> 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.
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Donlan supports the Bush HSA plan, but I would say the piece is less a
vigorous argument for it, than a grudging acknowledgement that a single
payer system is probably inevitable, and would even be positive for US
employers in that it would relieve them of the burden of health care and
make them more competitive. I don't think the US bourgeoisie really sees the
Bush scheme as viable - either in terms of winning public support, or as a
means of resolving the health care crisis. If Donlan is another bellweather,
American employers seems to be moving with resignation to the same
conclusion previously reached by capitalists elsewhere - and, for the same
reason, it is no longer affordable for them to keep the state largely out of
this sphere. But they will only dither and look for more palatable solutions
without the other ingredient: a massive political push from below.
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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.)
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My fault. I clipped this part of the article because I thought the whole
piece would exceed the LBO posting limit. Here is the missing excerpt:
"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:
Theodore Roosevelt and the American Medical Association (yes, the AMA) tried to create universal health-insurance plans state-by-state.
Some of Franklin D. Roosevelt's most ardent New Dealers sought to include national health insurance as part of Social Security;
Harry S Truman renewed the struggle in the 1940s, but could not get his national health plan through Congress.
Lyndon B. Johnson's Great Society enactments of Medicare and Medicaid in 1965 were the only victories for the cause.
Richard M. Nixon proposed mandatory employer-paid insurance against catastrophic health expenses and extension of Medicaid to all those not employed.
Jimmy Carter's reformulation of Truman's plan ran into an energy crisis.
The "managed-competition" proposal of Bill Clinton's Administration fell to intense opposition from the health and insurance industries, which would have had to live under its complex system of carrots and sticks.
Underneath this lack of political progress, the private-health-insurance industry was growing, and it now covers more than half of all Americans: About 175 million are covered by employer-sponsored health-care programs and about 25 million more pay as individuals.
Despite tallying only one victory among the attempts of seven administrations, the government health-care system nonetheless grew. The federal government subsidizes employer-sponsored programs with a tax deduction (but none for individual premium payments). More directly, it pays most Medicare expenses for 40 million disabled and elderly people using a payroll tax and general revenues. Another 40 million very poor people are on Medicaid, whose benefits are shared by states and federal government.
And more than 45 million Americans have no insurance, so when they seek care they go to hospital emergency rooms and public-health clinics -- and those institutions build the cost of uncompensated care into their service charges billed to all the other payers.
As complex as this description of our health-care system may sound, it is actually much more complicated. To sort out what is public and what is private in the health-care system is to invite a never-ending argument. More than half of Americans are in private health-care plans, but more than half the money spent on health-care is tax money.
Neither of these is the really important percentage. Two other percentages are more important:
Americans spend about 16% of national income on health care -- more than any other country. And more than 90% of health care delivered to patients is paid for by somebody else -- an insurer, an employer or the government. Most patients incur only small cash charges compared to the price of their care. They do pay, although indirectly, through payroll taxes, lower wages, higher income and sales taxes, higher prices for goods and services and higher interest rates.
The national slogan for the existing American health-care system should be "This Is Not A Bill," which is imprinted on so many statements from health-care providers. The confused recipient is invited to believe he's getting something for nothing.
Making Choices
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..."