[This article also appears on Huffingtonpost.com. You can access it from my author page here.]
When it comes to health care reform, I feel like the house is on fire, but nobody in Washington (except maybe President Obama) seems to see it. Or worse, they see it, and they don't care.
Here are some statistics, via the nonpartisan/bipartisan National Coalition on Health Care (NCHC), to demonstrate just how dire the current health care situation is:
- 46 million Americans under the age of 65 (which represents 18 percent of the population) had no health insurance in 2007. And given the spike in the unemployment rate and downturn in the economy since then, that figure has to be even higher now.
- $2.4 trillion was spent on health care in 2008, representing 17 percent of the U.S.'s gross domestic product. That's more than four times what we spend on defense.
- Costs are trending in the wrong direction. Projections have costs reaching $3.1 trillion in 2012 and $4.3 trillion by 2016, if the same health care system remains in place.
- The NCHC has compiled projections on the negative impact of spiralling health care costs on the economy, state and federal budgets and employers, large and small, and the effects are stifling. Health care costs are a major threat to our future.
- We are also very inefficient. We spend more money per person on health care than nations that provide universal coverage to their citizens. The NCHC, citing the Organization for Economic Cooperation and Development, points out that health care spending was only 10.9 percent of the gross domestic product in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, all countries that provide single-payer health care.
- And what about the small businesses Republicans are always pretending to defend? They are getting killed by health insurance payments. Employer-based premiums rose 5 percent in 2008. In 2007, rates for small employers went up 5.5 percent, and companies with less than 24 employees saw an even bigger increase, 6.8 percent. The Republicans call any health care reform measure from the Democrats a job-killer, but nothing is killing the ability of small businesses to hire Americans more than the rising cost of health insurance.
- Not that Republicans care about American workers, but I thought Democrats were supposed to be looking out for them? They are getting hammered, too, according to the NCHC. In 2008, employees had to pay a whopping 12 percent more in health insurance premiums than they did in 2007, so that the average worker is now paying $1,600 more a year for premiums than he/she did in 1999. In fact, since 1999, premiums for employment-based health insurance have increased 120 percent. (NCHC notes that during that same period, wages grew only 29 percent.) That means that health insurance costs are increasing four times faster for American workers than their wages are, on average.
- Republicans love to talk about how bad health care will be if the government gets involved, and President Obama has taken great pains to assure Americans that, under his plan, if they like the coverage they have, they can keep it. But the evidence points to the fact that care in the United States isn't as good as it could or should be, and is not the best in the world. The NCHC notes that we are not in the top three in infant death mortality rate; ours is 7 percent, while the leaders are at 2.7 percent. The U.S. rate of mortality from treatable conditions is a third lower than the world's leader. A drop more than half of adult Americans get the care recommended for them, and less than half of those suffering from diabetes and less than a third with coronary heart disease receive proper care. There are also growing problems with medical errors and infections in hospitals.
There really isn't a question of if there needs to be a complete overhaul of the health care system. Rather, the only question should be, How much can we change it? But if you listen to the debate in Congress right now, it sounds like a race to see who can do the least. And you would certainly never get the idea that the status quo is as broken and dangerous as it actually is.
The last time I wrote about health care, last month, my central concern was that Republicans were intentionally stoking fears of "socialized medicine" to kill a public option, all in defense of the insurance companies at the expense of the American people. A month later, my concern seems almost quaint by comparison.
A Washington Post-ABC News poll released over the weekend showed that support for President Obama's handling of health care dipped below 50 percent for the first time. (It should be noted that more respondents still supported him than not, 49 percent to 44 percent, and Republicans continue not to be thought well of on health care, with only 34 percent trusting the GOP on the issue.)
While I wish President Obama's rating was higher, I can't say I am surprised. Yes, part of the blame goes to Congressional Republicans who are on an all-out blitz to kill health care reform, and their motives for doing so -- the protection of the big corporations who control the industry, including the health insurers and drug companies -- are in no way involved with helping the American people.
But if the Republicans were the only problem, I wouldn't be too concerned. Reforming the country's broken health care system is such an obvious need, I am sure that the Democratic majorities in the House and Senate would be able to shepherd through meaningful legislation, if that's what they wanted to do.
The problem, as I see it, is that none of the bills working their way through the House and Senate committees now really address making fundamental changes to the broken-down health care system I described above. Instead, the proposed pieces of legislation would seek to find ways to pay for more Americans to be covered under the old, broken, insurer-dominated status quo.
