Arizona Senatecritter John
McCain has unveiled his health care plan
(finally). McCain’s plan is nothing more
thana recipe for failure and a boon to the
private health insurance industry, tantamount
to tax breaks for the oil industry.
He wants voters to think
he is going after health care cost inflation.
In reality, he wants to dismantle the
employer-provided system that now covers over
60 percent (or about 158 million) of
non-elderly Americans, forcing millions of us
who now get fairly decent health insurance on
the job to instead buy whatever they can find
on the individual market controlled by
unregulated and predatory insurance companies.
And he would drive health care costs upward,
not downward.
This is truly amazing:
McCain and his handlers knew they had to say
something about health care. So they turned to
their friends (and financial supporters) in
the health care industry and the conservative
think tanks. And they have adopted the most
extreme right-wing ideological approach,
premised on the idea that the big problem in
health care is that Americans have too much
insurance – in their words, we don’t have
enough “skin in the game” – and that only when
we have to buy health care with money that
comes directly out of our own pockets will
consumers force doctors, hospitals and
insurance companies to become more efficient.
So that’s the theory. But
it is contradicted by the facts. Most of us
already pay part of our premiums out of our
own pockets, and we increasingly have to shell
out for co-pays in order to get to see a
doctor. The result—in practice—is that most
people, even those with good insurance, now
think twice or three times about even getting
regular preventive health checkups. Having
lots of “skin in the game” has meant that
millions of Americans don’t get health care
they need—and that’s one of the big problems
in U.S. health care driving costs up, not
down.
But McCain, like George
Bush, pays more attention to
ultra-conservative theory than he does to the
facts. So McCain wants to tax workers’ health
care premiums that are paid for by employers.
Ask any expert, conservative or liberal, and
they will tell you the result will be
companies will stop providing health care as
an employee benefit.
Fortune Magazine quotes one of their experts
on the impact of McCain's plan: “I predict
that most companies would stop paying for
health care in three to four years,” says
Robert Laszewski, a consultant who works with
corporate benefits managers.
Now keep this in mind:
McCain and his corporate advisers don’t
dispute this. The massive upheaval that would
result – millions of families losing their
health coverage on the job and then having to
try to find an insurance company that would
sell them a new policy that would cover their
families—that’s not an unintended consequence
of his proposal. That chaotic loss of health
security is exactly what McCain intends to
happen. He wants us all to buy insurance not
as part of a group—like an employee group or a
co-op—that can negotiate for better coverage
at lower premiums, but as individuals, at the
mercy of the private insurance companies.
And get this: McCain
wants to abolish the regulations that
currently exist in most states that require
companies to insure people with pre-existing
conditions, provide benefits that don’t
exclude some medical conditions, and prevent
them from charging huge premiums for crumby
benefits. How would he do this? By “giving
people the freedom” to buy insurance in other
states with weaker regulations. You can bet
that most of the big insurance companies are
now shopping around for the state that wants
to become the corporate headquarters state for
the new deregulated health insurance industry
– if President McCain wins. Delaware?
Mississippi? Arizona?
But, but, but . . . I can
hear some people saying, McCain does give
people refundable tax credits to help pay for
health insurance. And that is part of his
package. But his whole philosophy is that too
many millions of American’s are getting health
care benefits that are too rich, and you
certainly can’t say that about the level of
tax subsidy he would provide—$2,500 per year
for individuals and $5,000 for a family,
according to the McCain for President website.
Last year the average yearly cost of the most
popular type of insurance plan offered by
employers hit $11,765, according to a Kaiser
Family Foundation study. So the average person
with a family would end up paying $11,765
minus the $5,000 tax credit, or $6,765—about
double the $3,226 Kaiser tells us the average
employee paid for his or her share of
premiums.
Again, this is NOT
unintentional. McCain and his corporate
advisers think it is good for individuals and
families to pay more because it makes them
think twice before seeking health care, and—in
theory—they will shop around for cheaper care.
