Will America still be Sicko and continue to be the only industrialized nation without universal health care? The complaints against American health care are simple: too expensive, too many uninsured, and too unpredicatable coverage. Every decade or two a movement to fix our disasterous health care system pops up and gets smited down by special interests or co-opted by interest groups. For the epic history of American medicine and reform failure, I recommend The Social Transformation of American Medicine for a history up to 1982 (for a quickie, check here).
President Barack Obama has declared that he wants universal health care out of Congress this year. The history of health care reforms failures spans at least sixty years when Harry Truman ran on a platform of universal health care in 1948 and upset the leading Republican candidate for president. Truman defeated Dewey only to have his plans defeated by the American Medical Association, Republicans, and Southern Democrats. When Lyndon Johnson created Medicare and Medicaid in the 1960s, it was over the opposition of the AMA (that’s right… they didn’t want to insure old people).
The AMA is back and has come out against Barack Obama’s “public-plan option” that would compete against private insurers. Since government insurance plans have lower administrative costs than private plans, more money goes into actual health care (per dollar) than with, say, Blue Cross/Blue Shield. To quote the New England Journal of Medicine:
Indeed, the key reason for public-plan choice is that public health insurance offers a set of valued features that private plans are generally unable or unwilling to provide: stability, wide pooling of risks, transparency, affordable premiums, broad provider access, and the capacity to collect and use patient information on a large scale to improve care. Public health insurance emphasizes the broad sharing of risk, ensuring coverage that is affordable and of high quality for the small portion of the population that accounts for most health care spending.
This doesn’t outlaw private insurance, it just competes with it. But the dirty secret is that a public plan can be a backdoor way to government insurance for all! On a truly equal playing field, government insurance would outcompete private insurance for cost savings and eventually drive the private sector out. Insurance company hacks in Congress will try to prevent that from happening, but Speaker of the House, Nancy Pelosi, has said that she will not allow a non-public plan reform package to come out of her chamber. The big story is how the two committes in the Senate led by Ted Kennedy and the more conservative Max Baucus (D-Montana) will agree on their differences. Red state Democrats are saying they are against a public plan.
The health care debate will be long and confusing, but I’ve included links at the bottom for those who want to follow the debate closely. But perhaps the most important actor with be the general public, working through Obama’s Organizing for America community organizing tool. Events will be held all over America this month (yes, even in Texas) to get communities organized to fight for health care reform. Sign up and participate to make this the last time America has to debate covering the uninsured. (P.S. doctors, nurses, and students are especially wanted!)
Slate – Chatterbox Archives (excellent news/analysis/controversy on health care)
Slate – “The Online Guide to Health Care Reform”
The New Republic – “The Treatment” health care blog
New England Journal of Medicine – “Healthy Competition – The Why and How of a Public-Plan Choice“