Monday, September 28, 2009

(No.55) Fear & loathing in U.S. health insurance reform

Since my last column about reaction from the U.S. to my Toronto Star op-ed piece about the health insurance reform debate in that country (see No. 51, I have wondered about the apparent extent of citizen opposition not just to health care reform itself but specifically to a "public option" (i.e., government health insurance) as an alternative to insurance company health insurance in a 'reformed' American health insurance system.

It seems foolish to me (and I suspect to many Canadians following U.S. news) to oppose having available at least one alternative that does not involve health insurance companies with whose coverage, cost and claims practices so many Americans are dissatisfied.

Doubtless one could compile a long list of reasons for this but several seem to me to be major factors in how this debate is playing out.

1. Large, well-funded misinformation and anti-reform propaganda campaigns by various groups with vested financial interests in the outcome of all or specific aspects of proposed health care reform -- from the health insurance companies to the pharmaceutical companies into the medical establishment and over to the Republican Party and beyond on the political right.

2. Among Americans there are those who by tradition and belief tend to see ANY government involvement in a reformed health care system as dangerous and another step toward even bigger government and therefore greater government control of their lives. Health care reform, as much needed as it is by the 45 million uninsured and to address the rising cost of the existing unreformed health system, is inextricably bound up for many Americans with the ongoing ideological debate about the proper role of government, appropriate limitations on it and indeed about ethics and equity in U.S. society.

3. Fear of endangering or losing what they already have in the way of health care, especially since government subsidy will be required to provide those now uninsured with access to affordable health insurance.

Polls show this to be a particular concern among more than half of Americans 65 and older covered by Medicare because the President's reform includes the saving of $400 - $500 billion dollars (depending on whether it is the Senate or House version) in Medicare costs by lowering payments to private providers -- the Medicare "Advantage" program -- involving a quarter of those in Medicare AND reinvesting all of these savings in the U.S. health care system. This has been used by reform opponents to try (with some success) to frighten this important voter constituency. Hardly surprising action coming from supporters of the Bush administration's shameful surrender to the pharmaceutical companies that obliged the federal government NOT to negotiate for lower drug prices based on its status as a massive customer under Medicare.

4. The health care reform proposals are being negatively affected as more Americans become increasingly concerned, in the wake of Wall Street and auto company bailouts plus a giant economic stimulus package, that health care reform may be the financial straw that breaks the U.S. camel's back in terms of both the economy and the huge accumulation of $trillions of government debt. Such concerns are entirely understandable.

5. The facts of health care reform have been confusing for many if not most Americans. In a CBS poll in early Sept. 67% of respondents said they did not understand health care reform ideas because they found them to be too confusing. Not all of this confusion is the result of deliberate misinformation directed at the public by various special interests. In part it is because there has been too little during the debate in the way of firm detail about what the FINAL health care reform package will look like and what it will actually mean to currently insured Americans. It is a complex subject made more confusing by the absence of clear explanation as five different proposals were being developed and debated in the U.S. House and Senate.

In terms of the ongoing negative propaganda campaign being directed at the Canadian single payer government health care system by various anti-public option lobby groups in the U.S., there are several key indices which effectively refute this nonsense. For example:

-- life expectancy: U.S. 77.8 ; Canada 80.4

-- child mortality: U.S. 6.37 deaths per 1000 ; Canada 5.4 per 1000

-- % of GDP on health care: U.S. 16% ; Canada 10%

-- health care insurance company premiums as a % of U.S. GDP: 1970 1.5%; 2007 5.5%

-- number who were uninsured throughout 2008: U.S. 45.3 million ; Canada 0

Although one needs to be on guard against easy exaggeration, it must also be noted that an unknown (and unknowable) number of Americans -- encouraged by propagandists on the loony right -- are taking strong public positions against health insurance reform as camouflage for a visceral dislike of the Obama presidency.

It would be tragic if there were to be a repetition of the defeat of the Clinton health care proposals of the early 1990s, if the combined effect of fear and loathing robbed Americans of even a comparatively modest "public option" in this latest round on the very long road to effective and meaningful health care reform in the U.S.

Alastair Rickard