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Health care reform: separating fact, fiction and fantasy
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As health care reform continues its long march towards final passage in the fall, spurious emails continue to make the rounds from inbox to inbox spreading falsehood and distortion, and in many cases, scaring some of our most vulnerable citizens into opposing much-needed reforms. Their design is simple: make every conceivable effort, no matter how untrue, blatantly false, or simply outrageous in an effort to kill any proposed overhaul of America's increasingly unsustainable health care system. The following are some of the talking points from these emails - most of which have their origins in the boardrooms of special-interest lobby groups, far-right politicians, and their allies on the talk-radio circuit.
Myth: The United States has the best health care system in the world.
Fact: Not at all. The United States is the only country in the world without a universal health care system, whether it is a completely single-payer system as in Canada, a completely public plan as in Britain, or a a public-private partnership as practiced in Germany. While America certainly spends more than any other nation on health care - 18% of Gross Domestic Product (higher than any UN member-state except Timor-Leste) or $2.4 trillion per year, or almost $7,000 per person per year, according to the Organization for Economic Cooperation and Development - the current system currently leaves out 1 in every 6 Americans, and this is exemplified in some startling statistics:
1. Canadians live, on average, 3 years longer than their American counterparts.
2. Infant mortality rates are higher in Detroit (15.5%) than in El Salvador (9.7%). As a whole, according to the CDC, the United States ranks 29th in infant mortality, tied with Poland and Slovakia.
3. Britons, particularly older people, have fewer incidents of diabetes, heart attacks, strokes, lung disease and cancer, according to a 2006 study published in The New York Times.
4. Overall, the World Health Organization puts the United States at 37th in the world in terms of health system performance, which looks at statistics such as infant mortality, preventable deaths, infant mortality rates, etc.
In essence, America has replaced the slogan "We're number one!" with "We're number thirty-nine!"
Myth: The government could cover all Americans by simply providing a flat tax credit for everybody who buys insurance.
Fact: Such a plan would likely cause prices to rise, and thus cause increases in the amount of uninsured, because it ignores low-income and high-risk individuals. Flat credits do not take into account such things as pre-existing conditions, and the corresponding increases in health insurance premiums; people who have such conditions always pay more than healthy people and always run the risk of "maxing out" their health insurance coverage.
Myth: Nobody is denied access to health care based on inability to pay, because everybody can access emergency health services.
Fact: Emergency room access is simply no substitute for long-term, readily-accessed care. Most people do not access emergency services unless their condition is already life-threatening, because simply, if they don't have $50 to see a GP, they probably don't have $5,000 to visit the emergency room. 18,000 people a year die because they can't access health care, sometimes for things as simple as an infected tooth that abscesses and causes a heart attack.
Additionally, over 1 million bankruptcies occur every year in this country due to medical debt; most of these people are already insured.
It simply does not square that in a country based on the notion of upward social mobility - a.k.a. "the American Dream" - that people should lose their homes because they can't afford to access services that are vital for the maintenance and preservation of life.
Myth: The current proposal for health reform mandates "pulling the plug" on elderly or terminally ill people based on some arbitrary rating of that person's value to society.
Fact: No such provision existed in the Bill pending in Congress over the course of the summer. The bill in fact proposed that medical providers be reimbursed for having conversations with elderly people or the terminally ill in regard to what are known as "advance directives," or plans for a person's end-of-life care options, as first proposed by Republican Senator Johnny Isakson of Georgia.
The proposal, in fact, made fiscal sense; the default position of our health care system is to continue treating a person until all their treatment options are exhausted unless the person has already specified otherwise (example: Do-Not-Resuscitate Orders.) This in turn continues to increase the costs of health care with limited benefit to the patient. However at no time were these decisions to be made, or privy to, anybody but the doctor, the patient, and the patient's relatives.
U.S. Government policy since 1992 - and the Administration of President George H. W. Bush - has been to encourage advance directives such as living wills or durable powers of attorney for health care. All the proposal did, up until the firestorm of nonsense allegations forced its removal from the legislation, was to provide for the reimbursement of doctors discussing care choices with their patients.
No such thing as the "death panels" as referenced by former half-term Alaska Governor Sarah Palin ever existed.
Myth: A plan with a Public Option would force everybody onto government insurance, bankrupt insurance companies, and lead to rationed health care.
Fact: A public option is simply a mechanism which would force insurance companies to reduce their overhead and the outrageous dividends as paid to shareholders and executives in order to provide quality care for less money. According to the New England Journal of Medicine, administrative overhead accounts for 31% of all health care costs in United States; for almost 12% of the costs of private insurance plans; for Medicare, overhead runs at 3.6%. As these costs continue to rise incrimentally in priavte plans, it stands to reason the costs of premiums will continue to rise as well, thus leading to more and more uninsured individuals; a public option would halt and reverse these trends and thereby make insurance more readily accessible to more people.
Insurance companies can be expected to continue to survive into the future as long as they remain competitive and inventive (as free-market conservatives have argued the automakers should do, but strangely enough take the opposite track when it comes to banks and insurance companies.)
As far as the red-herring argument regarding health care rationing, America already has it. However America rations health care completely differently than most countries, as it rations on the demand side by essentially disallowing 1 in 6 people from accessing expensive health care options, regardless of how needed it is - unless, of course, that person is willing to risk bankruptcy and lose everything for which they have worked for all their life. Contrast this with Canada, which "rations" on the supply side (i.e., each province and territory pays for X number of beds for X number of operations per year.) However nothing in Canada precludes people from seeking treatment in another province or territory when their condition requires treatment with immediacy; additionally, as health care is considered a right, no person can be turned away from necessary surgeries in times of immediate threat to life.
Myth: Illegal immigrants will be covered under the current bill.
Fact: According to the text of H.R. 3200, Sec. 246:
"Nothing in this section shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."
Additionally, under current Statute, people not legally in the United States do not qualify for any federal health programs. The Pew Hispanic Center reports that about half of the illegal immigrants in this country have it because it is offered through their employers; the other half lack it because it isn't offered through their places of employment.
While these are only a few of the more frequently referenced claims made by right-wing politicos, media, and their corporate benefactors, this list is by no means exhaustive. Look for Part 2 later in the week of August 16th.
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