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Universal Health Care Now: Questions and Answers

Why is there a push for universal health care now?

Everyone – government at all levels, insurance companies, the business community, and the public-at-large – agrees that the US system of health care is in trouble. Here’s why:

  • Both the delivery of health care and the financing systems are inefficient, extremely complicated and unfair.
  • Millions of Americans – estimates range from 39 million to 45 million – have no health insurance at all; millions more have inadequate coverage.
  • Health care costs are simply spinning out of control while benefits for those with health insurance are becoming more limited.
  • Businesses are finding that their health plan costs are escalating too rapidly; the average increase for 2002 is expected to be 12%.
  • Unions are being faced with an increasingly difficulty choice between wage increases and maintenance of health coverage.
  • State governments, some of which must fund 50% of Medicaid costs, are finding this growing burden next to impossible to handle.
  • CALPERS, the California state employee benefit program, has announced health insurance premium increases averaging 25%.
  • HMOs have been dropping many Medicare beneficiaries, asserting that reimbursement rates are inadequate.
  • Millions of Americans have no prescription drug coverage even if they have health insurance. 2001saw a 17% increase in prescription drug prices. At that rate, even those who now have such coverage may not be able to afford it much longer.
  • The reduction in number of hospital beds with associated high occupancy rates leaves us with little or no capacity to handle sudden surges in need such as those that occur during the flu season or during a disaster.
  • The multi-year legislatively mandated reductions in Medicare reimbursement are taking place at the same time as physicians face significant increases in costs including hikes in malpractice insurance. As a result , many physicians are not taking on new patients who are Medicare beneficiaries.

The combination of all these factors means that health care in this country is now in crisis. It is a public health crisis of enormous proportions and the consequences, both social and political, will become even more dire if matters are left unchecked.

How is this movement for universal health care different from the push for universal health care that was tried and failed in the early 90’s?

In the ’90s the health care reform package known as the “Clinton Plan” was defeated. It failed because the debates about it were held without adequate input from the public and tried to incorporate the giant health insurance companies into a system of universal coverage. What resulted was a bizarrely complex proposal that was extremely vulnerable to attack. And attacked it was – by the same health insurance companies that the plan tried to accommodate. The insurance companies took advantage of the fact that the vast majority of the American people found the plan hard to understand. They waged a multi-million dollar media campaign to scare the American people away from the Clinton Plan, and it worked. The structure that came into being after rejection of the plan depended heavily on market forces and the spread of HMOs to hold down prices and provide broad coverage. That “managed care” approach did not work. Costs are rising rapidly and broad coverage was never attained. The growth of administrative expenses, including profits, plus the hikes in the prices of prescription drugs account for most of these health cost increases.

This time, however, there is a push nationwide for free and open public debate about universal health care. Americans have had time to reflect and they realize, from their own increasingly harrowing health care experiences, that change must come. They’re ready to listen and, increasingly, many are ready to act. Rekindling Reform is just one of numerous umbrella groups that have emerged recently to take on this issue.

America’s approach to universal health insurance could, for example, build on our country’s successful Social Security program. We are learning as much as we can about universal health insurance in other countries in order to determine what can usefully be adapted from systems that work. We will encourage the creation of a system that is easily understood , that includes everyone both as contributor and as beneficiary, and that has widespread support.

Isn’t it better to push for small, incremental reforms rather than attempting the bigger jump to universal coverage?

Incremental reforms don’t get to the roots of the health care crisis in the US. Our current system is based on employment rather than entitlement. Access to quality health care for all, under this system, isn’t seen as a right. It’s something that depends on the profitability of employers as well as their good will. With a highly mobile workforce, and with many employers failing to provide health insurance, let alone adequate health insurance, this system simply doesn’t make sense. The one partial program we do have that treats health care as a right is Medicare and it’s the sort of model that could be extended to all Americans. Medicare is an essential part of our nation’s Social Security system.

With incremental changes alone, we’ll still be left with the instabilities and inadequacies of means-tested and employer-based programs and with the most expensive health care system in the world, a system that fails to provide quality health care for everyone. Incremental reform has taken the place of building a movement for a universal, comprehensive, affordable, high quality and equitable health care system. But now that movement is gathering strength across the US.

Doesn’t the US already have the best health care in the world? Why tinker with a health care system that seems to work so well?

There is a good chance that our current system works well if you’re one of the lucky few with a secure hold on good health insurance. But even if you are insured , you run the risk of poor care because the system’s inability to cope intelligently with costs leaves it understaffed and overstressed. Unless fundamental changes are introduced, we will be left with a system able to provide excellent health care for a small part of the population, less than adequate health care for a significant part of the population and very little health care for the rest.

