Will There Be Real Health Care Reform?

Most people are not health care experts, but then neither are they financially tied to the insurance industry or pharmaceutical manufacturers except in so far as their medical premiums help pay executive salaries, increase the bottom line of those business interests and nourish the stockholders invested in them. But is the business of providing medical coverage the same kind of venture as, say, banking? What are acceptable profit margins when addressing the health care of human beings? Should absolutely all things function under a capitalistic umbrella driven by concerns about how the Stock Market responds?

In the discussions now taking place in Congress and throughout the country the word "competition" often drives the debate, but it has different meanings depending on who uses it. To industry hawks it means a system that rewards the stewards of medical practice who represent insurance companies focused on turning huge profits which in turn help fund congressional war chests or enhance personal investment properties. When reformers use it the word means a new approach that would create a government option to compete with private plans in a way that would cut administrative costs, lower salaries to more reasonable levels and remove the profit motive from the conduct of health care. For many self-interested parties, that isn't the kind of competition they had in mind.

The arguments against real reform currently being used come right out of the playbook that informs conservative thinking, and the language that goes along with it can be heard in the media and in Congress. Republican leaders like Boehner in the House and McConnell in the Senate pound away on talking points received from opinion formulators on high just in case they weren't otherwise properly prepared to get the message out. That's why their speeches all have a familiar ring to them - - the market system works, health-care will be rationed, the government will come between you and your doctor, we will become a socialist country and, the kicker, "people will die."

The funny thing is - - well actually it's not really so funny - - that insurance companies regularly intrude on the medical decision-making process and come between doctors and their patients. As former Cigna executive, Wendell Potter, explained on the Bill Moyer show the industry uses all sorts of tactics to reduce its roll of unprofitable clients, i.e. people who need extensive care, or have pre-existing conditions. Like many other businesses it is 'sensitive' to "Wall Street expectations." Industry PR reps are dispatched to bad-mouth, for example, Michael Moore's movie "Sicko", threaten to withdraw campaign funds, or even troll for candidates to oppose recalcitrant members of Congress.

At a recent conference the preponderance of speakers were Republican doctors, some of whom are currently in Congress. They offered, it was suggested, a kind of counterpoint to the administration's plan for health-care reform. But, although they took questions from attendees, they weren't really open to any views that called theirs into question. What is often heard from doctor-politicians and insurance executives is a kind of 'we'll be good' approach because 'we want to cut costs and provide good care as much as anyone' - - no guarantees of course, just a lot of verbal good intentions. Typically, it was claimed that people who can afford to do so jet over for complicated medical procedures in order to access the "best care in the world" right here in the good old U.S. of A.

The catch is that affordability thing. The best doesn't come cheap even if one accepts the premise that exceptional care isn't available in other industrialized countries. As for rationing, it isn't hard to find examples of coverage denied by insurers in this country when patients' lives hung in the balance. If companies reap financial benefit by ridding themselves of 'unprofitable' policy holders it is clear that the "best care" isn't for everyone and in that case people actually do die. A friend told me recently she was afraid that when she retired, her workplace health-care provider would deny her coverage as a retiree because of a pre-existing condition. How weird is that?

The challenge is of course to define what an adequate health-care system should look like. Defense spending is justified to protect the homeland from external threats. But lives are also threatened by internal failures to address the medical needs of our citizens. Reforming the health-care system isn't just a side issue; it's central to our national well-being and economic vigor.