And if they can’t cover the costs of real
health insurance with McCain’s tax credit, the
insurance industry will sell you lower-cost
plans with big holes in coverage or costly
co-pays—that is, if you are not already sick
and you aren’t too old for them to see you as
profitable.
And McCain will be glad
to help you invest your tax credit in a Health
Savings Account —a savings account coupled
with an insurance plan cooked up by his
friends in the insurance industry with such
high deductibles that it only applies for
catastrophic health costs. For those normal
trips to the doctor, you just take money out
of the savings account until there is nothing
left—and then you really reduce health care
costs by forgoing the trip to the doctor
altogether.
The ultra-conservatives
have a name for this combination of tax
credits and HSAs. They call it
“consumer-directed health care.” A better name
is “high-cost health care”—or “insurance
company-directed health care.” And although
they promote it as saving money for
individuals, for our economy and our society,
the available evidence shows that it does
nothing to reduce health care costs—but it
will leave millions of people with worse
coverage, more chronic health problems, and
higher levels of health cost-driven
bankruptcies. And, perhaps most importantly
for McCain’s financial backers, it would leave
the insurance industry and the drug industry
even more in control of America’s health care
system than ever before.
The release of this
McCain health care plan is an important test
for the mainstream media. Health care experts
who are “reality-based” will, if asked to
comment, tell reporters that there is no
evidence that McCain’s proposals will do
anything to reduce health care costs, but will
the media fall for the McCain spin?
Here’s the story they
would like major media to report:
“While Democrats Obama
and Clinton, stuck in an endless primary
contest, fight with each other over who
would cover more of the uninsured, John
McCain has been using the luxury of
uncontested time to develop a thoughtful
plan for bringing down health care costs—the
issue voters care most about when it comes
to their own family budget worries. And
McCain’s plan would attack the health cost
spiral by unleashing the power of individual
consumers and families in a more competitive
health care marketplace, not by using the
power of the federal government to either
provide health care and not by dictating
health insurance arrangements between
workers and employers. Expanding consumer
choice—and encouraging health care consumers
to be wise purchasers of health care, said
McCain, is the best way to force the health
care system to become more efficient and
reduce the burden of health care costs.”
Most honest reporters
will note that the McCain will not improve the
lot of America’s 47 million uninsured, but
they may give McCain credit for focusing more
on controlling prices than Obama and Clinton.
That might sound “fair and balanced”—but it
would be wrong.
The reality is, McCain’s
proposals would greatly increase the number of
uninsured Americans, while also doing nothing
about health care costs except increasing the
number of people who can’t afford good quality
health care for themselves and their families.
Let’s see if the media gets both parts of the
story right.
back to top
2008 is shaping up to be the election year
that we finally get to have the Great American
Healthcare Debate again. Harry and Louise are
back with a vengeance. Conservatives are
rumbling around the talk show circuit
bellowing about the socialist threat to the
(literal) American body politic. And, as
usual, Canada is once again getting dragged
into the fracas, shoved around by both sides
as either an exemplar or a warning -- and,
along the way, getting coated with the
obfuscating dust of so many willful
misconceptions that the actual facts about
“How Canada Does It” are completely lost in
the melee.
When the right-wing hysterics drag out these
hoary old bogeymen, this time, we need to be
armed and ready to blast them into straw.
Because, mostly, straw is all they're made of.
1. CANADA'S HEALTH CARE SYSTEM IS
"SOCIALIZED MEDICINE."
False. In socialized medical systems, the
doctors work directly for the state. In Canada
(and many other countries with universal
care), doctors run their own private
practices, just like they do in the US. The
only difference is that every doctor deals
with one insurer, instead of 150. And that
insurer is the provincial government, which is
accountable to the legislature and the voters
if the quality of coverage is allowed to
slide.
The proper term for this is "single-payer
insurance." In talking to Americans about it,
the better phrase is "Medicare for all."
2. DOCTORS ARE HURT FINANCIALLY BY
SINGLE-PAYER HEALTH CARE.
