“I want to cover everybody,” President Obama said at his news conference Wednesday night. “Now, the truth is that unless you have a – what’s called a single-payer system, in which everybody’s automatically covered, then you’re probably not going to reach every single individual …”
The same conventional wisdom keeping single payer off Washington’s table has been spinning for various “reform” plans with such accelerated RPMs that at this point the nation’s “health care debate” is suffering from a severe case of vertigo.
“The overwhelming majority of Americans want health care, but millions of them can’t afford it,” Obama told the assembled journalists. “So the plan that has been – that I’ve put forward and that – what we’re seeing in Congress would cover, the estimates are, at least 97 to 98 percent of Americans. There might still be people left out there who, even though there’s an individual mandate, even though they are required to purchase health insurance, might still not get it, or despite a lot of subsidies, are still in such dire straits that it’s still hard for them to afford it. And we may end up giving them some sort of hardship exemption.”
That may sound good. But it’s in the service of an agenda for “health care reform” that’s seriously flawed.
Days ago, buried in a chart under the headline, “How the Health Care Bills Compare,” The New York Times provided some cogent yet cryptic information in the category of “Public Plan.”
A key Senate committee had just approved a bill with a public plan that would “compete with private insurers,” the Times chart explained on July 18. The public plan “would provide ‘only the essential health benefits,’ as defined by the bill, ‘except in states that offer additional benefits.'”
Meanwhile, the newspaper noted, “Democrats from three House committees are working on a single plan.” Under that plan, “Different levels of coverage – ‘basic, enhanced and premium’ – can be offered through the public option.”
Those few grainy sentences, quickly swept beneath the waves from oceans of media, referred to a disturbing aspect of “public plan” scenarios. If the ostensible goal is health care for all, then – at best – some of the “all” would end up being much more equal than others.
The Republican Party is coming from such a right-wing place that any government action to improve health care access is ideologically unacceptable. In contrast, the broad outlines of a Democratic “public plan” at least embrace the precept that the not-so-tender-mercies of the market are insufficient to fully provide for the population’s medical needs.
But as a practical matter, a “public plan” coexisting with the private health insurance system – generally touted by US media as the pole of real options farthest from the Republican “free market” fixation – is inherently reconciled to major inequality in access to health care.
Even while straining to put forward a “public option” as some sort of stunning government intervention to level the health care playing field, media coverage rarely comes to terms with the situation that would actually remain under such a scenario.
How does “health care apartheid” strike you?
For the government to offer the public a multi-tier set of options for health insurance – in the words of The New York Times, “different levels of coverage” such as “basic, enhanced and premium” – is to imitate the approach of the corporate health care establishment.
After all, isn’t it implicit that the government plan’s “different levels of coverage,” offered to the public, would be based on ability to pay?
Missing from the dominant health care debate – not only along Pennsylvania Avenue but also along media row – is a principle that could be debated and should be debated.
In a few words: health care is a human right.
And a human right should not be contingent on ability to pay. Nor should it be divided into “basic, enhanced and premium.”
Media accounts keep telling us that the current political debate on health care is unprecedented and groundbreaking. But an article in the latest edition of the Columbia Journalism Review, by seasoned health care reporter Trudy Lieberman, makes a convincing case that little has changed within the frames of media parameters.
The press “has mostly passed along the pronouncements of politicians and the major stakeholders who have the most to lose from wholesale reform,” Lieberman writes. “By not challenging the status quo, the press has so far foreclosed a vibrant discussion of the full range of options, and also has not dug deeply into the few that are being discussed, thereby leaving citizens largely uninformed about an issue that will affect us all.”
What we’re seeing now is a slightly freshened version of a timeworn tap dance that ranges across a constricted media stage. As Lieberman notes: “Absent from the debate are not only single-payer systems like the ones in England and Canada, but other systems with multiple payers, like ones in Germany and Japan – or, for that matter, any discussion of why a system that relies on competition among private insurers in The Netherlands hasn’t resulted in lower prices for consumers, as advocates claimed.”
The variety of health care delivery systems abroad, in industrialized countries, spans a common assumption – health care as a human right – an assumption that doesn’t cut the mass-media mustard in the United States. “What’s common to all these systems,” Lieberman points out, “is that everyone is entitled to health care and pays taxes to support the system, and medical costs are controlled by limits on spending. The specter of a system that takes a significant bite out of stakeholder profits in the US is the real reason the debate is so restricted.”
As Trudy Lieberman puts it, “Reform efforts have danced around this impasse for decades.”
That helps to explain why so much media coverage of health care reform proposals is apt to be so baffling to most readers, listeners and viewers. When the big elephant (or, if you will, donkey) in the national newsroom is dependent on the insurance, pharmaceutical and hospital industries for financing, there’s a distinct shortage of candor about the consequences of such ongoing intrusions. Newsgathering, media debate – and, of course, health care – suffer the consequences.
In the mid-1960’s, Medicare became law with the stroke of a presidential pen. Lyndon Johnson was able to sign the measure despite a huge onslaught of opposition from right-wing politicians, their corporate backers and professional groups like the American Medical Association.
These days, the AMA may be somewhat more circumspect in its continuing opposition to progressive measures, but the overall balance of political power remains heavily tilted against health care for all.
“In the Senate,” columnist Gail Collins noted in the July 23 New York Times, “everyone is waiting on Max Baucus of Montana. Nothing is going to happen on health care without the approval of Baucus,” the chair of the Senate Finance Committee. As The Washington Post reported days ago, he “has emerged as a leading recipient of Senate campaign contributions from the hospitals, insurers and other medical interest groups hoping to shape the legislation to their advantage. Health-related companies and their employees gave Baucus’s political committees nearly $1.5 million in 2007 and 2008.”
Today, the kind of arguments heard during the early ’60s against guaranteed health care for the elderly can now be heard against establishing a comprehensive single-payer system – also known as Medicare for all. But now, the health care debate is trapped between a political establishment that doesn’t want a single-payer system and news media that insist on ignoring its real potential.
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