While we're busy preventing Bush's quixotic assault on Social Security, an even greater travesty is occurring behind the scenes, according to
Robert Reich in the May 2 USA Today:
The president just ended a 60-day whirlwind tour to try to sell his Social Security plan. But almost everyone inside the Beltway, and a growing number outside, know it's going nowhere.
Polls show most Americans don't want to tinker with Social Security. Many Republicans, facing re-election, don't want to touch it. Why still flog it?
Because Social Security is a place holder. As long as it remains on the domestic agenda, it blocks consideration of the real domestic crisis President Bush doesn't want to touch: the health care system.
Summary, commentary, and complementary beverage service from an honest-to-god medical sociologist below the fold.
Reich seems to be on to something. Just on dkos, a great deal of the policy focus on the front page and in the diaries for the past couple of months has been on Social Security deform and Bush's Bamboozapalooza (to lift
Josh Marshall's phrase). In the lead-up to the budget vote last week, I don't recall reading any diaries concerning the hits that Medicaid was going to absorb:
Medicaid, the government's health care program for the poor, is also in trouble. Its costs are rising so fast the White House and congressional Republicans want to whack it by $10 billion over the next five years. But governors don't want Medicaid cut. States pick up half its cost. If the feds bow out, states will have to make up the difference.
I'm afraid to say that in our desperate need to find a victory against the Right to rally around (the imminent demise of Social Security deform), we've developed a tunnel vision that has allowed the Rethugs to further corrode the social safety net that has been in place for the latter part of the 20th Century. Even though the Dems stood united in opposition to the budget (save a few no-shows), I'm left to wonder if we had made some noise about the importance of Medicaid, could we have prevented the cuts?
I have to admit though, $10 billion in Medicaid cuts might be the Rethugs fix to Social Security - they'll die before they can retire and start collecting!</snark>
Reich also discusses the miserably high (and rising) number of Americans without insurance:
Symptom No. 3 is the increasing number of Americans without health insurance. Ten years ago, when President Clinton's proposal for universal health care tanked, 38 million lacked health insurance. Now, 44 million are without it at some point during the year.
Last week was "Cover the Uninsured Week," and with it came the release of a depressing report detailing the percentage of adults (and working adults) without health insurance broken down state-by-state. You can find the links to the report and some commentary in a
diary I posted on the subject last week.
Reich does offer measures to be taken to ameliorate the crisis:
But it's possible to control health costs and at the same time give Americans far more health security.
One step is to use the government's bargaining clout to cut the prices medical providers and suppliers charge. Through Medicare and Medicaid, the U.S. government is the biggest health purchaser in the world. It has the heft to get pharmaceutical companies to agree to far lower drug prices. The same bargaining power could be used to bring down prices of other health care supplies and services.
Another step is to offer every American the chance to buy basic health insurance for the family at say, a few hundred dollars a year. The low cost would be possible because so many Americans would be in the same plan, generating vast economies of scale. In such a uniform system, transacting with a doctor or hospital of your choice would be as easy as using an ATM.
Judging from the experiences of other industrialized countries, single-payer health care seems the way to go, but given the political opposition to any sort of "socialized medicine," Reich's suggestions seem like workable common-sense alternatives.
Common sense, however, always seems to be in short supply within the Beltway - especially when it's buried under millions of dollars in campaign contributions. Health care in this country is big, big business. In 1999, health care costs were estimated at over $1 trillion, or 14% of the GDP (source: Howard Waitzkin, At The Front Lines of Medicine). Pharmaceutical corporations and for-profit health care providers donated handsomely to the President's re-election campaign, as well as to the Republican party in general, especially after the generous giveaways to industry embodied in the Medicare prescription drug "benefit." The medical-industrial complex has their man, Dr. Bill "I'm-not-a-neurologist-but-I'll-play-one-to-pander-to-the-religious-right" Frist, at the helm of the Senate. Frist, of course, made a killing by contributing to rising health care costs with the family business.
Reich's proposals, however, won't ultimately end this crisis. A focus on controlling costs addresses only a small part of the picture. For example, a contributing factor to rising costs is the use of costly technology that has a negligible therapeutic benefit. This is, of course, driven by the for-profit nature of the health care business; health care corporations must expand their market or create new markets in order to maintain healthy profits.
Likewise, a focus on the causes of illness in society could help mitigate rising costs. Reich is absolutely spot-on when he asserts the importance of preventive care. However, we need to do a better job regulating those in society who contribute to the ill-health of Americans. Tobacco companies, polluters, purveyors of "food" devoid of any nutritional content but packed with chemicals to tantalize the tastebuds - the list could go on and on - should be forced to shoulder the social costs of their harmful products and/or practices.
This, of course, would require tremendous courage on the part of our legislators - courage to stand up to one of the most powerful sectors of American industry, and courage to stand up to those whose search for profits contributes to the poor health that plagues many in our country. And, unfortunately for us, courage is in short supply these days.
This is not an issue that is going away. It affects each and everyone of us, our families, our peers, our workplaces. Health care was an issue in last fall's campaigns, but it seems to have fallen off the radar. It is incumbent upon us to make it a priority. And we should not settle for some half-ass reforms that actually put more money in the pockets of corporate campaign donors, like health savings accounts. Basic health care must be made available to all. Look in your communities for groups that are organizing around this - if there aren't any, start one! And get on your congresscritters and let them know that while the Three Ring Circus we call D.C. continues its fascination with political brinkmanship, real people are suffering because of their failure to deal with issues that are directly affecting the physical, mental, and financial health of millions.
Update [2005-5-3 6:13:32 by wobblie]: The AP wire has an article out discussing health care pooling by public school districts. It's being pushed by Republicans in Ohio and Michigan - and being resisted by teachers' unions. On the other hand, unions in Minnesota and Oregon support pooling proposals in their neck of the woods to remedy proposed K-12 budget cuts. Doesn't seem to be a clear consensus yet on the pros and cons of pooling - anyone know more about this?
Oh yeah, you'll probably want the link to the AP story. Paz.