Issue #11
July 31, 2002
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Commentary Why do we persist? We have a medical care system with which neither doctors, patients nor HMOs are happy. Doctors hate it because, having feared government control for so many years, they opted for corporate control instead and found it many times worse than they ever thought the government could be. Patients hate it because access to medical care (except for the very rich, to whom no rules apply) is too expensive if you are of modest means and not covered by an employer-based medical plan; subject to shrinking benefits, byzantine rules and ever-increasing co-payments if you are covered by an employer-based medical plan; or requiring a humiliating means test if you are poor. HMOs hate it because our population is aging and medical costs are rising, and people insist on having their medical bills paid, even if that cuts into the HMO's profits. (In the bizarre world of HMOs, the amount of money they pay out to deliver the product people are paying for is known as the patient loss ratio.)
Having created what is arguably the developed world's worst health care system, why don't we change it? Medicare has been a successful program since its inception. It delivers health care at reasonable cost with a minimum of paperwork, and has an overhead and administrative cost that is a tenth of that reported by HMOs (so much for the inefficiency of governmental agencies). Why not just expand medicare into a universal medical program, funded partly by money from general revenues, and partly from employer taxes that would be offset by the money that employers pay out now in medical benefits?
Without minimizing the practical problems and costs, which are actually less than current problems and costs, the answer is simply ideology. It's a continuation of the old fear of "creeping socialism", not mutated into a general dislike, on the right, of any governmental function that does not enable the rich to become richer or the military and police stronger, or provide enforcement for their particular notions of morality. These ideological blinkers prevent a dispassionate look at the possibilities and problems of government action in any sphere having to do with fairness and social equity. The latest example of this is the defeat, in the Senate, of all bills bringing prescription benefits to all of the elderly. The breakdown was not over cost, but over the issue of governmental vs private control of the plan. Most Democrats and some Republicans wanted the prescription plan to be part of Medicare. Most Republicans and some Democrats wanted prescriptions to flow through private HMOs and not be part of Medicare.
As a result, people are dying. In order to solve these problems of delivering adequate medical care to all at an affordable cost, we must remove the ideological blinkers. The true cost of delivering medical care through private health organizations (including administrative overhead and profits) must be compared with the true cost of delivering such care through Medicare, for the entire population at risk. Than a rational course can be set. Even conservatives with no love for the government can be persuaded if the numbers are right.
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