The whole scenario is absurd, you might say. (In fact, it's close to what many Americans experienced before public fire departments were established in the mid 1800s, when homeowners without insurance often watched their houses burn while negotiating fees with fire companies.) Why have a bureaucracy of insurance company middlemen, demanding high fees as gatekeepers for fire protection without actually providing the service itself, when we can have a far less expensive public system that guarantees firefighters will show up in an emergency regardless of who you are, where you live, or what's in your bank account? Any reasonably intelligent human would recognize privatized fire departments as a disaster, a menace to public safety and utterly irrational.
So why do we tolerate a health care system that's run the same way?
Private health insurance companies and HMOs don't provide medical treatment. Instead, they act as gatekeeping bureaucracies that make an enormous profit based on the likelihood that at some time in your life you'll suffer illness or injury and will need medical treatment. They provide cost but no value.
Physicians for a National Health Program notes that "[o]ver 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc." ( http://www.pnhp.org/facts/singlepayer_faq.php ) The overhead for Medicare, based on administrative costs but without the demand for profit, is about 3%. Why not convert to a public system, expanding Medicare to cover all Americans, perhaps saving us a third of the cost by eliminating the insurance and HMO middlemen -- a system comparable to our public fire departments?
That's what a Single-Payer national health care system would do. It would guarantee health care and medical prescriptions for everyone regardless of ability to pay, employment, age, or prior medical condition (criteria currently used by private insurance firms and HMOs to limit or deny coverage). Single-Payer would allow everyone to choose their health care provider -- you could visit the physician or hospital of your choice, rather than select from a limited list of those approved by an insurance company or HMO.
We'd pay for Single-Payer with a progressive tax plan. Tax sounds like a bad word, until one realizes that the amount most middle- and low-income working Americans would pay would be far less than we currently shell out for private insurance and HMO plans, and any additional fees when you go to the hospital or clinic or doctor's office would be zero or minimal. That's because HMO-insurance company profits, big CEO salaries and bonuses, and administrative waste would be eliminated. Just as public fire departments have created an incentive for public education and measures to prevent fires, Single-Payer would create an incentive for encouragement of good habits, like a healthy diet, exercise, and quitting cigarettes.
Obstacles to Real Universal Health Care
Why can't we get a Single-Payer/Medicare For All system? Because the profit-making health insurance and HMO industry holds svengali power over most Republicans and Democrats in Congress and the White House, thanks to campaign contributions. According to the Center for Responsive Politics, the amount of such contributions was over $46 million in 2008 ( http://www.opensecrets.org/industries/indus.php?ind=F09 ). Sen. Max Baucus, chair of the Senate Finance Committee, thus declares that Single-Payer is "off the table." Barack Obama once supported Single-Payer, before he launched his bid for president ( http://www.youtube.com/watch?v=fpAyan1fXCE&feature=player_embedded ). Now he favors a plan that would leave the insurance industry in charge.
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