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Change You Can Believe in? Single-payer Appraisal of healthcare Reform

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To those led to believe that, as President Obama claimed, the passage of the health care bill is "comparable to the passage of Medicare and Social Security", and that "every American will be guaranteed high quality, affordable healthcare coverage" as a result of it, my advice is to hold off on uncorking the champagne.

For one, Social Security and Medicare were public programs that from their inception offered immediate benefits to millions of ordinary Americans, who for the first time could rely on old-age pensions and access healthcare services that until then had been completely out of reach.

But, aren't single payer advocates party spoilers, unable to recognize that the bill, even if "not perfect" is, as President Obama has asserted, a "step in the right direction" that will bring the American Dream closer to millions of suffering Americans?

The short answer is no.

As Physicians for a National Health Program has argued (disclosure: I am the vice-president of the California Chapter of this organization), there are multiple reasons to be deeply concerned about the bill, and not a shred of evidence that whatever good it may do required that Main Street pay Wall Street the bill's trillion-dollar price tag.

Yet this is precisely what it does, because this "historic bill", instead of eliminating the root of our healthcare woes, a profit-driven health insurance industry which makes money when it succeeds in not paying our medical bills, will enrich and further entrench the power of this industry.

How so? By forcing millions of Americans to buy its shoddy products or pay a fine, even as it offers eligible ones subsidies courtesy of taxpayers -- to purchase those products. Sound familiar? It should. The bill consolidates the major transfer of wealth from

Main Street
to Wall Street of the last decades, only second to the recent, similar transfer implemented under the dubious claim that otherwise the economy would disintegrate.

Below follow selected facts about the bill to help readers assess if this is the sort of change they were waiting for or, indeed, can believe in (Further information is available at www.pnhp.org).

* Millions of middle-income people will be mandated to buy commercial healthcare policies costing up to 9.5 percent of their income, yet covering as little as 60 percent of "covered services" (God only knows what those may be), leaving them vulnerable to financial ruin if they become seriously ill. Let us note that close to 80% of those filing for bankruptcy due to medical bills had insurance when they filed, because their policies, as will remain the case with many sold under the current bill, were impossible to use due to high co-pays, co-insurance, and deductibles. So yes, over 30 million Americans will be "covered" by this bill, but by an umbrella full of holes under pouring rain.

* People with employer-based coverage will be locked into their plans' "preferred providers' networks". So yes, workers will "keep their plans if they like them" (assuming they can afford the ever-increasing prices and don't lose their jobs, or their employers don't drop their plans), yet will have to keep them even if they don't like them.

* Insurers will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products, which will entrench their financial and political power, thus their ability to block future reform.

* Health care costs will continue to skyrocket because the bill will do nothing to reduce the $400 billon wasted every year pushing paper to market thousands of plans and separate people according to eligibility criteria, services covered, etc.

* The much-vaunted insurance regulations e.g. ending denials on the basis of pre-existing conditions are riddled with loopholes. For instance, older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017. Policies can still be cancelled in case of "fraud or intentional misrepresentation", the very, number one excuse insurers use to cancel policies today.

* About 23 million people will remain uninsured nine years out, which translates into about 23,000 unnecessary deaths annually and an incalculable suffering.

Did it need to be like this? Not at all. Whatever good selected provisions in the bill may have done, such as funding community health centers, could have been implemented as stand-alone measures.

Instead, Congress and the Obama administration have chosen to burden ordinary people with a "uniquely American" individual obligation to buy a flawed private product even as they called it, with a straight face, "a major triumph over special interests" -- in conjunction with new taxes on workers' health plans, and a perpetuation of a fragmented, unsustainable system that is eroding our health and our economy.

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Claudia Chaufan, M.D., Ph.D., is Associate Professor at the University of California, San Francisco. She is also a member of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).


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