Himmelstein & Woolhandler p. 681 on HC reform (Trenton & Liz)
Summarize the essay, raise questions for discussion, tie to your exam question on Justice and HC. You'll probably want to email beforehand to create your joint presentation, and then post here.
Himmelstein and Woolhandler, the authors of the essay, argue that single-payer national health insurance (NHI), as opposed to incrementalism, is a much more practical option than the media leads us to believe. They contend that our current health care system is not doing its job, and the most effective way to fix this problem is to completely eliminate private health insurance, and replace it with universal coverage. This cannot be done in small steps (aka incrementalism), but rather must be done all at once. Universal NHI will cut overall health care costs while providing coverage to the 18 million individuals who are currently uninsured. Those who oppose NHI claim that it cannot possibly decrease costs while expanding coverage. This may be true if an incrementalist approach is taken to implement NHI, which would require vast amounts of new funding to the poor, while bureaucracy continues to eat away at health care funds. Additionally, the incremental system aims to expand coverage, which means increasing costs or reallocating resources throughout the system, both of which are not ideal considering the U.S. already has health care costs double of any other nation. Thus, a straightforward approach to NHI would eliminate much of this bureaucratic burden, which currently accounts for nearly 30 percent of our health care budget. By doing away with clerks and administrative jobs as well as the profit and overhead that private health insurance companies keep for themselves, nearly all health insurance funds will be used to directly finance health care to patients. This huge elimination of jobs means current workers will need to be retrained and placed into useful positions within the reformed health care system. By significantly decreasing the amount of misused funds, NHI would allow all citizens to be insured while providing better coverage to current insurance holders and decreasing the overall cost. Furthermore, there are several other benefits of single-payer health insurance. As mentioned above, single-source payment through a public insurer would greatly reduce the huge amounts of paperwork and billing currently associated with health insurance. Secondly, those who lost their job or became ill would not need to worry about losing their insurance. Third, the insured would be able to choose between multiple providers, but all under one system. Also, many services that are not currently covered, such as long-term care and prescription drugs for the elderly, would be included. Finally, the overall focus would shift from causative to preventative medicine, as there would be need for patients to worry about expensive doctor visits. NHI has excelled when used in the health care system of other nations; all nations with NHI have lower health administration costs than the United States. Canada is a good example of the cost benefit of NHI. Although health care in Canada provided insufficient coverage to the poor in the 1990s, this was due to a lack of government funding. A national health insurance program in the United States would save at least $140 billion annually, enough to fully cover the uninsured and upgrade coverage among those now underinsured, so a lack of government funding would not be an issue as long as these savings were used wisely.
The end of the essay delves into the current (for that time) political situation. The paper was written during Bush’s presidency (~2002), where the government shifted from Democratic to Republican-controlled. The authors spend some time discussing voucher schemes (related to Bush’s “premium support”) and how people see its downfall in the fact that it doesn’t stabilize the health care system or provide good enough care to ensure workers’ productivity. This makes NHI attractive to some cooperate leaders and many smaller businesses. Himmelstein and Woolhandler close the essay by urging people to “break the iron curtain of media and political silence on NHI” (685), insisting people fight for NHI like Rosa Parks did for her seat on the bus. Presenting these concepts in modern day 2013, the new political climate and the installment of “ObamaCare” means that things are very different now, compared to when the article was written. ObamaCare, or the Patient Protection and Affordable Care Act, gives citizens a choice between private and public health insurance. Although this is much closer to NHI than the previous health care system, it is not what the authors are promoting. Himmelstein and Woolhandler call for a complete and immediate switch to single-payer insurance, rather than this “half and half” system that we are currently under. ObamaCare is sort of a compromise between the authors’ approach and the incrementalist approach. Instead of taking small steps toward NHI, it takes one gigantic step, but doesn’t make it the whole way. I believe Himmelstein and Woolhandler would agree that this health care system stuck in limbo does not accomplish what a full-fledged NHI system would. Although the number of people under private insurance will be significantly decreased, the huge administrative costs of these companies will still be there. The economic impact of ObamaCare is still to be determined, but according to the line of reasoning expressed in this article, it is doomed to fail.
