Health Insurance Reform or Health Care Reform?

The ideas of those who call themselves liberal or conservative do not reach to the base of the health care problems and their solutions. Health insurance could help if it were universal and comprehensive although it need not reach to the first dollar of expenses for every individual. The need for health care arises before the health care providers and patients ever make contact and before health insurance has any impact. The causes of accidents, diseases, and sickness are mostly unnatural and are best solved by correcting the environment, the production and distribution of food, unemployment, poverty, education, and training of more health care workers at every level. There is a direct connection between the reform of the health care delivery system and solving the problems that arise from the unnatural causes. There is almost no political will in our government to get at root causes and real solutions. It seems it is not a government of the people, by the people and for the people, but one managed by and for the short term interests of wealthy individuals and corporations.

Yesterday, I was surprised when a friend who is a marketing director for a large health insurance company told me he thought that “Medicare for Everyone” was the proper health insurance reform. He said this even though he was opposed to a government run health insurance system and he expressed the views of people who are politically conservative. He said such a solution seems very reasonable since the details of it were in place and there would be a need for supplemental insurance from the private companies based on prescribed benefits. He concluded that the benefit prescription, as in the Medicare Gap insurance, created a fair and competitive market. He assumed that the “Medicare for Everyone” would not cover from the first dollar and that given the current increases in medical costs the gaps in coverage would grow. A new system would take years to catch up to the operation and regulation that is already mature in the Medicare system such as; contracting with providers, determination of rates, claims administration and quality assurance measurements.

I suppose the political objection to “Medicare for Everyone” is that the big insurance companies would lose administrative income and underwriting profits and the beneficiaries of the current payment system would have to accept Medicare rates which are thought to be too low by the hospital corporations and some of the doctors. The big six: United Health Group, Wellpoint, Aetna, Humana, Cigna, and Health Net may not be willing to just sell Medicare Gap Insurance in competition with the thousands of other insurance companies that would be able to compete with them. Reporters for newspapers and TV stations keep telling us that the majority of the people support a single payer health plan. Is that not what Medicare is? Why is it that someone can say he would be in favor of “Medicare for Everyone” in one breath and then be against a “Single Payer Health Plan” in the next breath?

It could be that “Single Payer” sounds like the elimination of Medicare and Gap insurance and it would pose a threat to insurance jobs and current medical fees. Whereas, “Medicare for Everyone” is a known system, has established rates and defined benefits.

Insurance has never reached down to the level of payment for basic health care services. Yet, people will pay premiums for 1st dollar coverage in order to maintain a monthly budget even when such premiums are more than their routine expenses over a short term. I think like my friend, the marketing director, that “Medicare for Everyone” is the most practical choice for health insurance reform but I understand why the President and Congress may want a “new program.” They do not represent the people, conservative or liberal, but represent the money that put them office and keeps them in Washington. They love the way lipstick looks on pigs.

If you want to reform “Health Care” then you should ask Dr. Paul Farmer and the other physicians who work for Partners in Health for their recommended solutions. They stand head and shoulders above every health care expert in the country. Health insurance is simple compared with health care and health care is simple when compared to solving health problems that arise from the unnatural causes. If the government actually wants to fix the “health insurance crisis” they have a system in hand to do it and the majority of the representatives know it. If they lack the political will to oppose the lobbyists then perhaps the people can send new representatives. If they want to fix “Health Care” they had better get to the roots of the problems: environmental degradation, industrialized food, unemployment, poverty, education, and lack of training for a broader range of health care providers.

Don McCormick

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