suggest that the business community is by no means united in believing that passage of health reform is a critical priority and is by no means a reliable ally of reform forces...

...No assurance under the Guaranteed Affordable Choice plan that patients would have a free choice of doctors if they remain with a private insurer who limits their option...

...These include the following: • Imposition of often unaffordable "individual mandates" topurchase insurance...

...jobs to lowwage nations, New York Times columnist Thomas Friedman, now worries, "When I look around for the group that has both the power and interest in seeing America remain globally focused and competitive— America's business leaders— they seem to be missing in action...

...At some point Obama could be forced to consider a single-payer plan simply in order to make up the needed funding...

...They want health care to be affordable as their flat or declining wages make them increasingly less able to absorb more co-payments, deductibles, and other out-of-pocket costs...

...Passage of the Clinton health plan, Kristol thundered, would "relegitimize middle-class dependence for 'security' on government spending and regulation," and thereby "revive the reputation of ...the Democrats...as the generous protector of middle-class interests...

...According to Harvard's Woolhandler, about 50 percent to 60 percent of these administrative costs are drawn from public dollars...

...While embracing the "more robust" plan originally advanced by Hacker as a valuable transitional step toward a single-payer plan, Kuttner describes himself as "appalled" by the manner in which the Herndon Group's "pollsters put a subtle thumb on the scale in the way they worded the descriptions of various approaches that were read to focus groups...

...Even with their slight majority last session, the Democrats lacked the will to repeal the costly 13 percent to 17 percent bonus that the Medicare Advantage program gives to private insurers— which simultaneously undermined Medicare...

...almost overnight, the question shifted instead into whose interests would the government intervention serve...

...Excess administrative costs imposed by the forprofit insurers will siphon money that could provide the funding for universal care...

...At the same time, the corporate bailout has served to re-legitimate the nearly extinguished notion that ordinary citizens are also entitled to count on their government to protect their economic security, The question of the day is no longer about the morality of government intervention in the economy...

...government from negotiating fair drug prices with the major pharmaceutical corporations, leaving Americans forced to pay nearly twice as much for their pharmaceuticals as do their Canadian neighbors...

...Spending on health care measured as a percentage of after-tax corporate profits has declined steadily from 1986 to 2004, except during the 1998-2001 period [due in part to an overall drop in corporate profits hit by the dotcom and high-technology sectors in that period]," Gottschalk notes...

...citizens, as Canada and Britain do...

...Subsequent polls have found similar results...

...But a vexing set of problems will surely be generated by any acceptance of the highly inefficient and intrusive role of for-profit insurers in the U.S...

...But building around—rather than uprooting the for-profit insurers—may carry another set of risks...

...But now, in sharp contrast, the AMA is a shadow of its former self, as doctors have gravitated to specialist organizations...

...If we start by assuming we can't have a single-payer system, then a distressing "No We Can't" label may well apply to universal health care in any form...

...GRASSROOTS ACTIVISM At the grassroots level, it appears that the Obama plan will have more organized and enthusiastic support than did the Bill and Hillary Clinton effort, when labor and progressives were still reeling from wounds inflicted by the regressive NAFTA trade deal...

...The effect, according to Harvard doctors Benjamin Day, David Himmelstein, and Steffie Woolhandler, is that the "unsubsidized coverage mandated for middle income individuals (most of whom have incomes between $30,000 and $50,000) offers the bitter choice between unaffordable premiums (at least $7,200 for comprehensive coverage for a single 56-year-old or plans so skimpy (e.g., a $2,000 per person deductible with 20% co-insurance for hospital care after that) they hardly qualify as insurance...

...Health Care for America Now, a vast coalition of some thirty national groups, including the AFL-CIO, SEIU, La Raza, USAction, and other consumer, health, and labor groups has already taken shape...

...doctors now favor a "single-payer" health care system like those in Canada, Taiwan, and other nations, where for-profit insurers have been replaced by a single public entity paying medical claims and negotiating rates...

...But Corporate America has been extremely successful in shifting the burden of ever-rising health premiums to American workers...

...Yet, soaring costs are the fundamental problem...

...Of course, the outlines of Obama's plan will be profoundly changed by the legislative process, and it may be virtually unrecognizable once a finished product reaches the presidential desk...

...however, few see them as likely to generate the significant savings needed to fund the health plan...

...Treasury at a moment of declining tax revenues, the prospect of reducing the administrative waste generated by 1,500 separate insurers gains a new urgency...

...Mlany reformers believe that American business has largely abandoned its decades-old opposition to universal health care, having recognized that the burden of health care costs renders them uncompetitive with foreign firms enjoying low-cost health care...

...But would his health plan go far enough to transform a system that has been dominated and distorted by for-profit insurers who maximize profit by rationing care to patients, restricting doctors' choice of treatments, and raising premiums...