Implications of the September 11 Tragedy for a National movement for Universal
Health Care
This 11-part discussion thread explores the changes in mood and circumstances resulting from the
Sept 11 national tragedy in terms of the UHC movement. Note that the
discussions below (other than the EINO comments) do not recognize the importance
of the UHC work
going on at the state level - but rather discuss only a national movement in
Washington. Similarly, the national organizations mentioned in the
discussion are not primarily grassroots activist organizations.
Original statement from Jeoffry Gordon, entitled "A Shift in Strategy" arguing
that conditions may presently favor committed efforts toward universal health
care.
Commentary from Theodore R. Marmor
Largely agreeing with Dr. Gordon and bringing up specific questions that will
need to be considered in expanding medicare to all Americans.
Commentary from Arthur Caplan
Caplan makes brief statement and refers to a more complete work of his
own about extension of ethical principle for health care to all Americans.
Commentary from Jonathan Oberlander
Oberlander comments on how distant the conditions still are which would
precipitate towards successful efforts towards either medicare for all or
single-payer national health insurance.
Comments from Martin Donohoe
Donohoe disagrees with Oberlander and argues that it would be best to aim for a
complete solution like Single-payer
Comments from Don McCanne
McCanne summarizes agreement thus far and calls for unity behind doing what is
best for the American patient.
Comments
from Bob Griss
Griss lists 3 major factors which emphasize the current opportunity and argues
that now is a good time to pressure representatives.
Donald Light suggests
Convening a closed door meeting of leading to experts to work out differences
now and make proposal for workable plan for universal health care acceptable to
business, labor and all parties.
Mark Hannay emphasizes
The basis of reform must be a broad movement.
EINO suggests
The growing movement in the states for UHC and "right to health care"
though unmentioned by the above discussants, may be the broad movement they are
looking for.
Ken
Frisof suggests
The legislation in the U.S. house submitted by Rep. John Conyers already
provides us with a legislative vehicle to organize around.
Commentary entitled "A Shift in Strategy"
By Jeoffry Gordon, MD, MPH, a San Diego member of Physicians for a National Health Program (PNHP) and California Physicians Alliance
(CaPA)
It seems to me that our current world crisis has changed the political playing field and opened the probable opportunity for a swift move to a national health program. We ought to adjust our rhetoric, strategies, and thoughts accordingly.
(1) The terrorist attack has the unintended byproduct of curing the civil society malaise described by Robert Putnam in BOWLING ALONE (an outcome he predicted), and people are not just rallying around the flag, they are esteeming the government, depending on it for safety and solutions. This is a tectonic shift in attitudes.
(2) We are in a recession; businesses are going to be doing poorly and watching their pennies very closely.
(3) Health insurance companies are at a point in their business cycle where, after competitively driven price cuts and consolidation, they will be requiring repeated >10% price increases to maintain viability (Aetna or PacifiCare/Secure Horizons) or profitability.
(4) The health insurance premium costs are going to be very onerous to all businesses who will be passing on costs to employees or dropping benefits or health insurance altogether.
(5) As people are laid off (and have been in huge numbers in the service industries as a result of 9/11), the number of uninsured is going to explode and many of the newly uninsured are going to be middle class.
Thus the stage is set for an as yet publicly unanticipated crisis - the final breaking point - in the health care system in the USA. The federal government is going to have to step in (and can with the rationale of protecting the public welfare during wartime). The simplest solution and easiest to promote is to expand Medicare to everyone (and not to get into much of the details about how the providers organize themselves). This will have great public support from the newly uninsured and unemployed, and maybe even from the AMA, etc., as doctors and hospitals feel even more squeezed by falling income and will be eager for public subsidy for "a physician full employment program," and by the states who will now be too poor to subsidize their own reformed health systems. As unlikely as it seems, the Republicans (like Bismarck and Lloyd George) are likely to be more successful at pulling off a national health program than the liberals and the Democrats as a way to help the business and corporate classes (except for the health insurance industry) save money (overhead costs) and as a way to reward, support and calm a worried and activated civil society.
PNHP can have a pivotal role in promoting these changes, as might other national organizations active in this arena. Publicize these pages to friends and colleagues. Read on below.
Visit PNHP.
A Need for Attention to Details
Prof. Theodore R. Marmor, Ph.D., Public Policy and Management, Yale University School of Management, responds to Jeoffry
Gordon.
Gordon's call for a shift in strategy of reformers seems to me eminently sensible. The landscape of American politics has certainly been altered and it is surely the case that the reliance on government has been newly noted and accepted. Furthermore, we are likely to have a crush on health coverage, though it is just as likely that the demand will be for extensions of COBRA as Medicare for all. Nonetheless, if ever there will be a dramatic shift in setting--short of depression and short of a l964 electoral avalanche--this is one of them. And advancing Medicare for all--absent endless details --is certainly more appealing post-9/11 than in August of 2001.
But there is also a need for attention to details--like how to price a premium for voluntary enrollment in Medicare. Does one advocate using the present Part B structure, mostly general revenues and a premium? Or, do we rely on Part A financing? If so, there will be a big shift to Part A from employer-based insurance. In short, the rhetorical opportunity is there, but the incremental steps remain complicated. Pay or Play in the l992 period was one answer.
I do not know how to answer the questions I posed, but I do think them worth posing even as I agree with Gordon about the significance of the change in context.
Public Good Before Private Interest by Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania, responds
to Dr. Gordon
Arthur Caplan responds by referring to his opinion article on msnbc.com,
with this excerpt:
"In the past, efforts to create a national health care plan have foundered when private interests have defeated the public good. Americans can no longer afford to put the public good behind private interest. No mother should be worrying about how to pay for her kids’ medical bills because her husband has been killed by terrorists. President Bush and Congress ought to announce a plan to mandate that every American will have access to high quality health care."
The full article by Arthur Caplan is available, CLICK
HERE.
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