I thought Health and Human Services Secretary Kathleen Sebelius did a pretty good job battling David Gregory on Meet the Press yesterday. She made a good case that no consensus bill has emerged yet, so it's unfair to claim that any eventual legislation would include the failings that any of the proposals currently contained. And she did an excellent job pointing out that we have a long way to go, from the current broken system to one that eventually achieves the president's three goals of improving quality, lowering costs and expanding coverage.
But the one fact that Sebelius could not get around, and one that Gregory pressed her on repeatedly, is that the current pieces of health care legislation in Congress, according to the Congressional Budget Office, will not significantly lower costs.
I wasn't surprised by this problem, since as the debate has unfolded, it seems as though the policies that might actually reduce costs by addressing the domination of profit-motivated health insurers are the ones that have been the most contentious, especially the introduction of a government-run public health insurance option to compete with the private insurers. As I pointed out last month, there is an inherent contradiction to right-wing criticisms of the public option. They say that such a policy would create poor care for Americans while wiping out private insurers. The problem, of course, is that if the care would be so bad, why would people choose it at the expense of their current private insurers? And, if the private insurers would be ruined because the public option would create less-expensive, superior care, why wouldn't we want to adopt a system that raises quality and lowers costs? The Republican argument is completely disingenuous.
And yet, there are plenty of Democratic senators who have come out against a public option or failed to openly support it.
The Republicans are seizing on the obstacles President Obama is facing with health care reform, sensing an opportunity to dent his popularity. A banner headline on the Huffington Post today trumpets that Republicans from Michael Steele to William Kristol are predicting, as Sen. Jim DeMint of South Carolina did over the weekend, that health care will be "Obama's Waterloo." Hell, things are looking so good to the Republicans that Kenneth the Page impersonator/governor of Louisiana, Bobby Jindal, has reappeared to chime in that he has "seen enough."
But blaming the Republicans for risking the health and economy of the American people to kneel in supplication at the altar of their big-business patrons is like blaming the scorpion of the famous proverb for stinging the frog. It's in their nature. Few of the GOP's policy positions actually benefit the majority of Americans, and even fewer are adopted for that purpose.
No, the blame gets spread across the entirety of Capitol Hill for the current state of health care reform, since not even all of the Democrats seem to realize the enormity of the problem. Rather than pushing for systematic change, they are dancing around the edges, trying to find ways to cover uninsured individuals without changing the way in which Americans receive (and pay for) health care.
I sincerely believe that President Obama sees the need for a massive overhaul of the health care system to lower costs, cover most Americans, and provide quality care. It's time for the Democrats in Congress to become as committed to these principals as the president seems to be. In light of the attacks by Republicans, which paint the president is some kind of take-over-crazed socialist trying to turn the U.S. into some amalgam of the Soviet Union, Sweden and hell, it seems like Democrats from pink and red states are running scared, afraid of being painted as too liberal in their next elections. And I'm sure that these same moderate Democrats are also feeding from the same insurance-company-supplied troughs as their Republican brothers and sisters.
Frankly, I'm less concerned about the "why" than the "how," as in, How do we move forward from here? So far, the concerns in Congress have led to tepid legislation that, if you believe the CBO, may cover more people, but won't address the underlying problems in the system. A government option should, if done correctly, help lower costs by forcing the private insurers to be more competitive in pricing and service. But even if a public option can find its way into a final bill, will it be strong enough to accomplish what it is designed to do?
In the end, we need a massive overhaul of the health care system that increases costs, increases quality, and covers most Americans. And it seems that right now, President Obama is one of the few players in Washington who seems to realize this fact. I was glad to read today that he is going to take a more aggressive approach to the health care debate, because I don't think it's an exaggeration to say that health care is shaping up to be the biggest leadership challenge of his presidency thus far.
The way things are going now, we are either going to get no health care reform (if the Republicans win) or watered-down health care legislation that acts as a bandage, helping some people but ignoring the larger problem creating the pain. Neither of those options are acceptable if we want to prevent a looming health care disaster that will not only risk our well-being, but also our economy, both individually and nationally.
We need fundamental change to the health care system, and President Obama has to find a way to convince his fellow Democrats on the hill that it's in their best interest politically to get on board. Because if the Democrats can come up with a solution that truly provides quality health care to more Americans for less money, their constituents will reward them in the voting booths. And if no health care legislation emerges, or if the bill that is produced is easily assaulted for threatening to balloon the deficit without addressing rising costs, voters will hold the Democratic lawmakers accountable.
The fire is burning, and it's time for real action to extinguish the flames. President Obama needs some help to do it. Let's hope he can convince enough of his colleagues in Congress to join him.