Health Care By and For the People

by Sarah van Gelder

The Obama transition team is asking you to help create a new health care policy. Really. Host a meeting, invite friends and associates, look at the Obama team's proposal, and let the transition team know what you decide. If you are among a lucky few, Senator Tom Daschle, Secretary-designate for Health and Human Services, may show up at your meeting.

This may be more important than it sounds. The key dividing lines over how to fix our country's broken health care system are becoming clear. It may take the same sort of grassroots involvement that got Obama elected president to keep the private insurance industry from hijacking the process as they have during previous reform efforts.

Here's one of the key decision points. The Obama plan calls for giving everyone the option of signing up for a public or private insurance plan. But according to The New York Times, the private insurance industry is lining up against that option. It's no small matter. According to a report released Wednesday by health policy analyst Jacob Hacker, having a public option could make the difference between a system that covers everyone and controls costs, and one that will continue to leave millions out while costs soar.

As Americans are painfully aware, our health care system is broken. 45 million Americans or more are without health care coverage. Half of all bankruptcies are caused, at least in part, by unaffordable health care bills. We're spending more—16 percent of U.S. GDP (gross domestic product) to cover 85 percent of our population, while Canada and France each spend less than 10 percent of GDP to cover everyone.

The harm to our economy of our backward health care system is especially evident today, as all three U.S. auto makers suffer from the competitive disadvantage of covering health care costs that their overseas competitors can leave to more effective government-run insurance programs.

Americans voted for change this November. But what system makes sense?

According to the research we did at YES! for our special coverage of health care reform, government involvement is critical. A majority of Americans agree—two out of three believe the government should provide national health care coverage, even if it would mean higher taxes. Other wealthy countries have adopted various methods, but a system like Canada's is one of the most efficient at providing good coverage for everyone while keeping a lid on costs. Under this system, the government is the insurer, but patients choose their doctors from private, public, or non-profit health care providers.

Having a public system is the way to cut bureaucracy and cost. But government involvement is where things get controversial. The private insurance industry opposes such a move. And some say that the switch to national insurance is too big a leap for Americans. People will be afraid to give up the coverage they know for an unknown system.

So the Hacker proposal, which was adopted in part by Barack Obama, may be the perfect compromise. Keep your private insurance if you want. But if you aren't covered, or if your premiums are too high, or your deductions and exclusions are too onerous, you can opt for the public insurance system. You would still choose your doctor. Subsidies would insure the plan is affordable to all. At the lowest income levels, it would be free.

Including a public system in our range of options is what it will take to control costs, and thus make sure everyone is included, according to Hacker. The private insurance industry has made a lot of money by excluding things that are expensive, shifting costs on to individuals and families by, for example, excluding pre-existing conditions, and working to write coverage only for those who are less likely to need health care. They have a big incentive to figure out how to exclude a treatment or test and little incentive to invest in our long-term health, since people tend to shift insurance companies over time. Their business, after all, is not keeping us healthy. It’s generating profits for shareholders.

Medicare has kept costs under control more effectively than either private insurance companies, or pools of private insurers, like those who contract with the federal government to provide health insurance to federal employees. According to Hacker's report, Medicare spending per enrollee increased only 4.6 percent per year from 1997 to 2006, while the cost of private insurance increased 7.3 percent each year during the same time period.

Innovations in the public sector have helped contain costs, and there are substantial additional savings to be had from better use of information technology, care coordination strategies, and databases of practices and outcomes, according to Hacker. And public health insurance agencies are in a better position to negotiate for reasonable prices from private health care providers.

The nonpartisan Lewin Group estimates that Hacker's plan would save the U.S. economy $1 trillion over 10 years, while covering 99.6 percent of Americans.

The Massachusetts system, enacted in 2006, is a stark example of what happens when there is no public option. Everyone in the state is supposed to be covered, but their choices are limited to private plans. Premiums have been rising 8 to 12 percent per year, which means the system will soon be out of reach of individual families, employers, and the state government.

A public option assures that there is a benchmark against which private companies must compete. Without such a benchmark, private companies have no incentive to contain costs or improve services.

It's hard to argue with giving people a choice.

But the health care industry is arguing. The New York Times says medical associations are encouraging their members to attend the health care discussion groups being organized by the Obama transition team around the U.S. Past efforts to reform the health care system stalled in the face of powerful health industry lobbyists with huge campaign war chests. Will the industry be as adept at dominating the health care policy discussion when it's happening in living rooms and coffee shops around the country?

Here's how President-elect Obama put it at his December 11 press conference:

Year after year, our leaders offer up detailed health care plans with great fanfare and promise only to see them fail, derailed by Washington politics and influence peddling.

If Obama is able to bring together ordinary Americans, who so clearly are desperate for change, and if they get as engaged in health care reform as they were in the bottom-up presidential campaign, perhaps this time we'll get the change we need. Maybe people power will overcome corporate power, and we'll finally be able to join the rest of the developed world who enjoy health care security.

So far, more than 4,000 meetings are scheduled around the U.S. Here's where you can sign up to lead a session. All the information you need is online, including the moderator's guide and instructions for reporting the results back to the transition team.

Note: If you are part of such a discussion, please let YES! know. We'd love to read your report and post a selection. Send us an email at editors [at] yesmagazine.org. Put the phrase "health care discussion" in the subject line.