What about the economic cost? Wouldn’t it bankrupt the country to support truly universal health care?

No. France, Germany , Canada and the United Kingdom are all countries with comparable economies and with universal health care. They are not bankrupt. Each of them achieves universal coverage differently. We have learned that universality in coverage does not require direct government provision of care.

The US now spends more money on health care, both per capita and as a percentage of national income, than any other country in the world; and yet, there are somewhere from 39 million to 45 million people uninsured. Right now, the US spends about twice as much per capita on healthcare as other industrialized countries (in 1998, the US spent $4270 per capita, while Germany spent $2400, Canada spent $2550 and France spent $2120), Medicare, a government program, has administrative costs of a mere 2.1%. We could actually spend the same amount of money as we do now but in a more efficient system with far more humane and equitable results and without bankrupting ourselves.

How would universal health care work? Would there still be insurance companies? What would be the role of government?

More and more Americans now believe that a substantial restructuring of the health care system is needed. It is fast becoming one of the most important issues for elected officials and will be a topic during the next Presidential election.

Many ideas have been circulated about universal health care and how it might work in this country. In April 2002, California released the results of a study that tried to find ways to give everyone in the state the health care they need. One of the most important findings is that universal health care in California could be viable and affordable. If it can be done in California, it can be done throughout the US.

The role of the insurance industry in a universal health care system is a matter of debate. Some believe that a workable and equitable universal health care system requires that there be a single public insurer–the government–that replaces the 1500 private insurance companies that dominate the health care system in the United States now. Some “single payer” advocates believe that some private insurers could technically administer national health insurance in the way that Blue Cross does now for Medicare. But that would be a very different role from the one they play today. Other proponents of universal health care believe that it will be possible to preserve a larger role for private insurers, while strongly regulating them in order to avoid the inequities of today’s system. Whatever plan is finally accepted must lead to reasonable and stable administrative costs in a system providing quality health care for all in an equitable manner, with effective oversight by the government.

What we have learned from our studies of other countries is that universal health care can bring about greater autonomy for doctors in clinical decisions . In contrast with these universal health care systems, many of our present day “managed care” structures have insurance company arbiters with the power to deny essential tests. With universal health care , excess paperwork is eliminated for both doctor and patient, thus reducing administrative costs and channeling health care dollars directly into treatment and its support. Standards for care can be developed on a national level based on recommendations by the health professions and approval by Congress.

What currently stands in the way of achieving universal health care in the US? What steps need to be taken before the US can have universal health care?

The defeat of the Clinton plan by some of the most powerful political forces in our country has left a residue of marked pessimism. This has helped make elected officials nervous about taking public positions on many domestic policy issues, especially health care. In addition, the enactment of large tax cuts has destroyed budget surpluses and much hope for expansion of health care coverage.

However, misinformation and/or lack of information remains a significant obstacle to universal health care. The American people need to learn more about how universal health care works in other countries and decide which kinds of policies would work best for the US. Rekindling Reform is public education in action! Confronting fears and misinformation, we are helping people to understand the rolling crises that now characterize the American health care system and we are helping them to realize that there are practical alternatives that can provide quality health care for everyone.

Rekindling Reform is bringing together health care providers, health professional societies, academic institutions, labor, business groups, non-profit health insurance carriers, health policy experts and consumer groups to learn how quality health care for all can be achieved. The translation of these ideas into increased sensitivity and awareness by politicians is happening and is becoming a major political force to be reckoned with in the 2002 and 2004 elections.

Who Supports Universal Health Care?

Increasingly, people and groups throughout the US are organizing themselves into a potentially powerful movement for universal health care. The 40 member- groups of Rekindling Reform alone account for approximately 200,000 people. As more and more people realize that universal quality health care should be considered as an American right, not a privilege, the ranks of supporters will continue to swell.

How can people get involved in the universal health care/ Rekindling Reform movement?

  • Ask members of Congress to support House Concurrent Resolution 99, which calls for Congress to enact universal health care by 2004.
  • Ask members of the NY State legislature to sponsor public hearings on health care.
  • Contact Rekindling Reform and other organizations that support universal health care (like the Metro New York Health Care for All Campaign, PHYSICIANS FOR A NATIONAL HEALTH PROGRAM, pnhpnyc@igc.org, (212) 666-4001 and the PUBLIC HEALTH ASSOCIATION OF NEW YORK CITY, (212) 342-5752, info@phanyc.org, and invite a speaker to come to a gathering you or your organization may want to sponsor.
  • Find out where your elected officials stand on universal health care, and help them to appreciate its importance for the country and their own political standing.
  • Visit the following web sites for more information: www.pnhp.org, www.pnhpnymetro.org, www.phanyc.org