On Monday, President Bush signed landmark legislation that, in addition to adding a drug benefit to Medicare, places more of the responsibility for providing health care to older Americans in the hands of private insurers and health plans.
But for advocates of universal health care — including many doctors and hospitals — the bill signing represented a step backward. They say that increased privatization is dismantling the public-private safety net that first emerged in the 1930s and will add to the growing number of Americans who do not have health insurance.
Not for everyone
“Medicare was responsible for older people, Medicaid for the poor and those who are unemployed, and the private sector would cover their employees,” said Marc D. Smith, president of the Missouri Hospital Association. “In theory, those three pieces should include every American.”
The reality, however, is they don’t.
According to a recent study by the Missouri Foundation for Health, a nonprofit organization that researches health care issues, when access to medical care is linked to employment or eligibility for federal programs, more and more people are left to fend for themselves. For example, Medicare and Medicaid cover less than half of the roughly $30 billion spent on health care each year in Missouri. Employer-sponsored health plans cover about a third of the costs, while the rest is paid out-of-pocket by people without insurance, who number almost 650,000 in Missouri.
“The system is broken,” said Deborah Hume, director of Voice-Health Advocates and Women’s Resource Center Inc., a Columbia organization that helps people access social services. “It’s unthinkable that a person could work hard all their life, support a family, and at some point develop cancer that could impoverish them.”
With fewer people qualifying for Medicaid and more employers not offering health insurance to their workers, government must assume a greater role in ensuring access to medical care, said Sharon Feltman, chair of the health task force for Missouri Association for Social Welfare, or MASW.
“It’s a good time to bring this issue up again because a lot of people have lost jobs and are going through the shock of finding out how much coverage costs,” Feltman said. “We hear about huge profits and corruption in some of the massive provider networks — it inspires people to look at the system that we have now and think that there must be a better way.”
One way recently proposed by the Missouri Foundation for Health is provoking interest and discussion among some health-policy experts. “A Universal Health Care Plan for Missouri” would be financed by existing Medicare and Medicaid expenditures, plus revenue from a new state payroll tax. Depending on the level of coverage that would be offered state residents, the new tax would range from 8.2 percent, for a typical benefits package, to 9.1 percent for more generous benefits.
The revenue generated by the tax — between $8.7 billion and $9.2 billion — would eliminate the need for private insurers and health plans, according to the foundation. The plan would also reduce the amount spent in Missouri on health care by streamlining claims processing and other administrative costs.
While the foundation acknowledges that such a government-run system would involve a “substantial redistribution of health care financing,” the plan would provide health insurance for all the state’s residents under age 65 without any reduction in payments to providers.
Visitor to speak on alternatives
Claudia Fegan, who was recently elected president of the Physicians for a National Health Program, said single-payer systems such as that proposed by the foundation make government responsible for collecting and spending health care dollars, but not for providing actual medical care. Moreover, she said, because private insurers and health plans have a financial interest in limiting doctors’ abilities to treat their patients, eliminating them from the equation would improve the quality of care.
“They couldn’t profiteer off of health care,” said Fegan, who will be in Columbia on Thursday and Friday for a series of talks with community groups about the need for universal health care. Physicians for a National Health Program represents more than 10,000 physicians and practitioners from around the country who think government should play the lead role in making health care available to everyone.
Fegan’s visit is being sponsored by a coalition of local and state advocates, including the MASW, the League of Women Voters of Columbia-Boone County and Mid-Missourians for Universal Single-Payer Health Care, a group based in Columbia. The coalition plans to reinforce Fegan’s message with a call for repeal of the recent Medicare reforms, said Mary Hussman, chairwoman of Mid-Missourians for Universal Single-Payer Health Care.
Missouri Foundation for Health’s payroll tax-funded plan is just one of several ways that health care could be made available to all Missourians, Feltman said. Other ways include income taxes and plans that offer a different mix of private and public funding sources.
“We don’t even have the language or a clear way of discussing the options,” Feltman said. “We are just getting involved in current discussions, looking at who has ideas, what those ideas are and how they could work.”
Tom Holloway, director of government relations for the Missouri State Medical Association, said a plan such as the Missouri Foundation for Health’s would turn doctors into government employees, reduce health care options and stifle innovation.
“I just don’t see how that would be efficient,” Holloway said. “The government’s the king of red tape. I’ve seen very few government activities that couldn’t be done better and less expensively than the private sector could do.”
But, according to the foundation, there is ample evidence that uninsured people are sicker and die younger than those with insurance. Marc Smith of the Missouri Hospital Association says that as long as the number of uninsured Americans continues to grow, universal health care is a moral obligation.
“Knowing that we have the people, the technology, the facilities, and the drugs to care for people, to save their lives or at least comfort them, but (we’re) frustrated because they can’t get to us,” Smith said. “This country has the world’s best health care services. Every American ought to have access to get the health care services they need.”