True and False. Doctors in Canada do make less
than their US counterparts. But they also have
lower overhead, and usually much better
working conditions. A few reasons for this:
First, as noted, they don't have to charge
higher fees to cover the salary of full-time
staffers to deal with over a hundred different
insurers, all of whom are bent on denying care
whenever possible. In fact, most Canadian
doctors get by quite nicely with just one
assistant, who cheerfully handles the phones,
mail, scheduling, patient reception, stocking,
filing, and billing all by herself in the
course of a standard workday.
Second, they don't have to spend several hours
every day on the phone cajoling insurance
company bean counters into doing the right
thing by their patients. My doctor in Arizona
tells me he works a 70-hour week: 35 hours
seeing patients, and another 35 hours on the
phone arguing with insurance companies. Most
Canadian doctors, on the other hand, work a
35-hour week, period. They file invoices
online, and the vast majority are simply paid
-- quietly, quickly, and without hassle. There
is no runaround. There are no fights.
Appointments aren't interrupted by vexing
phone calls. Care is seldom denied (because
everybody knows the rules). They get their
checks on time, see their patients on
schedule, take Thursdays off, and get home in
time for dinner.
One unsurprising side effect of all this is
that the doctors I have talked to in Canada,
and I have many of them on my correspondence
list who have contacted me because of my web
site, are, to a person, more focused, more
relaxed, more generous with their time, more
up-to-date in their specialties, and overall
much less distracted from the real work of
doctoring. You don't realize how much stress
the American doctor-insurer fights put on the
day-to-day quality of care until you hear from
doctors who don't operate under that stress,
because they never have to fight those battles
at all. Amazingly: they seem to enjoy their
jobs. In fact, I have heard from several
Canadian physicians who have returned to
Canada after initially emigrating to the US,
because of the hassle they have experienced in
the American health system, I am also hearing
from American physicians inquiring about the
Canadian system and their prospects to move
their for the same reasons.
Third: The average American medical student
graduates $140,000 in hock. The average
Canadian doctor's debt is roughly half that.
Finally, Canadian doctors pay lower
malpractice insurance fees. When paying for
health care constitutes a one of a family's
major expenses, expectations tend to run very
high. A doctor's mistake not only damages the
body; it may very well throw a middle-class
family permanently into the ranks of the
working poor, and render the victim
uninsurable for life. With so much at stake,
it's no wonder people are quick to rush to
court for redress.
Canadians are far less likely to sue in the
first place, since they're not having to
absorb devastating financial losses in
addition to any physical losses when something
goes awry. The cost of the damaging treatment
will be covered. So will the cost of fixing
it. And, no matter what happens, the victim
will remain insured for life. When lawsuits do
occur, the awards don't have to include
coverage for future medical costs, which
reduces the insurance company's liability.
3. WAIT TIMES IN CANADA ARE HORRENDOUS.
True and False again -- it depends on which
province you live in, and what's wrong with
you. Canada's health care system runs on
Ottawa-dictated guidelines that ensure uniform
standards of care, but each territory and
province administers its own program. Some
provinces don't plan their facilities well
enough; in those, you can have waits. Some do
better. As a general rule, the farther north
you live, the harder it is to get to care,
simply because the doctors and hospitals are
concentrated in the south. But that's just as
true in any rural county in the U.S.
You can hear the bitching about it no matter
where you live, though. The percentage of
Canadians who'd consider giving up their
beloved system consistently languishes in the
single digits. A few years ago, a TV show
asked Canadians to name the Greatest Canadian
in history; and in a broad national consensus,
they gave the honor to Tommy Douglas, the
Saskatchewan premier who is considered the
father of the country's health care system.
(And no, it had nothing to do with the fact
that he was also Kiefer Sutherland's
grandfather.). In spite of that, though,
grousing about health care is still
unofficially Canada's third national sport
after curling and hockey.
