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Beyond Incremental Strategies
At EINO we have excluded all incremental reform believing that it never belongs
logically with strategies of moving towards universal health care. This
assessment holds whether the reform is what Mr. Frisof would call "piecemeal" or his version of "incremental".
In neither case does the change take us measurably or permanently closer to genuine universal health care.
As we have stated elsewhere, EINO is not actively opposed to incremental reforms.
Insuring even a few more people is preferable to leaving them uncovered. But that is not what we are about, it is not that for which we are working. More importantly it is not that for which we believe committed activists around the country should be sacrificing time and resources.
Mr. Frisof has one example of incremental reform. That example is medicare, while medicaid, CHIP and other programs are mentioned as "piecemeal". He
contends that providing health care either to an entire age category (like medicare) or to an entire state are the two ways of achieving an incremental step towards universal health care. There are several aspects of Frisof's "incremental" category that
are logically flawed.
First, it might be asked whether every elderly person no matter what their medical condition
is fully and equally covered by medicare. In fact, we know that medicare only partially covers treatments and that many elderly are still choosing between eating and needed medical treatments.
Depending on an elderly person's medical condition, medicare may cover only a minor fraction of
health care expense. We would argue that like CHIP, medicaid and other "piecemeal" reforms
which Frisof finds unacceptable, medicare is also NOT a step towards universal health care.
A genuine universal health care plan can not include persistent underinsurance.
People must be covered for all possible medical needs and circumstances
(unemployment, permananent disability etc.).
Secondly, the distinction that Mr. Frisof draws will be one that can only be evaluated in retrosprect. One will have to look back at any program after a decade or more and judge to what extent it qualifies as "incremental" or "piecemeal" (by his definitions).
This will never be obvious when the program is proposed, nor even in its final form when the legislation is being voted up or down. How permanent is Medicare? Can't the benefits be further scaled back depending on budgetary restraints and
Congress' other priorities?
Cannot even the age of qualification be moved up? If the permanence and completeness of medicare cannot be judged ahead of time, how will Frisof's distinction ever be useful
deciding what "incremental programs" are worthy of support at the time of
proposal?
Indeed, the distinction will only introduce confusion.
Note that 1 of every 2 americans is not confident they will be able to afford
healthcare without financial hardship once they are Medicare-eligible (CLICK).
We have elsewhere discussed the concept of achieving state-by-state universal health care. We do believe that this is logically possible, but only if genuine universal health care "everybody in nobody out" (and all necessary medical treatments) are covered within the UHC states. Of course this is only incremental UHC for the country, to the extent there is a plan to gradually extend UHC to more and more states. Similarly, age categories could
conceivably also be imagined as genuine steps toward UHC. If, unlike medicare, they covered all patients within the age category completely and universally. This would definitely be appropriate if the organization pushing for such reform envisioned this as a stepwise process and had plans to push for each additional age category until everyone in the country is included.
Is that UHCAN's unstated intention?
Another crucial failing of all incremental reform which we have raised elsewhere
is the unfeasibility of adding each of many population groups step by step, requesting additional funding from the taxpayer for each step.
This important failing applies equally to either of Frisof's categories.
By contrast, strategies for genuine universal health care by eliminating inefficiencies, pooling everyone together (all ages and all risk levels for illness) and controlling profits in the medical industries could afford to cover everyone completely
for what we are already spending. Strategically, this is a whole different ballgame than requesting additional fund allocation
program by program from state legislatures.
A final failing is that even with his refined definition of
"incremental" any reform no matter how small might qualify. For
example, even if UHCAN were to agree that medicare is too spotty, they still
might be willing to work for an incremental program affecting end of life
care. If it affected everyone judged to be in their final months then it
would qualify, as would a program for first three weeks of life. Why
not? And the program could have an undetermined and unstated projected
term in which to expand to other age categories (remember no plan or timetable
is suggested thats the key distinction). So these programs would also be
valid strategies for achieving universal health care
(incrementally)?
The blurry distinction between piecemeal and incremental can have disastrous consequences for health care activists. The recent ballot initiative for UHC in the state of Massachusetts (2000) was in large part lost because a large contigent of supporting organizations suddenly abandoned the ballot initiative and accepted an offer for incremental reform (a patient's bill of rights).
The deserters did this in exchange for their coming out AGAINST the UHC initiative they had earlier
supported. It is crucial for state UHC organizations to be absolutely clear about where they and their allied organizations stand on incremental reform and how very different it is from genuine universal health care.
For EINO the distinction is simple. Genuine UHC is everybody in nobody out. That means no matter who you are or what your medical condition.
It might be achieved step wise IF THAT IS THE PLAN over the course of several years. But stepwise improvements that are not planned as leading towards UHC and which do not even achieve universal coverage for a whole state or even a whole age category are definitely not building incrementally towards UHC. They may well be designed with the intention of resisting genuine UHC for the entire population and assuring exorbitant industry profits into the future.
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