Friday, June 19, 2009

Strong Public Option: Our Right and Preference

Pouring Concrete woodcut (Pouring Concrete V, woodcut 2000 by Linda Lee Boyd)

Everybody has to have health care. If you don't get it when you need it, you get sick or sicker. Your productivity drops, and eventually you either (a) go to a emergency room where indigent care is covered but the expenses are exponentially higher, for a condition which might have cost a few dollars if it was treated way back when; (b) you wind up on disability (if you're lucky); or (c) you die.

How can any of these options be called in the common good? More to the point, how can any of these options be called "profitable"?

A well-constructed national study, Medical Bankruptcy in the United States 2007 was recently published in the American Journal of Medicine. It begins "As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem. By contrast, our 2001 study in 5 states found that illness or medical bills contributed to about half of bankruptcies."

The study abstract states (emphasis added by me):

Since then [2001], health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened. RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
Forget about the stock market, or even foreclosures: The economic threat to working Americans is lack of affordable health care. We do NOT have the "best health care in the world", not unless you are rich or a member of Congress whose government-funded medical plan is phenomenal.

We out here know this, of course. I'm not telling you anything you don't already lie awake nights worrying about. But the debate that is going on is, as usual, full of distortions and "compromises" that are no such thing.

Bottom line: Strong public option or else. This means if a law is passed insisting you have health care insurance (as exists already for car insurance), one of your options is to buy it at an affordable rate from a government-run program, or have it provided free a la Medicare if your income qualifies. You will not be denied coverage for any reason, such as pre-existing conditions, and your insurance will be accepted at any public facility in the nation. It will be completely portable, not linked to a job or living in a particular state.

What Republicans want is to force us to buy insurance from private companies -- the same companies who are already making millions in profits by denying us coverage, cancelling coverage if we get ill, or delaying payment so long we die before we get the care we need. The crisis in health care is currently caused by private insurance plans linked to PROFIT.

Republicans, and Democrats who work as lobbyists for the insurance industry or have major contributions from said industry (cough cough Daschle), claim that insisting on a public option will mean too many people will choose that instead of private insurance. Some of their mouthpieces are pushing a "co-op" option, knowing full well that states with small populations will never have enough clout to create co-ops that survive against private insurance. Other mouthpieces complain about the competition that will force private companies to lower rates and provide better coverage. In other words, they want corporate welfare once again.

They also claim it means a government worker will decide what kind of treatment you get. Well, currently those decisions are being made by cubicle drones for private insurance companies who receive bonuses for denying you care. Your disability and death have no impact on their bottom line. But a "government worker" will have no such incentive to keep you away from necessary treatment, and in the big picture, having more citizens alive and productive is better for the government's bottom line. You tell me which one looks more attractive.

And to help you, check out this video of the Commerce Subcommittee on Oversight and Investigations hearing on "Terminations of Individual Health Policies by Insurance Companies." Of particular interest is the practice of recission, where insurance companies are cancelling coverage for tens of thousands of patients who developed cancer or other serious conditions, a cancellation which makes these patients liable for medical expenses retroactively. None of the three insurance companies who testified -- Assurant, UnitedHealth Group, and WellPoint -- would commit to stopping the practice of arbitrary recission unless there was intentional fraud in the patient's application. [Starting at 4:48 in the video.] They all indicated they will go on putting profit ahead of patient well-being. Until we demand the government stops them, of course, or we find an alternative to their own cancerous death-grip on our medical system.

The time to act on this is now, before we get sold out again by so-called moderates who are actually far to the right in many human rights aspects. All it would take is for President Obama to say he will not sign a bill that doesn't include a public option. Speaker Pelosi responded this week to a question from Huffington Post about whether she she would allow a reform package without a public option out of the House: "It's not a question of allow. It wouldn't have the votes."

HuffPo states a bill without the public option "would lack the votes because the GOP generally opposes Democratic reform proposals, and the 77 member Congressional Progressive Caucus -- rarely heard from on the Hill -- has been particularly vocal in its commitment to oppose any reform that doesn't include a public option. The public plan's popularity extends beyond progressives and is broadly popular with the Congressional Black Caucus, Congressional Hispanic Caucus and even two-fifths of Blue Dogs, the conservative Democratic coalition."

Dr. Howard Dean and Democracy For America have created an explanatory video and petition for a strong public option in health care reform, available at Stand With Dr. Dean. On the same page is a list of other actions you can take with DFA.

Senators Dick Durbin, Patrick Leahy, and Chuck Schumer have created an online advocacy effort to build support for real health care reform that includes a public option. You can read about it and sign their petition at Citizens For A Public Option.

Organizing For America has a Health Care Action Center page where you can enter your address and zip to find your Representative and Senators' phone numbers, along with some calling tips.

We only need 50 votes to get this done, or a President who won't sign a bail-out to the insurance industry. (If he caves on this, you can kiss off the rest of his term.) 76% of the American people want the public option, which is ALREADY all the bipartisan support necessary. Write, call, do your bit. And be well.

ADDENDUM: This issue, what constitutes a human right that should not be determined by profit margins, reminded me of a song by the great lesbian-feminist singer/songwriter and Red Diaper baby Alix Dobkin, written in the late 1970's. I've just received the correct lines from her and share them with you now:

How the patriarchy scars us
From the moment we are born
Heavy hands are interfering
From our mothers we are torn
Everyone's a victim at the hands of men
They've stolen childbirth, they profit on our lives
Through to our earthly end
It's so outrageous to think about it
I have to think about it
I have to think again...