And for Canada’s newspapers, it's a prime
watch-dogging opportunity. Any little thing
goes sideways at the local hospital, and it's
on the front pages the next day. Those kinds
of stories sell papers, because everyone is
invested in that system and has a personal
stake in how well it functions. The American
system might benefit from this kind of
constant scrutiny, because it's certainly one
of the things that keeps the quality high. But
it also makes people think it's far worse than
it is.
Critics should be reminded that the American
system is not exactly instant-on, either. I
have excellent insurance. Yet I routinely have
to wait anywhere from six to twelve weeks to
get in to see a specialist. Non-emergency
surgical waits could be anywhere from four
weeks to four months. In Canada, the
experience is pretty much comparable, and
often better. The notable exception is MRIs,
which were easy in the states, but can take
many months to get in Canada. (It's the number
one thing people go over the border for.)
Other than that, urban Canadians get care
about as fast as urban Americans do.
4. YOU HAVE TO WAIT FOREVER TO GET A FAMILY
DOCTOR.
False for the vast majority of Canadians, but
True for a few. Again, it all depends on where
you live. It is, absolutely, harder to get to
a doctor if you live out in a small town, or
up in the territories. But that's just as true
in the U.S. -- and in America, the government
won't cover the airfare for rural folk to come
down to the city for needed treatment, which
all the provincial plans do.
5. YOU DON'T GET TO CHOOSE YOUR OWN DOCTOR.
Scurrilously False. Somebody, somewhere, is
getting paid a lot of money to make this kind
of stuff up. The cons love to scare the kids
with stories about the government picking your
doctor for you, and you don't get a choice. Be
afraid! Be very afraid!
For the record: Canadians pick their own
doctors, just like Americans do. And not only
that: since it all pays the same, poor
Canadians have exactly the same access to the
country's top specialists that rich ones do.
6. CANADA'S CARE PLAN ONLY COVERS THE
BASICS. YOU'RE STILL ON YOUR OWN FOR ANY
EXTRAS, INCLUDING PRESCRIPTION DRUGS. AND YOU
STILL HAVE TO PAY FOR IT.
True -- but not as big an issue as you might
think. The province does charge a small
monthly premium (about $108/month for a family
of four in BC) for the basic coverage.
However, most people never even have to write
that check: almost all employers pick up the
tab for their employees' premiums as part of
the standard benefits package; and the
province covers it for people on public
assistance or disability.
"The basics" covered by this plan include 100%
of all doctor's fees, ambulance fares, tests,
and everything that happens in a hospital --
in other words, the really big-ticket items
that routinely drive American families into
bankruptcy. In BC, it doesn't include "extras"
like medical equipment, prescriptions,
physical therapy or chiropractic care, dental,
vision, and so on; and if you want a private
or semi-private room with TV and phone, that
costs extra (about what you'd pay for a room
in a middling hotel). That other stuff does
add up; but it's far easier to afford if
you're not having to cover the big expenses,
too. Furthermore: you can deduct any
out-of-pocket health expenses you do have to
pay off your income taxes. And, as every
American knows by now, drugs aren't nearly as
expensive here, either.
Filling the gap between the basics and the
extras is the job of the country's remaining
private health insurers. Since they're off the
hook for the ruinously expensive big-ticket
items that can put their own profits at risk,
the insurance companies make a tidy business
out of offering inexpensive policies that
cover all those smaller, more predictable
expenses. Top-quality add-on policies
typically run in the ballpark of $75 per
person in a family per month -- about $300 for
a family of four -- if you're stuck buying an
individual plan. Group plans are cheap enough
that even small employers can afford to offer
them as a routine benefit. An average working
Canadian with employer-paid basic care and
supplemental insurance gets free coverage
equal to the best policies now only offered at
a few of America's largest corporations. And
that employer is probably only paying a couple
hundred dollars a month to provide that
benefit.
7. CANADIAN DRUGS ARE NOT THE SAME.
More preposterous bull hockey. They are
exactly the same drugs, made by the same
pharmaceutical companies, often in the same
factories. The Canadian drug distribution
system, however, has much tighter oversight;
and pharmacies and pharmacists are more
closely regulated. If there is a difference in
Canadian drugs at all, they're actually likely
to be safer.
