Sam Uretsky

Delaying Inevitable Health Care Reform

"When it comes to health care," George W. Bush said in his 2007 State of the Union address, "government has an obligation to care for the elderly, the disabled, and poor children. And we will meet those responsibilities. For all other Americans, private health insurance is the best way to meet their needs. But many Americans cannot afford a health insurance policy."

Right! Our president didn't explain why the responsibilities of government are limited to just a few groups of people, nor did he take the time to explain why private health insurance is the best way to meet the needs of others. Faced with a crisis in both public health and the federal budget, our president pulled out his remedy that has more uses than Dr. Kilmer's Swamp Root -- tax cuts. This, he explained, will make private health insurance more affordable -- to those who can already afford private health insurance.

Meanwhile, one of the largest private insurers, United Healthcare, and its subsidiary, Oxford Health, have been accused of violating the US Racketeer Influenced and Corrupt Organizations Act (RICO). Two New York hospitals, Jamaica Hospital Medical Center and Flushing Hospital Medical Center, have accused United Healthcare and its subsidiary, Oxford Health, of operating a rogue business plan. In simplest terms, UHC has been accursed of refusing to pay its bills. In some cases, patients would be admitted to hospitals with the assurance that their costs would be covered, and then the claim would be retroactively denied. When bills were accepted, payment was delayed. The lawsuit also claims that patients were steered away from Jamaica and Flushing Hospitals by being told that these hospitals were out-of-network.

Meanwhile, William McGuire, CEO of United Healthcare, has been questioned about backdating of stock options. The options he holds have been valued at around $1 billion. And, on March 5, Adweek magazine featured one of United Healthcare's television spots in its Best Sports column. Finally, the American Medical Association has accused United Healthcare of improperly calculating "usual and customary" fees for certain procedures in order to reduce the actual payments to physicians and hospitals.

Obviously, United Healthcare isn't the only insurance company to face similar allegations, and that's what's wrong with the system. Private insurance companies are in the business for their health, not yours. The costs of health care are high everywhere, and even European nations, all of which have far more efficient health care financing than the US, are scrambling for ways to keep costs down. Every modern nation faces the same challenges -- aging population (which is a result of better health care to begin with), and the availability of modern (meaning expensive) technology.

What makes the US different is the existence of the extra layer of fat, the massive health insurance industry. The health insurance industry imposes an extra layer of bureaucracy, as more people spend more time confirming eligibility for care and arguing over coverage. The money spent on television spots and magazine ads shows up in the healthcare part of the budget. Countries with national health systems don't have to pay multi-million dollar salaries to CEOs. They don't have to cover all these needless expenses, and then show a profit, and because they aren't traded on the stock market (and there are no stock options for the managers), they don't have to show a bigger profit every year. The logical first step in cutting health care costs isn't to make private insurance more affordable with tax cuts, it's to get rid of private insurance entirely.

The insurance companies won't go easily. In 2006 the insurance industry gave over $30 million in political contributions on a national level (65% to Republicans). When Hillary Clinton tried to develop a universal health care plan, while there was still time to head off the current crises, she made a sincere attempt to placate the insurers. They weren't satisfied, and the Health Insurance Association of America developed the very effective Harry and Louise advertisements to tell us that everything was fine, and we should just leave the system alone. These are companies that have a vested interest in the status quo, and they're big enough to be a real problem if they don't get their own way. Once a society is built around certain systems, whether it's the internal combustion engine and imported oil, or private health insurance, major change becomes difficult.

But it has to be done. In contrast to what our president said in his State of the Union address, government has a responsibility to care for all the people, because government is the way all the people care for themselves. Once we understand this, we may be able to improve a system that is dangerously broken.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, April 1, 2007

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