[From the December Progressive Magazine]
WRONG PRESCRIPTION
Bill Bradley's Health Plan Is No Cure
BY DR. IDA HELLANDER AND DR. STEFFIE WOOLHANDLER
Bradley Healch Care Plan
THE RIGHTWARD DRIFT OF THE DEMOCRATIC PARTY is nowhere more
evident than in health care. In September, Bill Bradley,
the former Democratic Senator from New Jersey and current
Presidential candidate, declared his support for health reforms
previously espoused by the ultraconservative Heritage Foundation.
Bradley's plan is at its core profoundly reactionary, a vehicle for
the Heritage Foundation's explicit agenda of "rolling back the welfare
state."
Bradley's plan has already been endorsed by Chip Kahn, president of
the powerful lobbying group the Health Insurance Association of
America. And little wonder: Insurance companies and HMOs stand to gain
billions of tax dollars from the Bradley plan, while Americans would
still have no right to health care.
Bradley has impressed many with his ideas on race (and his jump shot).
Yet his health proposal is so shameless in its $200 billion transfer
of tax dollars to the private insurance industry that it might have
made Richard Nixon blush. At a time when the possibilities for
progressive reform seem bright, why are Bradley's health care
proposals so backward?
Meanwhile, Al Gore would not guarantee the right to health care
either. Nor would he loosen the chokehold of the insurance industry
over health policy. At most, he trumpets his support for the Patient
Bill of Rights, advocates putting additional money into the failed
Children's Health Insurance Plan, and proposes a modest tax credit so
that some in the fifty-five to sixty-five age group could buy into
Medicare.
While national health insurance was espoused by Warren Beatty's
fictional Senator Bulworth, not a single real-life candidate has the
courage to advocate the nonprofit national health insurance program
America needs and Democrats supported from the New Deal era until the
1992 Clinton candidacy.
BRADLEY HAS COMPARED HIS PROPOSAL for the 11.1 million uninsured
children to the Medicare program for seniors. This is nonsense.
Medicare has guaranteed seniors basic health coverage for more than
thirty years. Bradley's proposal is a mandate that parents buy their
children private insurance. Admonishing parents to buy private
coverage--even if such coverage were affordable and available (which
it's not)--is a long way from guaranteeing kids coverage.
Bradley's plan relies on tax credits and a new federal bureaucracy to
help poor families afford children's coverage. The subsidies would
tempt employers to drop coverage of employees and their children but
wouldn't be adequate to help many low- and middle-income families buy
private coverage. This is exactly what happened with the federal
Children's Health Insurance Plan, the most recent incremental effort
to increase coverage. In 1998 alone, the number of uninsured children
rose 330,000, following rises of 188,000 in 1997 and 755,000 in 1996.
Bradley also proposes privatizing Medicaid, the current government
insurance program that covers some of the poor and the disabled, as
well as nursing home costs for poor seniors. The $193 billion in
current Medicaid spending would go to private insurers. The nonelderly
Medicaid recipients would get a voucher to purchase private coverage
from plans participating in the Federal Employees Health Benefits
Program. Bradley would also offer tax credits to the uninsured to buy
into that program.
As for the poor elderly who receive help from Medicaid with nursing
home and long-term care costs, Bradley would simply end thirty years
of joint state and federal responsibility for their care and turn this
over to the states completely (just in time for the boomers'
retirement). Bradley would do the same for the disabled, risking the
loss of the safety net for this vulnerable community.
With premiums rising at 8 percent per year, poor adults with Bradley's
fixed tax subsidies or skimpy vouchers would be able to afford only
the cheapest plans (mainly HMOs) in the Federal Employees Health
Benefits Program, not the high-end coverage that members of Congress
receive. Many millions of uninsured would continue to fall through the
cracks. As with children, the tax subsidies for adults are inadequate
to cover all the uninsured but might encourage employers to drop
coverage to low-income workers.
For seniors, Bradley would create an optional prescription drug
benefit to cover medication costs over $500 annually. Seniors would
have to sign up and pay an extra premium for this modest benefit.
