With 44.3 Million Uninsured, Health Care Returns to Politics

The number of Americans without health insurance rose last year to 44.3 million, an increase of about 1 million people since 1997. Now one in six must pay their medical bills out-of-pockets, or -- more likely -- go without health care.These latest figures, released in a Census Bureau report on October 4, reveal that despite the nation's strong economy and numerous government health initiatives, America's current insurance system cannot serve the needs of many citizens. In particular, the system is failing immigrants, minorities and those living below the poverty level. Hispanics suffer a 35.3 percent uninsured rate, and almost half of all poor, full-time workers lack coverage.The Census Bureau figures come at a time when health care reform is making its way back on to the political agenda and capturing front-page headlines. Both Vice President Al Gore and former Senator Bill Bradley have unveiled health care reform packages within the past month. By and large, the mainstream media has received their plans favorably, especially Bradley's, which has been deemed more "expansive" and "bold" than Gore's (essentially, Bradley's plan would privatize Medicaid and allot an extra $65 billion to subsidize insurance costs for children, the poor and the elderly)."By seeking reform in swallows rather than sips or gulps," editorialized USA Today, "Bradley promotes substantive change without jarring the system."But for those in the trenches of the health care system, Bradley's plan smells like a rotten red herring."Bradley promises straight talk, fresh ideas and the courage to take on vested interests," wrote Harvard Medical School's Dr. Steffie Woolhandler in a USA Today op ed. "But his health plan recycles ideas floated by Al Gore and, before him, Richard Nixon and Jimmy Carter. [His plan] would deliver billions to insurance companies and HMOs. But it won't deliver the universal health care that America deserves."Dr. Woolhandler knows the debate well. Twelve years ago, she co-founded an organization called Physicians for a National Health Program (PNHP), whose 8,500 members oppose "patchwork reforms" such as the Bradley plan. According to PNHP, health care in America won't work until profit-driven HMOs and insurance companies are eliminated and a universal, nonprofit system is created. The Bradley plan, on the other hand, would turn millions of Medicaid recipients into HMO customers, strengthening the for-profit sector of the health care system.Such patchwork reforms and privatization schemes have failed in the past. When the Clinton Administration promised to replace lost welfare benefits with the Children's Health Insurance Program (CHIP) in 1997, it aimed to cut the number of uninsured children -- currently 11 million -- in half. But a representative study in Chicago found that out of 380,000 eligible children, only 17,000 had been signed up under CHIP, a mere 4.5 percent. Critics fear that Bradley's privatization plan would have similarly dismal results."The good thing about Bradley on health coverage is that he raised the issue," says Charles Andrews, author of [ital]The Drive to Corporatize Health Care.[ital] "The bad thing is that he's just shoveling money to private insurers instead of covering everyone in a single public plan."Such a public plan -- often called a "single-payer" system -- would eliminate the profit motive that currently encourages the health care industry to deny sick people care, jack up drug prices and put crucial health decisions in the hands of bureaucrats, instead of doctors. What's more, explains Dr. Quentin Young, another veteran health care reformer, eliminating insurance companies and HMOs would free up the 15 percent of every dollar that they skim off the top for profit and overhead -- nearly $150 billion annually. Such an influx of money would be enough to cover every uninsured American, improve coverage for millions more and provide free drug coverage for all seniors.If a single-payer plan would work as well as Dr. Young and PNHP claim, why aren't any mainstream politicians proposing such a system?"Cowardice," says Dr. Young. "Politicians are scared to death of the backlash they'd get from the HMO, insurance and hospital industries. They'd lobby as hard as they could -- attack ads, revoking contributions -- to keep the politicians in line." Sounds dramatic, but the figures prove that Dr. Young is soberingly correct: In the 1998 election cycle, hospitals, nursing homes, drug makers and HMOs gave $18.3 million worth of campaign contributions to members of Congress. Over the same period, insurance companies stuffed another $10.4 million into Congressional coffers, and spent untold billions lobbying for or against specific legislation. Consequently, politicians don't spend much time confronting the HMO or insurance industries."Our health insurance system is imploding," says Dr. Young. "About 100,000 people drop out of the system every month, and any downturn in the economy could dramatically increase that number, as employers cut costs by revoking medical benefits. Millions of Americans have such poor insurance that a serious illness or injury would bankrupt them. It's as if a particularly mischievous devil has gotten loose and has sowed madness in the health care industry."