A Heartless “Philosophy”

After six-and-a-half miserable years, it is hard to tally up the worst abuses of the Bush administration.

Narrow the field, and focus only on abuses related to the economy. That’s the universe of all the favors that the Bush-Cheney cabal has done for Big Business, so it is still a very competitive contest.

A case can be made that the administration’s effort to block expansion of the State Child Health Insurance Program (SCHIP) should top the list.

SCHIP is a complement to Medicaid, and provides health insurance to uninsured children from low-income families, typically those making up to 200 percent of the poverty line ($34,000). It has had enormous success in its 10 years of existence. Four million children receive health insurance through SCHIP. It has reduced the number of children in families at or slightly above the poverty line who are uninsured by about a quarter.

This has very real and concrete meaning. As the Center for Budget and Policy Priorities has shown, children with insurance get more preventative care, get better treatment for chronic conditions like asthma, have far fewer unmet medical needs, and get better dental treatment.

SCHIP is now up for reauthorization. Because of medical inflation, the program needs more money to provide insurance to the same number of kids. Because the program has been a clear winner, members of Congress from both parties want to provide this needed funding, and to expand the program further.

But President Bush says no.

He has a “philosophical” objection to expanding SCHIP.

“I believe government cannot provide affordable health care,” Bush said at a media event last week. “I believe it would cause the quality of care to diminish. I believe there would be lines and rationing over time. If Congress continues to insist upon expanding health care through the SCHIP program — which, by the way, would entail a huge tax increase for the American people — I’ll veto the bill.”

Here’s what is most remarkable about this philosophical objection from the White House: It isn’t shared by the for-profit insurance industry.

Last week, the Senate Finance Committee, by a 17-4 vote, approved a reauthorization of SCHIP that would enable the program to cover an additional 4 million children without insurance. Most of these children — 85 percent — would already be eligible under existing standards, but would not be covered for lack of funds. The Senate proposal is funded by a 61-cent-a-pack cigarette tax increase, which would have health benefits of its own: deterring almost two million children from taking up smoking, encouraging more than a million adult smokers to quit.

America’s Health Insurance Plans (AHIP), the trade association for the health insurance industry, “supports the Senate package,” says Mohit Ghose, AHIP Vice President of Public Affairs.

“Kids coverage come first” in the effort to get all Americans covered, he says.

Isn’t it strange that the administration is trying to protect the industry, but your position is supportive of the Senate approach?

It’s about a “philosophical point,” not protecting the industry, says Ghose.

“I defer to the White House on what is government-run healthcare.”

The Bush administration’s position is that an expansion of SCHIP will mean that some covered children otherwise would have received private insurance, and that the government program will therefore “crowd out” private insurance.

It is true that, under the Senate program, about a third of kids newly covered would otherwise have had private insurance. But as the Center for Budget and Policy Priorities emphasizes, this is unavoidable (if you are in fact trying to avoid it): the patchwork nature of U.S. private health insurance makes it impossible to cover any group outside of the very poorest and not also provide coverage to some who would otherwise have some private insurance. Moreover, says the group’s Matthew Broaddus, any parent switching their child from private insurance to a public program is doing so either because they have to pay too much out-of-pocket, or because they think they can get better care from the public program.

Where the private insurance industry does line up with the administration is in opposing a bolder plan moving forward in the House of Representatives. The House plan would cover more uninsured children, which does start to worry AHIP, and it would pay for the expansion both with a cigarette tax and by collecting excess payments to private insurers in the misnamed Medicare Advantage program. Medicare Advantage lets seniors opt for a private insurance plan in lieu of traditional Medicare. These private plans are collecting at least 12 percent more per covered person than it costs to treat a person under Medicare. The industry is adamantly opposed to efforts to stop these overpayments.

As against expanding SCHIP, the administration proposes a preposterous tax credit to help pay for individual insurance coverage. Because individual insurance coverage is both the least efficient component of the health insurance market and the one most rife with abuse, it is a certainty that the administration plan would be a failure.

One benefit of having already suffered through the long reign of President Bush is that he no longer commands the authority he once did. The vast majority of people in the United States oppose his position and — in a change — a strong majority in Congress oppose him, as well.

But will Bush veto SCHIP expansion? Will enough Republicans break from the administration to override (or prevent) a veto? That depends on how loudly the public insists its elected officials choose healthcare for kids over twisted philosophies.

Take action now via the Families USA website.

SiCKO, Part III: National Health Insurance — More Humane and More Efficient

Michael Moore’s extraordinary SiCKO makes the case for a single-payer national health insurance system — a Medicare for All — without bogging down in detailed policy debates.

