Monday, September 08, 2008
Want Health Care Reform? Don't Take 'No' for an Answer
By Winthrop Quigley
Journal Staff Writer
Last month, while sitting through yet another dull and unsatisfying legislative health care debate, I remembered a state senator's explanation of why attempts at health care reform fail year after year, in Washington and in Santa Fe.
Too many people can say "no."
In New Mexico in the recent past, doctors said "no" to electronic medical records and requirements that they must accept Medicaid patients as a condition of receiving a license to practice.
Businesses said "no" to either paying for employee health care or paying into a state fund to finance public health care programs.
Lawyers said "no" to extending malpractice payment caps to more providers.
Insurance companies said "no" to a requirement that they sell insurance to anyone, regardless of pre-existing medical problems.
Advocates of a complete government takeover of health care financing said "no" to anything less than that. Advocates of market-driven financing said "no" to a government takeover. Citizens everywhere said "no" to mandatory health care coverage for all.
Meanwhile, the state still has about 400,000 people without health insurance, entire counties are without anything approaching reasonable access to health care, employers continue to cut back on health benefits or drop them entirely because they can't afford the premiums, and medical costs keep rising faster than even today's oil-driven inflation rates.
Interests to protect
People said "no" for all kinds of reasons. Some legislation was so poorly crafted one simply could not say "yes." Some ideas made no sense. Some people have deeply held principles that do not allow compromise.
A lot of people – a lot of people – have a financial position to protect, among them doctors, insurance companies, hospitals, community clinics, state bureaucrats, lawyers, policy advocates, labor unions, businesses and employees.
The corollary, of course, is that no one in government has the power to get people to say "yes."
It doesn't help that there is such an awful lot of — to be charitable — spin that accompanies these debates.
A few years back, New Mexicans were bludgeoned into believing that the state was losing doctors at an alarming rate. Even though it wasn't true, the Legislature enacted gross receipts tax breaks for doctors, eliminated gross receipts taxes on groceries and raised gross receipts taxes on everything else we buy. You still hear that doctors are leaving at alarming rates, and it still isn't true.
This summer, an outfit called Health Care for America Now, in support of its mantra that insurance companies put profits before people, issued press releases that grossly inflated the financial position of Blue Cross and Blue Shield of New Mexico by including in its calculations money that was made by the company's parent in Illinois, Texas and Oklahoma.
There is a good case to be made for tax relief for doctors and for reforming or eliminating private insurance. Spinning really isn't necessary.
Since government is failing, getting to "yes" has to be the citizenry's job. So why don't we do our job better?
Partly it's because we debate the wrong things.
We talk endlessly about uninsured children in New Mexico, when the far bigger problem is working adults who make too little to afford insurance and too much to qualify for public help. We fret about insurance company administrative costs, which in New Mexico were about 11 percent of premium dollars last year, and spend no time on the accelerating salaries and mind-boggling waste spurring medical costs, which were about 84 percent of premium dollars.
Partly it's because we also talk about implementation details instead of the values that we citizens want a health care system to reflect.
What we look like
In Britain right now, the national health system is falling apart, for the same reason our system is struggling. It costs too much. The British ration care by withholding services and making people wait. Americans ration care by allowing 47 million people to have no insurance.
Polling shows that the British will accept the waits and the lack of services as long as everybody has the same wait and the same lack of services. Egalitarianism is a value system, and the health system reflects it.
Polling in the United States shows that most people dislike the nation's health system in the abstract but rather like their own care. Arithmetic shows that, if 47 million Americans have no coverage, about 250 million do. Our continuing inactivity shows that 47 million uninsured is consistent with our value system.
Therefore, I have a modest legislative proposal of my own: Since we don't do what is required to cover the uninsured, let us ban, by law, the use of the word "uninsured" until we're serious about solving the problem.
You can reach Win at 823-3896 or email@example.com. Joline Gutierrez Krueger's column will return this Friday.