More (or Less) on Reform of Health Care

Claudia Chaufan, MD, is an Argentine physician and assistant adjunct professor in the Institute for Health and Aging and Social and Behavioral Sciences at the University of California, San Francisco. She is also vice president of the California Chapter of Physicians for a National Health Program. According to its web site, PNHP supports “single-payer national health insurance – a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.” Dr. Chaufan talks to, and writes for, lay and expert audiences on the social dimensions of the diabetes epidemic and on single-payer health care reform. This is a recent email interview with her.

Seth Sandronsky: What is at stake for minority groups in the upcoming reconciliation of the Senate and House version of health-care reform?

Claudia Chaufan: It is a bit hard to talk about what’s at stake for “minority groups” generally, but I can certainly tell you what is at stake according to people’s income and health status (whatever their ethnicity). The bill will make it a federal crime not to buy a policy – and there are no “public options” to choose among (that would not have been necessarily cheaper anyway), so for the first time in American history you have a legal obligation to buy a private product. So then the question becomes: is this good or bad for us? Will it eliminate financial barriers to medically necessary care and will it control costs so that the country can guarantee health care for all?

What’s the case against mandating Americans to buy private health-care insurance?

This private product is likely to be insufficient to eliminate financial barriers to health care, because what it counts as “acceptable” to be sold is very unclear. Policies will be allowed to have high deductibles and out-of-pocket expenses that many, including middle-income Americans, will not be able to afford. This is likely to affect minorities more, because the rates of disease are generally higher among them (again, one needs to discriminate within these groups, because the very rich will always be better off, whatever their ethnicity).

What about President Obama’s case for people being able to keep their health-insurance policies with his approach to health-care reform?

The reason offered by President Obama that this approach is good is because “it will allow you to keep your plan if you like it.” This is a very poor reason. The fact of the matter is you are very likely to lose your plan as soon as you lose your job, and the price of your plan is very likely to increase, so even if it is there you won’t be able to pay for it. And what is worse, even if you don’t like your plan, if it is offered by an employer you will have to keep it because it will be illegal for you not to do so, and you won’t have other alternatives.

How will the president’s reform affect the affordability of health-care insurance?

The presumed lifetime maximum in health care expenses is unclear as well, and at any rate will only be operative for whatever counts as “covered services.” Put another way, if your policy does not cover services x, y or z, and you happen to need them because they are otherwise medically necessary, paying for them is likely to bankrupt you, as it has up to now.

There will be a huge increase in public expenditures in health care (i.e., your taxes) going into financing the sale of a very bad product, i.e., private health care policies. This is because in both bills there is almost half a trillion dollars of public money going into subsidizing your buying these policies. This huge transfer of money from our pockets into the for-profit corporate sector is likely to increase the power – economic and political – of private health care interests for years to come, and get in the way of the only approach that can both control costs and guarantee real (not near) universal coverage of medically necessary services, i.e., improved and expanded Medicare for All (Senate Bill 810 in California).

The so-called “improvements” to control costs (e.g., electronic medical records, comparative effectiveness research, menu labels, wellness, etc) are worthless to that effect. They are absolutely unrelated to the policy principle of pooling risk in a single financing pool, which allows systems elsewhere (Canada, UK, etc.) to cut costs through reducing paper-pushing (administrative overhead), bulk purchases and cross-subsidizing.

The good things (e.g., Medicaid expansions) could have been implemented anyway without the grandiose title of “reform” and without implementing the individual mandate. Of course, the mandate was what industry has wanted all along, because it gives them, by law, millions of new customers (they still complain because they want to get rid of the very minor constraints they might be subject to).

What percent of people’s income will health care insurance cost under the current multiple-payer system after its House-Senate reform versus a single-payer system?

With a single-payer system, anywhere from four to eight percent of your paycheck in the form of a health tax (at any rate no more than 10 percent, depending on calculations) total, whether or not you are sick, old or young, etc. What matters is that this amount would be predictable.

With the House and Senate bills, God only knows…. Your taxes will go up to pay for subsidies, public program expansions, and new regulations of industry (we’re already paying around 10 percent of our income in public health care, covering the bad customers that industry does not want – very old, very poor or disabled).

To this, you will have to add an unspecified amount for private policies and out-of-pocket costs. To the ordinary American, it does not (or should not) matter what you call the money you spend in health care, whether taxes or out-of-pocket – money is money.

In sum, the current bills will make health care far more expensive that the reasonable alternative (a social insurance system, with no profit allowed for medically necessary services) would.

To make matters worse, they will also constrain your choices. The bills will force you to “choose” from within constrained lists of “preferred providers,” euphemisms for constrained choices. What social insurance, including single-payer systems allow for is the sort of choices that really matter: of doctors and medical establishments (like Canada, France, Switzerland, and even Taiwan, have).