Wednesday, December 21, 2005

Forcing a Broken System to Work

Roger Toussaint, the leader of the local chapter of the transit workers union, claims we should support the striking workers because they are taking a stand against the trend of forcing workers to pay higher and higher shares of the cost of healthcare coverage and other benefits.

It's true that America has a healthcare crisis. Over 40 million Americans are uninsured; many of them are children. But insurance itself is frequently insufficient. In 2003, Americans filed for personal bankruptcy in record numbers.

More than half of those bankruptcies were due to medical debt. Worse, seventy-five percent of the people drowning in medical debt had insurance.

There are a number of reasons why the costs of healthcare are rising and lots of blame to spread around. But these conversations are secondary to the trillion-dollar gorilla waiting in the emergency room: the system is broken.

The practice of tying insurance to employment simply has to end. Covering the cost of insurance for employees is proving prohibitively expensive even for enormous corporations who can buy bulk coverage; for smaller companies, the challenge is even worse. The burden is increasingly shifted to employees, in the forms of payroll deductions, higher deductibles and more exempted services. (This also profoundly impacts the quality of care, as what insurance companies will pay for tends to determine course of treatment, rather than the doctor's recommendation.)

Most Americans are actually quite healthy; it's a tiny minority of chronically ill people who make up the vast portion of medical expense. Therein lies one potential solution that deserves closer scrutiny.

Conservatives decry universal healthcare, preferring to rely on market forces and competition to keep quality high and costs low. But we see clearly this isn't working well. Government-run universal coverage smacks of socialism to them; and even saner people worry about trusting our healthcare to government incompetence and exposing it to rank politicization.

One answer would be to create a government agency that pays for catastrophic and long-term chronic care. If insurance companies didn't have to come up with money for risky surgeries, trauma, expensive drug therapy, and long-term care, it would dramatically reduce the cost of private insurance, to the point that employer-sponsored care would once again become reasonably affordable. Then we could expand the pool of insured people, meaning that more people could get to the doctor regularly, which would make us healthier and decrease the pool of people needing that more expensive care.

We should all oppose the trend of forcing Americans to pay more and more for their own healthcare. But the only effective way to achieve change is to recognize the system is hopelessly broken and get a different one.

Roger Toussaint has taken the City of New York hostage to force the MTA to pay even more money into a broken, expensive, inefficient system, thereby exacerbating the problem. By doing this, he's not only not standing up for the quality of care for all Americans, he's punishing the poorest New Yorkers, many of whom don't even have insurance, by preventing them from getting to work, losing desperately needed income and perhaps even their jobs.


Marc said...

Amen, Andy.

little-cicero said...

We can aggree that the system is broken, but universal healthcare is as failed as the current system. Canadians have to come down to the states to recieve medical treatment because of their waiting lists, and these countries never come up with any breakthroughs as a result of their astronomical health spending on all people, whether they need it or not. What we need is a streamlining of the healthcare system, not an expansion. If people need it, let them have it, but do not force one trillion dollar gorrilla on the backs of all Americans!

Andy said...

LC, that's a completely bogus argument. First of all, repeated studies show that even though the US far outspends any other country in healthcare, quality of care here isn't as good. Studies also clearly indicate that Americans would pay a LOT less in taxes to support universal coverage than they currently pay for private insurance, so it would save you money. Furthermore, that WOULD streamline the system. The gorilla is already on our backs, silly, and it's you pro-market types that put it there. And there's no reason to think that adopting a centralized governemnt-run healthcare system would by definition emulate Canada's shortcomings. We can make a better system than theirs.

Jeff said...

Here's a recent New Yorker article by Malcolm Gladwell about the problems with our health care system.

Matthew said...


I thought you were recommending that the government take on catastrophic health care plans, not the whole thing... Could you please clarify the scope of the government program you are advocating for?

Andy said...

Yes, I was calling for the government to take catastrophic care away from private insurers, and I got distracted by responding to the myth-based knee-jerk conservative response. Republicans claim to oppose government-run healthcare because of concerns abotu quality, but the real reason they oppose it is it takes profit away from private hospitals and the pharmaceutical industry. Healthcare should be a not-for-profit industry.

Steve said...

Well as the baby boomers age and the obesity crisis grows, I think that we are headed for an even great crisis.

We do not have many politicians on the national scene willing to propose the hard thing. After Hillary's debacle in the early 90's regarding health care, the mere mention of universal health care in the U.S. is a non starter.

Are we really just a country of greed? Do we really not care about the least among us? Some of us are going to be them perhaps. Our parents may be those uninsured.

My stepmother has had 2 heart attacks, dad has had a stroke and my mother has had a pacemaker put in. (I am GLAD I am adopted.) These three are all tittering on the edge of the abyss. When it becomes personal, the inaction by the federal government becomes outrageous and immoral.

Anonymous said...

"I Have A Dream" and "Universal HealthCare":
It's a *basic* human right; And that is an ethical no-brainer to those who believe in the most basic notions of Civilization (the Athens, not Spartan, model mind you). Merely because Canada, the UK (shudder), or even Laos is unable to provide a free healthsystem of both high-quality and efficiency says nothing of our *ability* to do so. Indeed, believing in defeat without even an effort is by definition un-American. That whole CityOnTheHill thingy became rubbish when ??

I guess we sold the CanDoSpirit somewhere in the 1980's. ("Let's just give up and wallow in our problems. Negative Bonding Rocks!") Yuck.

If we can clone a sheep and get our Mars probe to work more the double its lifespan via remote re-programming of its firmware in Houston, then Yes!, we might *just* be able to figure out universal healthcare sans some vision of a dickens-meets-haliburton healthsystem.

Did You Know ?
Martin Luther King planned on championing *economic* rights shortly before his murder, a campaign he promised "would be even larger and more widespread" than his civil-rights campaign.

Unions Obviously Work
I have been mesmerized by the American public's thirst for fiscal blood. Merely because your neighbor has adequate healthcare, a reasonable pension, and job security -- and you do not --- does not mean you should deny him of these things. Instead, take a page from his experience: Unions Work.

European workers realize this, and thus enjoy benefits many of you could only dream of in your shared-cubicles. Rather than being distraught, or angry, at those in America who have managed to resist TheMan's economic demands, we should, instead, encourage them -- and mirror them.

Something tells me we'd have universal healthcare in 6 months if there were a general strike in America's service-industry, if not sooner.

Imagine that.

Andy said...

vision of a dickens-meets-haliburton healthsystem

OMG, Rob, that is so hilariously apt. I am TOTALLY going to use that, I hope that's okay. You articulated so well what I had intended, with regard to the naysayers giving up before we even try. "Look at Canada!" Oh, boo-hoo, that's Canada, they're not even a real country anyway. ; )

I am pro-union, but I firmly believe this past week's transit worker strike was greed run amok. In my opinion, transit workers in New York are more than adequately compensated for their work and part of their job, more than to run the trains and drive the buses, is to serve the people of this city, not to make a buck for themselves. They abdicated that responsibility this week, holding the country's largest city and, indeed, the nation's economy, hostage while they rejected reasonable offers for the sake of impossible demands. Just because the MTA has a billion dollar surplus means priority #1 is sharing it with the workers. The system is incredibly vulnerable to terrorism, and some of the infrastructure is frighteningly dilapidated. Less than a year ago, a small fire in an electrical room threatened to greatly diminish service -- on a line that services 800,000 riders daily, larger than most American cities -- for three to five years. The stations are filthy, there aren't enough trains, and a lot of them are damn old. Those are higher priorities.