National Nurses United

RAD 1/9/07 1:28 PM Page 7 Rose Ann DeMoro Executive Director, CNA/NNOC Decoding the Healthcare Debate Despite the flurry of proposals, there are really only two choices here's a resolution for the new year. Let's not further mess up our already dysfunctional healthcare system. In Washington, Sacramento, and other state capitals, legislators are scrambling to put forward "bipartisan" or "politically viable" proposals to address our national healthcare crisis. Unfortunately, most of the options being suggested will exacerbate the problem, retard efforts to achieve genuine reform, and further enrich the corporate elite in the healthcare industry that created the present shambles. If your head is spinning from reading all the various ideas being thrown around, here's a Cliffs Notes version. Essentially, all the choices can be distilled into two general areas—reform that is patient-based with public accountability or market-based approaches. In the latter category fall most of the alternatives being swooned over today by the insurance companies and others who profit from human suffering, the politicians who cater to them, and the editorial writers who counsel us to lower our expectations. Among the schemes are health savings accounts, or HSAs, requiring individuals to purchase their own insurance, and expanded mandates that employers provide benefits for their employees or pay into a pool for coverage for those without insurance. All have a common thematic. They rely on market mechanisms that created the crisis by sacrificing quality, affordability, and access for private profit. Consider the current hot topic on Capitol Hill, the Massachusetts model. In Massachusetts, every adult is now required to buy insurance coverage by next July or face penalties. Subsidies are provided for low-income residents. But the plan has gaping holes. Parents are not obligated to buy insurance for their children. Moderate or even middleincome adults who would have to spend DECEMBER 2006 hundreds of dollars more each month for full family coverage may well be forced to gamble with their children's health. Or they may choose to cut back on other basic needs. The sort of plans available to middleincome residents typically have deductibles that can run into thousands of dollars. The result: Consumers are likely to foot the bill for most healthcare services in addition to the premiums the law would force them to pay. And, in the event of a serious illness or accident, they may find their cut-rate plan abandons them to financial ruin. Middle-class consumers are likely to lose choice of physician, because they will be and clinics, or a single-payer system, with one entity that pays for all healthcare services to the private provider of your choice. Single-payer is the way Medicare works (one reason Medicare is so popular), or in California, the California Public Employee Retirement System (CalPERS). Veterans Administration care, with their own VA hospitals, is similar to a national health program. Poll after poll documents such a plan has overwhelming public support. One example: A little-known facet of the botched 2003 Medicare reform plan was establishment of a Citizens Health Care Working Group under the auspices of the Comptroller of the U.S. Essentially, all the choices can be distilled into two general areas—reform that is patient-based with public accountability or market-based approaches. forced to pick among the doctors whose services are covered by the low-cost plan they can afford. But, the Massachusetts plan is loved by the healthcare industry because it transfers huge pots of public money to private healthcare corporations. Health savings accounts, marketed as "consumer-directed" solutions because they pair a high-deductible plan with a tax-free personal spending account, are similarly catastrophic. HSAs simply shift the cost of coverage from insurers to individuals, promote rationing of care, slice away the healthiest and wealthiest from larger risk pools, and do nothing to reduce the number of uninsured. And rather than reduce the bloated 30 percent of every healthcare dollar spent on administrative overhead and waste, HSAs actually increase administrative costs with servicing fees paid to the financial institutions which are climbing over each other to grab their chunk of this new lucrative market. By contrast, consider the approach in every other industrialized nation in the world, either a national health system with public administration and public hospitals W W W. C A L N U R S E S . O R G It held 31 community meetings across the U.S., conducted an Internet poll, and received 5,000 commentaries from people. More than 90 percent of those surveyed believe the healthcare system is in crisis or constitutes a major problem, feel affordable healthcare should be part of national public policy, and want uniform benefits for all. Asked to evaluate different proposals for expanding access, creating "a national health insurance program, funded by taxpayers, in which all Americans would get their insurance," ranked highest. It's not just a dream, it's legislation. HR 676 is pending in Congress, and a bill in California reached the desk of Gov. Arnold Schwarzenegger last September only to be vetoed. While politicians clamor to come up with inferior alternatives, it will be up to us to remind them why the U.S. lags behind so many other countries in quality indicators from prevention to infant mortality, and why inferior, market-based plans will simply perpetuate this national disgrace. ■ Rose Ann DeMoro is executive director of CNA/NNOC. REGISTERED NURSE 7

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