Also: pharmacists there dispense what the
doctors tell them to dispense, the first time,
without moralizing. I know. It's amazing.
8. PUBLICLY-FUNDED PROGRAMS WILL INEVITABLY
LEAD TO RATIONED HEALTH CARE, PARTICULARLY FOR
THE ELDERLY.
False, and boggling-the-mind so. The papers
would have a field day if there was the barest
hint that this might be true.
The health care system also makes it easier on
their care-giving adult children, who have
more time to look in on Mom and take her on
outings because they aren't working 60-hour
weeks trying to hold onto a job that gives
them insurance.
9. PEOPLE WON'T BE RESPONSIBLE FOR THEIR
OWN HEALTH IF THEY'RE NOT BEING FORCED TO PAY
FOR THE CONSEQUENCES.
False. The philosophical basis of America's
privatized health care system might best be
characterized as medical Calvinism. It's
fascinating to watch well-educated secularists
who recoil at the Protestant obsession with
personal virtue, prosperity as a cardinal sign
of election by God, and total responsibility
for one's own salvation turn into fire-eyed,
moralizing True Believers when it comes to the
subject of Taking Responsibility For One's Own
Health.
They'll insist that health, like salvation, is
entirely in our own hands. If you just have
the character and self-discipline to stick to
an abstemious regime of careful diet, clean
living, and frequent sweat offerings to the
Great Treadmill God, you'll never get sick.
(Like all good theologies, there's even an
unspoken promise of immortality: f you do it
really really right, they imply, you might
even live forever.) The virtuous Elect can be
discerned by their svelte figures and low
cholesterol numbers. From here, it's a short
leap to the conviction that those who suffer
from chronic conditions are victims of their
own weaknesses, and simply getting what they
deserve. Part of their punishment is being
forced to pay for the expensive, heavily
marketed pharmaceuticals needed to alleviate
these avoidable illnesses. They can't
complain. It was their own damned fault; and
it's not our responsibility to pay for their
sins. In fact, it's recently been suggested
that they be shunned,
lest they lead the virtuous into sin.
Of course, this is bad theology whether you're
applying it to the state of one's soul or
one's arteries. The fact is that bad genes,
bad luck, and the ravages of age eventually
take their toll on all of us -- even the most
careful of us. The economics of the Canadian
system reflect this very different philosophy:
it's built on the belief that maintaining
health is not an individual responsibility,
but a collective one. Since none of us
controls fate, the least we can do is be there
for each other as our numbers come up.
The bottom line: When it comes to getting
people to make healthy choices, appealing to
their sense of the common good seems to work
at least as well as Calvinist moralizing.
10. THIS ALL SOUNDS GREAT -- BUT THE TAXES
TO COVER IT ARE JUST UNAFFORDABLE. AND
BESIDES, ISN'T THE SYSTEM IN BAD FINANCIAL
SHAPE?
False. On one hand, the annual Canadian tax
bite runs about 10% higher than U.S. taxes. On
the other, Canadians are not paying out the
equivalent of two new car payments every month
to keep the family insured. When you balance
out the difference, they're actually money
ahead. When you factor in the greatly
increased social stability that follows when
everybody's getting their necessary health
care, the impact on their quality of life
becomes even more significant.
And True -- but only because this is a
universal truth that we need to make our peace
with. Yes, the provincial plans are always
struggling. So is every single publicly-funded
health care system in the world, including the
VA and Medicare. And so are many private
employment-based systems. There's always
tension between what the users of the system
want, and what the taxpayers (or premium
payers) are willing to pay. The balance of
power ebbs and flows between them; but no
matter where it lies at any given moment, at
least one of the pair is always going to be at
least somewhat unhappy.
But, as many of us know all too well, there's
also constant tension between what patients
want and what private insurers are willing to
pay. At least when it's in government hands,
we can demand some accountability.
