Listening to all the purveyors of conventional wisdom, you might well think only a glacially slow approach on healthcare reform is possible.
The most comprehensive reform, HR 676, providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible, the pundits insist, so let's settle for what we can get. Lower the expectations and turn down the public heat, they advise. Turn out the lights on a lot of patients too, they ought to add.
Gradualism – extending health coverage to some – is the mantra of the day, fawned over by some politicians and advocacy groups alike. The appearance of "bi-partisanship" or the staging of "strange bedfellows" is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.
The greater danger, we're told, is doing nothing.
But what are we getting done?
Virtually all the gradual reforms being touted would reinforce a multi-tiered health care system with as many standards of care as there are dollars to purchase them, and further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.
The public is ahead of the politicians and policy wonks. A recent New York Times/CBS poll found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.
Who will be left behind while we wait and wait and wait?
Every year, lack of health insurance causes 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks.
Among those without insurance, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment; heart attack victims are less likely to receive angioplasty; people without pneumonia are less likely to receive X-rays or consultations; and people with colorectal cancer are 70% more likely to die within three years than people with health coverage.
The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.
With public frustration over the collapse of our healthcare system mounting, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.
Our most successful national health program, Medicare, also provides one of the best arguments against incremental steps. When Medicare was enacted 40 years ago many contended that the dream of a full national health system was right around the corner.
Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.
Similarly, incremental healthcare reforms in a number of states including
Incremental changes, especially those that pour hundreds of millions more to the coffers of the HMOs and insurance giants by, for example, forcing everyone to buy insurance – the much hyped Massachusetts model – could also push the day of real reform further away.
Further, the campaign to lock more people into costly insurance policies comes at a time of widespread reports about the current disaster facing people with insurance. In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have "substantial problems paying their medical bills" Similarly, the Boston-based Access Project in mid-March found that medical debt growing as a result of rising premiums, deductibles and co-payments with many of those in financial stress because their insurance did not cover such basics as dental care, prescription drugs, or medical equipment.
It's time to stop promoting inferior approaches that aggravate the healthcare crisis, and insist on real reform.
American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.
Rose Ann DeMoro is Executive Director of the California Nurses Association