Sure, there’s quite a bit of data that Moore sneaks in, but SiCKO’s basic approach is to rely on regular people telling stories about their healthcare experiences. In the United States, those stories are pretty rotten, and frequently heartbreaking. The experience of people living in countries with national health plans is much better.

This makes for powerful film-making, which is not to say there’s no need for the nitty-gritty policy debates.

The health insurance industry and its allies have worked hard to respond to SiCKO by promulgating a series of deceptions. It’s awfully hard to defend the current U.S. system, so their emphasis is on criticizing other countries’ healthcare systems.

They have a lot of practice at this stuff. Get on a call with people like Sarah Berk of Health Care America and Sally Pipes and John Graham of the Pacific Research Institute, and they will compellingly recite three key misleading arguments:

– People in other countries have to suffer through long waiting periods before seeing a doctor or getting treatment.

– National health plans ration care.

– “Government-controlled healthcare” or “government monopoly healthcare” is inherently of inferior quality.

When you don’t feel well, or need treatment, you want to see a doctor right away. So, the image of waiting lists to get treatment has some resonance.

But exactly how easy is it to see a doctor in the United States?

It turns out that the answer is the same as in other countries: It depends.

It depends in large part on what you need to see a doctor for.

Live in the United States and have a bad rash and need to see a dermatologist? Well, try not to scratch too much.

My colleague Sam Bollier called 20 dermatologists in the Washington, D.C. area, included under Care First/Blue Cross-Blue Shield or Cigna insurance plans. The average wait to get in the door is 36 days.

He called OB/GYNs and asked how long the wait would be for a woman who found a lump on her breast. The answer on average: 16 excruciating days.

In fact, wait times to see a doctor in the United States are worse than other industrialized countries — all of which have national health insurance — except for Canada, where the system has been starved of funding (but overall performance is still better than the United States on most key measures).

In 2005, the Commonwealth Fund commissioned phone surveys of sicker adults in New Zealand, Germany, Britain, Australia, Canada and the United States.

In the United States, 47 percent of those surveyed said that, the last time they were sick, they were able to get a doctor’s appointment the same day or the next day. This was worse than every other country except Canada. In New Zealand, 81 percent reported being able to see a doctor by the next day.

Asked what happened the last time they needed care in the evening or on a weekend or holiday, and whether they could get care without going to the emergency room, a full third in the United States said it was “very difficult” and half said it was at least “somewhat” difficult. This was worse than every other surveyed country. In Germany, only 14 percent said it was very or somewhat difficult.

What about rationing?

It’s awfully hard to take this argument seriously, though there’s no question it resonates.

All insurance plans, if they have some budgetary constraint, must ration to some extent. The relevant questions are: who’s doing the rationing, on what grounds, and how is the rationing allocated.

In the private insurance system in the United States, rationing is done by the health insurance industry, which rations with an eye both to health needs and the insurers’ profitability.

And, of course, the worst rationing is imposed on the 45 million people in the United States without insurance.

Rationing is far worse in the United States than in other countries. In the Commonwealth Fund survey of sicker adults, 40 percent of people in the United States said there has been a time when they did not fill a prescription because of cost — twice the level of the next worst performing country. Far higher numbers in the United States said that, because of cost, they did not visit a doctor when they had a specific medical problem, or that, again because of cost, they skipped a medical test, treatment or follow-up recommended by a doctor.

And then there is the matter of quality of care. There’s no doubt that the United States often offers top-line care to those able to pay — including “boutique” service for the super-rich at leading hospitals.

But in the aggregate, U.S. healthcare indicators are terrible, for worse than other industrialized countries — all of which have national health plans.

With SiCKO heating up the debate, Business Week profiled the French health system, which is treated favorably in SiCKO. “To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population.” But, notes Business Week: “the French system is more generous to its entire population than the U.S. is to its seniors.”

Business Week lined up a comparison between the United States and France: No one is uninsured in France. Out-of-pocket spending in France is barely a quarter of what people in the United States pay. There are almost a third more doctors per capita in France. French life expectancy is two years longer for men, four for women. Infant mortality is 43 percent lower in France.

On top of which, French health expenditures amount to 10.7 percent of the national economy. In the United States, it is 16.5 percent.

It turns out that national health insurance is not just more humane, it is far, far more efficient, about which more in my next (and final) piece on SiCKO.

There is one other argument that is regularly made against national health insurance, but this one comes from different quarters — those sympathetic to national health plans. And that is that while national health insurance may be desirable, it is politically unattainable. More on this also in my concluding column on SiCKO.