By Carol Miller
Special to Roll Call
June 8, 2009

Miller: U.S. Needs a Holistic, Cradle-to-Grave System of National Health Care - Roll Call

In the 15 years since Congress gave up on universal
health care, about 300,000 Americans have died from the
lack of health coverage alone, using the government's
own data.

Added to the tragic death toll is the economic toll.
More than a half-million individuals and families
declare medical bankruptcy every year; most of them
have health insurance. Actually, they thought they had
health insurance because they pay for insurance. People
learn the hard way that when help is really needed for
a catastrophic health crisis, private insurance does
not protect them from financial ruin.

We stand again as a nation at the same fork in the road
on the path to improve access to health care for all of
our neighbors and family members.

One choice is the fork that brings us together to weave
a safety net. This fork is the Medicare-for-all
approach; everybody in, nobody out. Imagine a
cradle-to-grave, holistic system based on public
health, prevention, wellness, a medical home for
everyone and -- according to the Congressional Budget
Office -- doing all of this while saving money. This is
the single-payer choice.

Then there is the other fork: forcing everyone to have
insurance by building on the current broken system.
This is the deja vu path. Choosing this path continues
corporate rationing, procedure-based sickness care,
out-of-control costs and obscene CEO and executive
compensation. During the last debate on universal
health care, Congress fell for industry promises of
savings through an expansion of managed care. After a
year or so, all voluntary "savings" were gone and the
bad old days of skyrocketing costs were back.

Secret Bailout

It's bailout fever now; every corporation and industry
wants theirs. Some are out in the open like Wall
Street, American International Group and the
automakers. One big corporate bailout is secret,
disguised as a uniquely American way of doing business.

I'm talking about the for-profit corporate sickness
insurance industry. An industry that takes in money,
lots of money, much of it from us, the taxpayers, and
in return pays for as little health care as possible to
maximize profits for their investors.

It is strange to listen to the Members of Congress
criticize the Big Three automakers, when at the same
time they not only continue to support, but even
propose expanding the for-profit, corporate health
insurance industry. At least automakers make something.
They have the capability to retool and build better and
more efficient cars, light rail, solar panels or even
better mousetraps.

Strategy for Passage

There are two issues on the table. First is the fate of
the various "reform" bills as they continue to be
introduced and move through Congress, and second is the
strategy for actually passing reform this year.
Watching the same mistakes that killed the Clinton-era
reforms being made again -- by Democrats and Republicans
-- is painful.

There are three health reform choices being proposed
this year. One choice is the completely public option,
universal, single-payer social insurance, which the
president and Congress are trying very hard to keep
"off the table." The middle ground has an insurance
mandate with an individual choice of either private,
likely for-profit, insurance or a public insurance
plan, for example, buying in to Medicare. The third
option provides the least choice, a mandate to buy
private insurance.

This is where strategy matters. By leaving the
universal, social insurance option out of the debate,
it is easier for the industry, media and some Members
of Congress to paint the mixed public-private plan as
an extreme rather than what it is -- the middle ground.
And while not ideal, the mixed plan is a place for
Congressional compromise.

Why are powerful people afraid to give us the right to
choose a public plan? Are they afraid we will learn
that more than $1 billion every day is wasted on
insurance overhead? Or that more than a trillion
dollars bleeds from the health care system every two
and a half years -- money not spent on health care but
on insurance administration, advertising, marketing and
corporate profits?

In surveys of the American people, Medicare is always
ranked as the best and most popular government program.
If Congress fails to enact a universal social insurance
plan, enrolling in Medicare or a new public program
must be a choice for the uninsured and underinsured.

If we are lucky, we will see real courage from Congress
this year. Every Member knows that sooner or later,
because of the economics, the United States will join
the rest of the developed world and create a national
health plan. This is privately conceded even by the
biggest insurance industry boosters on Capitol Hill.
Without real reform, there will be more tinkering at
the edges until the tsunami of medical costs finally
forces the government to do the right thing.

During these challenging economic times, we have the
chance to complete the promise of full social
insurance. Universal access to health care has been
deferred for 74 years since it was stripped from the
Social Security Act of 1935 -- and that is long enough.

Carol Miller is a rural and public health activist who
lives in a small village in Ojo Sarco, N.M. Miller has
public service in Washington, D.C., in both Republican
and Democratic administrations, including the Clinton
Health Care Task Force. In 1994 she was the health
reform policy adviser for the National Rural Health
Association and the New Mexico secretary of health.