Bradley's tepid proposal barely scratches the surface of that problem.
THE HERITAGE FOUNDATION MUST BE FLATTERED by Bradley's adoption of its
ideas. For years, that foundation has pushed a similar plan for
privatizing Medicare in an attempt to reduce public control while
directing tax dollars to private insurers. Heritage scholars argue
that consumers will choose the most efficient private plans and that
competition in the market will reduce costs.
However, the evidence from seniors who have opted for HMOs is that
private plans are actually more costly than traditional coverage. The
U.S. General Accounting Office (GAO) found that Medicare lost $1.3
billion in 1998 by enrolling seniors in HMOs.
In the past two years alone, Medicare HMOs have dumped 750,000 seniors
who proved unprofitable. HMOs have recruited seniors by routinely
misleading them about benefits. This year, Medicare HMOs are
dramatically scaling back the prescription drug coverage that lured
many seniors into HMOs in the first place. A four-year study of
quality of care by John Ware, published in the October 2, 1996, issue
of the Journal of the American Medical Association, found that seniors
were more likely to decline in health under HMO care than in the
traditional Medicare program. Yet, instead of recognizing the failures
of Medicare privatization, the Heritage Foundation and its allies in
Congress push on.
While traditional Medicaid is a program of uneven quality, with large
variations by state, the record of for-profit HMOs in treating
Medicaid patients has clearly been worse. Florida officials banned
twenty-one of the state's twenty-nine Medicaid HMOs from expanding
enrollment several years ago after systematic abuse of patients was
uncovered not by state auditors but by courageous investigative
reporters at a local newspaper. These HMOs used fraudulent marketing
tactics (for instance, telling patients they would lose their Medicaid
if they didn't enroll), delivered poor-quality care, disenrolled sick
patients, and spent up to 70 percent of program costs on overhead and
profits.
In Oregon, the percentage of poor women with inadequate prenatal care
and the percentage of low-birth-weight babies rose after Medicaid
recipients were pushed into HMOs. A large experiment in which families
were randomly assigned to HMOs found that low-income persons fared
particularly poorly in the HMO setting.
A national health care system is financially viable. According to
studies by both the GAO and the Congressional Budget Office, a
single-payer national health program would streamline health care
paperwork and, in doing so, save enough money to cover the 44.3
million uninsured. It would allow patients to choose their own
physicians and hospitals, a right citizens of most industrialized
countries take for granted.
Drug companies have the highest rate of profit of any industry, and
the United States has the highest drug prices in the world. According
to a study by Alan Sager and Deborah Socolar at Boston University, if
the U.S. government used its bargaining clout to negotiate drug prices
down to Canadian levels, the savings (about $16.2 billion) would be
sufficient to provide the seventy million Americans lacking drug
coverage with necessary medications.
A recent New York Times article noted that the economy of Sweden is
doing so well that the government is giving seniors the right to have
a personal home care assistant. But when the U.S. economy does well,
as it has since 1992, another seven million people are thrown into the
ranks of the uninsured.
No nation has ever achieved universal health care through the market.
We and the 8,500 doctors at Physicians for a National Health Program
believe that health care should not be a business but a human service
that should be delivered through nonprofit national health insurance.
The United States spends nearly twice as much on health care as any
other industrialized country, including Sweden, and yet is the only
one of these countries that does not guarantee universal coverage.
An editorial in the Bangor Daily News recently argued that "health
care should be regarded as an essential part of an enlightened
society" and that "health care ought to be viewed as a right of
citizenship and not an obligation of business." Instead of tinkering
with tax credits and HMOs, the candidates should be debating more
fundamental questions.
Bill Bradley and Al Gore are pushing the corporate health agenda under
the cover of liberal rhetoric. That's no way to get progressives'
support.
Dr. Ida Hellander is Executive Director of Physicians for a National
Health Program, based in Chicago. Dr. Steffie Woolhandler is Associate
Professor of Medicine at Harvard and Co-Founder of Physicians for a
National Health Program.
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