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Thursday, October 16, 2008


Why single-payer health care is not the answer

I've written about this before (e.g., here and here), but last night's debate and a story in today's news prompts a review.

Let's start with the debate. One of the more interesting exchanges was this one:

McCain: Sen. Obama wants to set up health care bureaucracies, take over the health care of America through -- as he said, his object is a single payer system.

If you like that, you'll love Canada and England. So the point is...

Schieffer: So that's your objective?

Obama: It is not and I didn't describe it...
The transcript can't convey the horrified look that came across Obama's face with the thought of being associated with that dreaded concept known as "single-payer" - he wanted to get away from that as fast as possible.

The news today was this:

Health care premiums soared five times faster than increases in salaries in California from 2000 to 2007, according to a report released Wednesday.

From 2000 to 2007, health care premiums increased 95.8 percent for employer-based group coverage, from an average of $6,227 annually per worker to $12,194 annually.

Moreover, workers aren't only shouldering a greater burden in paying for health care premiums, but they're also paying a higher share of health care services, due to higher deductibles and co-payments, or reduced maximum allowable benefits.
Anyone out there think you're getting twice as much, or twice as good, helath care now than you were in 2000? Didn't think so.

Getting back to the debate, the question which started this section was this:

"Given the current economic situation, would either of you now favor controlling health care costs over expanding health care coverage?"
And while both candidates talked about such things as putting health records online and claiming that would reduce medical costs, and Obama talked about the obvious (but still not in place, thanks to business opposition) idea of "negotiating with the drug companies for the cheapest available price on drugs," neither candidate would address the elephant in the room, the one which was posed by an audience member in the last "debate" - "should health care be a marketable commodity?"

That's why the title of this post is "single-payer health care is not the answer." Because no matter who's paying for it, the fundamental problem in the United States is the profit system - doctors, hospitals, insurance companies, and drug companies and even, as I've noted before, medical education. Because until a government, a socialist government like Cuba, is responsible for all those aspects of health care, and not just footing the bill for the doctor and hospital, health costs will continue to involve profit, and health care will continue to suffer.

Both Obama and McCain talked about such things as (McCain in this quote) "We need to have more community health centers. We need to have walk-in clinics. We should have physical fitness programs and nutrition programs in schools." McCain, of course, is a complete hypocrite, since he doesn't even think the government should be involved with these things (two paragraphs later came his "Sen. Obama wants to set up health care bureaucracies, take over the health care of America"), and if he does, why does he think these things are a job for the federal government, but that abortion should be left to the states? Obama says, among other things, "We are going to invest in information technology to eliminate bureaucracy and make the system more efficient," but the real savings by "eliminating bureaucracy" would come from eliminating the bureaucracy of the entire health insurance system, the same insurance system which forms the centerpiece of Obama's health "care" proposals.

Single-payer health care, by eliminating the insurance companies (or should I say if it eliminated the insurance companies), would without any question be a major forward step. But without changing the entire profit system, and recognizing that a government "of the people, by the people, and for the people" has to run all aspects of the system - the research, development, and production of drugs, the education of doctors and other health care professionals, and the administration of health care (including those "walk-in clinics" McCain was talking about), real gains in health care cannot be achieved. Just as public education forms the bulwark of the educational system in this country, so must public health care form the bulwark of the health care system. Few outside of the extreme right-wing would question the centrality of public education; why do even liberals like Obama resist so strongly the necessary centrality of public health care?

There's another article in the news today which provides a nice footnote to this discussion:

The United States dropped to 29th in the world in infant mortality in 2004, the latest year that data are available from all countries, tying with Poland and Slovakia. The year before, it was 27th. In 1960, it was 12th.

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