Arthur Salm: Let’s make the HMOs disappear

Arthur Salm is SDNN's city columnist.

This is a column that shouldn’t have to be written, about a monstrous and horrific problem that needn’t be, abetted by an organization that shouldn’t exist.

Its annual convention is being held today and Friday in San Diego. That organization is America’s Health Insurance Plans.

The very name should be oxymoronic. People don’t need health insurance; people need health care. The only ones who need health insurance - that is, who need for health insurance to exist - are insurance companies and HMOs. It’s a gigantic, almost unimaginably lucrative business. CEOs and other top officers rake in millions, sometimes tens of millions in salary, benefits and stock options.

Meantime, 47 million Americans remain uninsured, and many of those who are insured find out how little their insurance is worth when a medical condition - caring for which is supposed to be what this is all about - threatens to prove expensive. People are afraid to leave their jobs, because they need the health insurance that comes with it; they stick with that company, they stay in that town, they put up with whatever they have to because if they don’t, they’re naked, exposed. And there’s not only the terrifying prospect of not getting treatment; a new Harvard University study links medical bills to 62 percent of the bankruptcies in this country.

The key words are “in this country.” So many Americans do not know that these problems simply do not exist in any other western, industrialized democracy. People in Canada, for example, and Great Britain, France, Germany, Norway, Sweden, Denmark, Iceland, Finland, the Netherlands, Belgium, Spain and Italy do not agonize over hard economic choices such as: mortgage or health care; education or health care; food or health care. Everyone gets government-provided health care. Everyone. Everyone.

And we’re not talking leeches and pungent poultices administered by a drunken sawbones who arrives at your hut in the back of an ox cart; medicine as practiced in Europe and Canada is every bit as good, as effective, and yes, as advanced as American medicine. Generally, their infant mortality rates are lower than ours. And their citizens live longer. Big, floppy, foam-rubber hands featuring extended index fingers notwithstanding, we’re not #1.

Here’s how those other countries do it: They don’t, for the most part, even have health-insurance companies. (Those countries that do - the Netherlands is one example - still provide health care to all citizens through those companies.) Insurance companies siphon off about 30 cents of every dollar spent on health care in the U.S. Knock them out of the picture, and that 30 cents becomes about three cents : Medicare’s administrative overhead. The rest of the money? It’ll go toward providing good health care for 47 million Americans who don’t have it now. And toward providing good health care - the word “affordable” will be, in this context, DOA - for you and your family. Whether you’re employed or not. Whether the people you work for are tightwad jerks or not. Whether you move or not. Whether you’re married, or getting divorced, or single. It’ll be there. Always.

No, it won’t be free; it’ll be paid for by our tax dollars. But it’ll be no more expensive, and probably cheaper than what we’ve got now - a system that spends more on health care, per capita, than any of those countries that take care of all their citizens all the time.

That type of health care system is called Single Payer, because instead of a myriad of organizations insuring and (sometimes) paying (part of) a patient’s medical bills, the government pays the bills. And for the first time in generations, Single Payer is being taken seriously in Washington.

Being taken seriously, and seriously dismissed, that is: It’s officially off the table, as far as President Barack Obama is concerned. That may be more his recognition of political reality that it is his philosophy; at this time in this country, no matter how rickety and corrupt and infuriating our health-care apparatus may be, we seem not to be ready to join other civilized nations in this regard.

Still, Obama is driving hard for health-care reform to be enacted this year. One of the proposals that hasn’t yet been swept off the table by the insurance companies’ paid-for elected representatives is called the Public Option, which would allow people to stick with their current plan (if they have one) or sign onto a government-run, decidedly non-profit plan - sort of an Optional Single Payer. Insurance companies and HMOs would not be allowed to cherry-pick healthy customers: All plans would have to take on all comers.

(Step back for a moment, look at the big picture, and say these words out loud: “Pre-existing conditions.” Pre-existing conditions??!!! Of course some people have pre-existing conditions. That means they should be denied medical care? But isn’t medical care all about treating … Shouldn’t that be … How the hell did we ever allow such a cruel, barbaric concept even to enter the conversation?)

In desperation, opponents are suggesting a seven-year “trigger”: That is, if health care hasn’t been pretty much fixed in seven years, then the Public Option will be put into play. That’s actually a great idea, as long as we start the clock seven years ago, yesterday.

Mega-bucked and mega-threatened insurance and pharmaceutical companies, who have nightmare visions of losing their 24-carat cash cows; and right-wing, free-enterprise/libertarian dead-enders, who shriek “Socialism!” whenever a civilization moves to act like a civilization, have rolled out the artillery. The bombardment has already begun: People in “those” countries must wait months and months to see a doctor (a flat-out lie - and besides, how long do you wait to see a doctor?); medical decisions would be made by “government bureaucrats” (as opposed to insurance companies and HMOs, which go ka-CHING! every time they deny treatment or reject a claim); and - don’t forget! - “Socialism!” (Just like our socialist, government-run police forces; fire departments; public schools; universities; highways; air-traffic control system; ports; national, state, and local parks; public health departments; lifeguards; Social Security; Medicare; Army, Navy, Air Force, Marines, Coast Guard, and National Guard.)

But the old litany of distortion, misinformation and outright lies don’t quite have the traction they used to; the Big Money Boys are starting to slip in the very muck they spew out. A lot of people are on to them, and a lot of others, sick to death - sometimes literally - of the old ways, are listening to new (to us) ideas.

On Thursday morning, in front of the Convention Center, people showed up to protest this latest gathering of America’s Health Insurance Plans. Unlike the conventioneers, their concern is human beings, not profit margins. Michael Lightly was there. He’s director of public policy for the California Nurses Association. What’s in it for them?

“The only way to deal with the crises nurses see every day is to guarantee health care for everyone,” he said. “And the only way to do that is Single Payer. …

“Money drives the system, instead of the health-care needs of the people.”

For now, anyway.

Arthur Salm is SDNN’s city columnist. Reach him at arthur.salm (at) sdnn.com.

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This entry was posted on Thursday, June 4th, 2009 at 11:59 am and is filed under Columns, Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.