Strategic  Considerations for  Achieving  Universal  Health Care

QUESTION:  Why couldn't the gaps in the present system be gradually filled in until that one final program that fills in where all others have missed?

If it will be possible to "fill in" with that one final program later, why is it not possible now?  Since we agree that is what we want to do, let's do that first so that the people suffering needlessly today can have the treatments appropriate for their conditions.  Let's compare the costs of more patchwork program plus the final necessary "fill in", versus coming up with a rationally designed complete system that best serves each particular state or the nation as a whole.

Dr. Marcia Angell:
In an interview appearing in the November 6, 2000 issue of the American Prospect, Dr. Marcia Angell former Editor-in-Chief of the New England Journal of Medicine stated that "incremental reform plans as proposed by Bush or Gore are still piecemeal and would likely backfire.  They exacerbate the fragmentation, make the system even less efficient, and depress access to affordable, high-quality care. They both rely on the private sector (Bush's more than Gore's)."    

QUESTION:  Why does EINO specify non-incremental reform?  Didn't the failure of Pres. Clinton's sweeping health care reforms early in his first term show that only incremental change would be politically feasible?

Short-sighted programs which do not solve the root problems of our present crisis although politically feasible right now will not long be viewed as "feasible solutions".  Eventually after wasting even more money (as we have all through the 1990s to present) on proposals which avoid upsetting industry lobbyists, the proposals we avoid now for not "being feasible" will appear highly feasible.  In state conferences "on the uninsured" and on "extending health care" we still witness in 2005 attempts to invite all the big industrial lobbyists together, to discuss the problem (which was exactly how Clinton went about addressing the issue).

In the first place these powerful lobbying industrys can't agree and in the second place they are the privileged class who are opposed to what the majority of Americans need and want. We can wait, if we wish, until half the public hospitals in the country run so deeply in the red due to treating the under and uninsured, who the private insurers know would cut into their profits, that the hospitals close their doors (to all of us).  At that point most people will have a different understanding of what is politically feasible. We already have many reports on failing public and academic hospitals in our news archives (search on "hospital").

QUESTION:  How about all the successful state efforts since 2000 in approaching universal health care at the state level, like in Maine?

Maine's effort is a good example of the short-sightedness of programs cobmining some state subsidization (for buying into private insurance) with mandating insurance payments by employers. In the first 4 years a meager 11,000 individuals (less than 10% of those uninsured in 2002) had been covered. Costs had not been controlled and both employers and low-income families were reporting they still could not afford premiums. What's the next step, go after the low-incomed people of the state for "refusing" to buy insurance they could not afford (like in the MA plan)? Reference HERE.

QUESTION:  Won't all the seriously ill and uninsured people move to any state which attains universal health care, bankrupting that system?

There are rather straightforward ways to make sure that the first states to enact such legislation would not be unduly burdened.  One such example would be to establish at time-frame for eligibility in the state.  One would have to prove state residency for a specified period prior to treatment.  This would be no more complicated to administer than the requirements most states have for discounted in-state college or university education for their residents.  

QUESTION:  But even some of your own experts like Marcia Angell (quoted above) have said that an incremental reform might actually be workable. Why do you insist that everyone suddenly be included?  That isn't realistic.

We do not disagree that change might have to be planned for a gradual roll-out over several years.  Marcia Angell clearly spelled out that the reasonable forms of incremental reform she endorses were either to roll-out reform to some states before others (as EINO  clearly supports, see map of state committees) or that the path to complete universal health care be planned over several years.  EINO also agrees with the concept of taking several years to plan and fully implement a plan.  We do not, however, consider either of these recommendations to be incremental reform.  These are just ways of achieving a genuinely universal health care on a reasonable timetable. 

A convincing difference between incremental reform and UHC is made by committing to the end goal NOW at the onset of the reform by establishing the Right to Health Care on a par with the Right to Education (secondary and primary school). This expression of government obligation is already broadly accepted by Americans and is just as necessary as the Right to Education for assuring a real functioning democracy with decent opportunities for all families. Allowing a few years to develop and implement a plan is not a problem.

QUESTION:  We already have a system that cares for all our seniors.  Why not just gradually bring the qualification age down on Medicare?

Unfortunately, Medicare is itself such a patchwork of allowances, restrictions and disallowances that it would be easier to start with coverage for seniors (and others!) that would be comprehensive.  Although much in the news in the early years of the 21st century, presecription drug coverage is just one item that Medicare lacks, another is "durable goods" that are medically necessary, then there are the many medically necessary procedures which are simply not listed in the books yet, not coded and therefore disallowed.  

Medicare began as a patchwork, allowing certain listed procedures the fact that it still is so far from comprehensive care (compared even to most of the better private insurance plans) shows where 60 years of incremental change with millions of hours in budget fights and whole forests lost into paperwork of restrictions has gotten us. As incomplete as Medicare is, what it does clearly indicate is how successful and efficient a government program can be. It also has allowed us to clearly see that Americans do trust such programs to the government; more than they trust profit-driven corporations! And it is not just seniors who trust the government to assure all Americans of health care coverage.  

QUESTION:  Why are there so many well-established and convincing looking coalitions and websites which agree that the only realistic possibility for achieveing UHC is by sticking with incremental reform, if this is such a foolish idea?

The insurance industry is one of the most profit-rich and powerful (number of lobbyists) in the nation.  So we should expect that anything of which they are supportive looks very professional and convincing (they can put whole offices to work putting out slick brochures with the dollars they extract from our health care system).  They are very much in favor of incremental health reform, especially if they are able to secure public subsidies to add additional programs. Our strategies for change must acknowledge the lobbying power of industries.

Having already "cherry-picked" the most healthy clients (the least likely to need any serious medical interventions) they now would like to "reluctantly" add programs to insure other populations.  "Reluctantly" because they will only do so when induced by public subsidies for doing so.  They expect to make the same profits, then, off these more at-risk populations as they have made from the more healthy.  We already pay by our taxes for the nation's most at risk through the federal programs of Medicare and Medicaid and recently are paying to subsidize private insurers so that they can afford (profit by) selling insurance to seniors to cover many of the disallowances and loopholes in those programs.

It is "curious", to put it diplomatically, that in the first years of the 21st century we are witnessing a plethora of coalitions and organizations working with the insurance industry on the "problem" of the uninsured, like  www.CoveringTheUninsured.org and www.nchc.org Of course they speak about "realistic" solutions and broad unity to achieve "our ends".  But their work is to make the public believe that moving forward to recognition of the "Right to Health Care" and commitment to genuine UHC by principle is "unrealistic" and not worth pursuing.  Project EINO rejects such coalitions which are designed to undermine the real grassroots efforts going on in so many states.

The public should also be cautious of such organizations as UHCAN,which while professing to be working toward UHC, clearly states that they believe that incremental reform is the legitimate path to follow towards that end.  They are doing the bidding of the insurance industry, even while they claim to be promoting UHC.