[lbo-talk] US health care (was: doom)

louis kontos louis.kontos at liu.edu
Sat Mar 18 19:15:47 PST 2006


Isn't the real issue in this piece about insurance companies? Donlan seems to think that more of them equals more competition among them as a good thing; but doesn't entertain the question as to whether there is any real competition in the insurance sector now, therefore what 'more' would mean. Nor does he provide any support for the 16 per cent GDP figure. Canada provides universal coverage with 9 per cent. The stuff about Americans not caring about the uninsured also lacks support. That's why six out of seven health care movements failed? (Don't know where he got these figures.) Not so. The concept of universal health care is popular in the U.S. When the question is put to them in real and straightforward terms, rather than a choice between 'government control' versus 'free enterprise', they overwhelmingly choose universal/single payer. Louis

On Mar 18, 2006, at 3:24 PM, Marvin Gandall wrote:


> Below is quite a remarkable piece on America's health care crisis
> considering its source - Thomas Donlan, the very conservative
> columnist for
> Barron's financial newsweekly. Donlan loyally supports the Bush
> administration's proposal for individual health savings accounts,
> but his
> support notably lacks conviction. What is even more striking is his
> candid
> admission that the US could "finance a British- or Canadian-style
> (single
> payer) system without the drawbacks", with the resources currently
> directed
> towards the present patchwork arrangement of government-subsidized
> employer-paid health insurance plans.
>
> "To a growing number of major employers", says Donlan, "the
> prospective
> benefits of a national health-insurance system are starting to
> outweigh the
> costs...Ford and General Motors are joining the United Auto Workers
> union in
> support of the idea...This is a new way of looking at the health-care
> issue - not as a crusade to extend a new right to all Americans,
> but as
> redistributing a huge burden that makes U.S. industries less
> competitive...Saving ourselves by saving employers by creating a
> national
> health-care system could become an unstoppable movement."
>
> Interesting also is Donlan's observation that the state-by-state
> movement
> for mandatory employer coverage has given Wal-Mart and other
> employers "with
> less-than-generous health-care benefits...a reason to look at national
> health insurance." This ties in with the current "stagist" emphasis
> of the
> US labour movement, whose views Nathan Newman represents. But the
> column
> also points to the wide circulation the single payer concept is
> already
> receiving, including within the corporations, indicating that it
> perhaps is,
> as Nathan's critics contend, an idea whose time has come. Frankly,
> it's
> still not yet clear to me whether these ideas are complementary or
> contradictory to each other, and we may need to watch both
> processes develop
> a little further - they appear to be unfolding rapidly and
> simultanously -
> before drawing any definitive conclusions.
> ==================================================
> An American Solution
> We can build a system of universal health care, one person at a time
> By THOMAS G. DONLAN
> Barron's
> March 20 2006
>
> CAN THERE BE SUCH A THING as a universal, affordable, high-quality
> health-care system? Most realistic analysts say you can have any
> two of
> these attributes, but not all three. Others say the realists are
> actually
> optimists: It's hard to imagine a system with more than one.
>
> Most universal systems are unaffordable in the long run to the
> economies
> that support them. A slow decline in quality is the natural result.
> In most
> of Europe, the long run has arrived.
>
> Even many nonuniversal systems, such as America's Medicare,
> Medicaid and
> Veterans' Administration systems, face long-run financial and quality
> crises -- unless the taxpayers who foot the bills are willing to
> pay a lot
> more to keep them going.
>
> Most affordable systems aren't universal: They can't cover the most
> expensive illnesses or the cost of long-term care for the aged. Or
> they
> scrimp on the quality or timeliness of the care, or both.
>
> Quality, anyway, is in the eye of the beholder: Health-care systems
> everywhere fudge their self-imposed standards of quality to cover more
> people or to lower prices.
>
> At a more basic level, each of these high-sounding values has a
> flip side:
> Universal also means compulsory; affordable also means price controls;
> high-quality also means highly regulated.
>
> Assuming we want universal, affordable, high-quality health care,
> do we
> really want a compulsory, price-controlled, highly-regulated health-
> care
> system? Aren't we already too close to that?
>
> In the abstract, universal, affordable, high-quality health care is an
> obvious political winner, and so the 20th century saw seven major
> presidential efforts to enact an American plan:
>
> [...]
>
> Can't we imagine another system -- a system in which we pay
> directly for
> what we get and know what we are getting?
>
> Some say they have one. A single-payer system of national-health
> insurance
> pays all charges. Even simpler, a national-health service can own all
> health-care institutions and employ all health-care providers. In
> these
> systems, citizens pay the government to make all health-care
> decisions for
> them.
>
> To a growing number of major employers, the prospective benefits of a
> national health-insurance system are starting to outweigh the
> costs. Ford
> and General Motors are joining the United Auto Workers union in
> support of
> the idea. They have noticed how much less of a health-care burden
> their
> Canadian employees and retirees are than their U.S. employees and
> pensioners. The latest round of auto-factory closings will hit
> Michigan much
> harder than Ontario.
>
> Meanwhile, the Maryland state legislature recently gave Wal-Mart a
> reason to
> look at national health insurance, by passing a law to force the giant
> retailer to provide more generous health benefits. Other states are
> considering similar action, and if it becomes a trend, all
> employers with
> less-than-generous health-care benefits will see that they could be
> next.
>
> This is a new way of looking at the health-care issue -- not as a
> crusade to
> extend a new right to all Americans, but as redistributing a huge
> burden
> that makes U.S. industries less competitive. As such, it is also
> gaining new
> adherents in small business, where health care's share of labor
> cost often
> drags down the creation of new and productive jobs.
>
> Insured Americans never have cared much about the uninsured --
> that's why
> six out of seven health-care movements never took hold. But every
> troubled
> company starts its restructuring by raising health-insurance
> charges and
> cutting retiree health care. Saving ourselves by saving employers by
> creating a national health-care system could become an unstoppable
> movement.
>
> It is possible that 16% of U.S. GDP is enough to finance a British- or
> Canadian-style system without the drawbacks. But that's not the way
> to bet.
> A universal national health system still will be unlikely to be
> affordable
> and offer high-quality care.
>
> A better approach would be to return to the concept of individual
> medical
> insurance, making it universal by making it compulsory.
>
> With hundreds of insurance companies competing for everyone's
> business,
> there would be affordable coverage styles for every budget. The
> federal
> government would buy basic coverage for those without means, but those
> checks should be its only contribution to the system.
>
> Quality assurance could then be left to informed consumers wielding
> their
> own money in the market, the most powerful force in the world.
>
> Americans have been properly cautious about national-health care
> schemes,
> but it's now time to build one, if we do it right.
>
>
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