A Perfect Storm: The Confluence of Forces Affecting Health Care
Coverage
This 6-part discussion begins with the original statement about a Confluence of Forces
and Possible Strategies Affecting Health Care Coverage, in particular how the
growing crisis in middle-class uninsurance may precipitate change.
Comments from Robert LeBow
Supportive of Miller's work, but wondering about lack of position on any
strategy to achieve universal health care.
"A Perfect Storm: The Confluence of Forces Affecting Health Care Coverage" Original position from Joel E. Miller, Director of Policy for the National Coalition on Health Care, from November 15, 2001
What we are about to witness is a fundamental sea change with the storm's aftermath leaving a significant number of middle-class people uninsured in the foreseeable future. In 2000, health insurance coverage rates decreased for those with household incomes between $50,000 and $75,000. This drop occurred during good economic times. With the economy in a recession, this drop for middle-income people will become even more pronounced.
A sustained recession over the next few years would very likely exacerbate the decline in employer-based coverage. In the absence of government or private sector intervention, the erosion of employer-based health insurance coverage will be significant. The situation will not self-correct. We need to protect all Americans who are in the storm's path. Steps must be taken to ensure that the number of uninsured Americans does not increase, and instead is reduced over time. We must move towards a health system in which EVERY American has health insurance coverage, health care costs are contained, and quality of care is assured.
The three major problems plaguing our health system today - mounting costs, the growing number of uninsured, uneven quality of care - are interrelated. Without universal coverage, you cannot assure equity or quality, and in the absence of quality, you cannot contain costs. In addition, without universal coverage you can neither make the system less complex administratively, control costs, stop risk selection and cost-shifting, achieve a level playing field of equitable financing, or create a truly competitive market-based system. It is thus a vicious cycle.
Editor: Joel Miller has assembled studies and forecasts, weaving them into a treatise using the appropriate analogy of "A Perfect Storm," with the antecedent calm, the storm, the tidal wave, the sea change, and finally the need for a safe harbor of health insurance. It is a tragic story up to this point, but it has not ended. The treatise is available at (ACROBAT) CLICK HERE
"One Risk Pool With Everybody In, Nobody Out"
Joel Miller's essay is great. It gives much useful data and well thought-out projections. Its conclusions supporting universal coverage are succinct and right on. But its shortcoming, like that of the organization he works for, the National Coalition on Health Care, is that he states the obvious ("We need universal coverage for all the right reasons") but stops there. It's as if they all know what has to be done, but they're afraid to come out and say it.
When he says, "We must move towards a health system in which every American has health insurance coverage," is he endorsing "incremental" change? He must know, and we know, that unless we have universal coverage -- and not just tweaking this group or that group to increase the number of insured Americans -- none of what he's advocating for will happen. Risk avoidance will not go away. Profit-seeking and high administrative costs will continue. The most vulnerable will continue to be the most vulnerable. Costs will not be controlled.
So why doesn't he...and the organization he represents...finally come out and say it? We need one risk pool with everybody in and nobody out. The euphemistic way of saying single payer or its equivalent. Maybe we need to find some way of getting people to accept single payer for what it is by giving it an appearance of some private sector involvement so it's more marketable to people and groups that make up the kinds of organizations that Joel Miller represents. They're good people, but I get the feeling their hands are tied. It would be wonderful if the National Coalition on Health Care could come out and say what they know has to happen to solve the dilemma of health care in America.
Robert LeBow, M.D., a former president of Physicians for a National Health Program
"Waiting for Other Shoe", Professor Aaron Beckerman responds to Robert LeBow's comments:
I agree with Dr. LeBow. I was waiting for the other shoe to drop. One of my professors once said, "Don't let analysis lead to paralysis." What would it take for the National Coalition on Health Care to address the issue of achieving universal health care in the United States?
Aaron Beckerman is Professor Emeritus Yeshiva University and Adjunct Associate Professor of Medicine New York University Medical Center
Making Single Payer "Marketable" by Philip Pollner, M.D. and Nancy Wooten, Ph.D. of Unity for NHI (national health insurance)
While we are trying, as we have for decades, to make single payer "marketable" to the kinds of organizations and individuals that Joel Miller represents, it would be far better (and probably easier) without "an appearance of some private sector involvement" to market it to those who have the most to gain - the uninsured, underinsured and even the insured who have witnessed the dark side of the present health care system.
It would, as a colleague has stated, take only ten minutes to empower such individuals to agree. If only ten million of them were mobilized nationally, our movement would have three times the membership of the powerful NRA (3.5 million members); at those numbers and political clout we would finally achieve our goal. Unity for NHI is struggling to reach out to educate and empower large numbers of the grassroots into a formidable voting bloc. We need the support of all of those activists who wish to make the vision of universal health care a reality.
"Political Strategy Required" by Sylvia Hampton, President of the Coalition for Quality Health Care, San Diego
This requires a political strategy. The insurance industry will fight it every step of the way. So many reputable organizations like League of Women Voters, AAUW, AARP, Neighbor to Neighbor, and organized Labor would be willing to work on reaching a consensus on a national health plan. You have your 10 million right there. Once consensus is reached you storm the doors of Congress and the White House. It took the League 2 years to reach consensus on universal health care.
Our concensus statement can be found at CLICK HERE
In our view while there are some important truths in each of these
contributions, nothing is more on the mark than Sylvia Hampton's brief
words. Indeed as several contributors pointed out with the current
possibilities, or confluence of forces, what is really lacking are some viable
strategies to achieve the necessary goal of universal health care.
The question brought up by Robert LeBow about NCHC's position on the incremental road to universal health care is very important.
We consider it one of the key strategical questions to be addressed by any
organization hoping to assist in achieving universal health care.
Even the commentary from Unity for NHI came closer to proposing a strategy in
this interchange than they have in any of their previous letters (even when
asked what strategy they would endorse, they have previously been reluctant to name any).
Next, maybe Unity should also think carefully about LeBow's questions to NCHC
for Unity also has no position on incremental reform. Maybe we are all
advancing towards recognizing the need for specific strategies towards our
goal.
At EINO we hope that these strategical questions are dealt with fully and openly
in the coming months and by all of the organizations involved in this
endeavor. Without a willingness to discuss strategy specifically, we can
only wonder what any of the organizations could possibly contribute to this
movement, given its current stage and the fact it is already proceeding in
several states. There are a lot of necessary fine points to develop, to
proposals like "empowering the uninsured". We hope that the groups involved are
interested in the details and look forward to assisting the discussion in any
way we can.
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