Questions: The article notes that "A single-payer reform would eliminate the jobs of hundreds of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers must be guaranteed retraining and placement in meaningful jobs." (682) But with so many jobs eliminated and so few opening up under the proposed NHI, this seems like a nearly impossible task. Do the authors really believe that hundreds of thousands of workers could be re-implemented into a health care system that no longer needs these jobs?
Competition is what creates the atmosphere in the current health care system that is constantly and efficiently making new medical breakthroughs. Useful drugs and effective treatments are rewarded with huge profits. Under an NHI system that doesn't use competition to its advantage, what will be the motivation behind the health care industry?
If health care is essentially free, the total cost of health care will increase. Instead of seeking medical attention when it is really needed, patients will pay a visit to the doctor over any minuscule concern they may have, and there will be no financial repercussions to doing so. We would see an increase of preventative health care, but don't you have to draw the line somewhere about what is preventative and what is superfluous?
How has the political and socioeconomic climate changed since this article was written (in 2003)? Do you think Obamacare is a more suitable plan than the complete NHI package proposed in the article? Are either of these models similar to your idea of an idea health care system?
Himmelstein and Woolhandler, the authors of the essay, argue that single-payer national health insurance (NHI), as opposed to incrementalism, is a much more practical option than the media leads us to believe. They contend that our current health care system is not doing its job, and the most effective way to fix this problem is to completely eliminate private health insurance, and replace it with universal coverage. This cannot be done in small steps (aka incrementalism), but rather must be done all at once. Universal NHI will cut overall health care costs while providing coverage to the 18 million individuals who are currently uninsured.
ReplyDeleteThose who oppose NHI claim that it cannot possibly decrease costs while expanding coverage. This may be true if an incrementalist approach is taken to implement NHI, which would require vast amounts of new funding to the poor, while bureaucracy continues to eat away at health care funds. Additionally, the incremental system aims to expand coverage, which means increasing costs or reallocating resources throughout the system, both of which are not ideal considering the U.S. already has health care costs double of any other nation. Thus, a straightforward approach to NHI would eliminate much of this bureaucratic burden, which currently accounts for nearly 30 percent of our health care budget. By doing away with clerks and administrative jobs as well as the profit and overhead that private health insurance companies keep for themselves, nearly all health insurance funds will be used to directly finance health care to patients. This huge elimination of jobs means current workers will need to be retrained and placed into useful positions within the reformed health care system. By significantly decreasing the amount of misused funds, NHI would allow all citizens to be insured while providing better coverage to current insurance holders and decreasing the overall cost.
Furthermore, there are several other benefits of single-payer health insurance. As mentioned above, single-source payment through a public insurer would greatly reduce the huge amounts of paperwork and billing currently associated with health insurance. Secondly, those who lost their job or became ill would not need to worry about losing their insurance. Third, the insured would be able to choose between multiple providers, but all under one system. Also, many services that are not currently covered, such as long-term care and prescription drugs for the elderly, would be included. Finally, the overall focus would shift from causative to preventative medicine, as there would be need for patients to worry about expensive doctor visits.
NHI has excelled when used in the health care system of other nations; all nations with NHI have lower health administration costs than the United States. Canada is a good example of the cost benefit of NHI. Although health care in Canada provided insufficient coverage to the poor in the 1990s, this was due to a lack of government funding. A national health insurance program in the United States would save at least $140 billion annually, enough to fully cover the uninsured and upgrade coverage among those now underinsured, so a lack of government funding would not be an issue as long as these savings were used wisely.
The end of the essay delves into the current (for that time) political situation. The paper was written during Bush’s presidency (~2002), where the government shifted from Democratic to Republican-controlled. The authors spend some time discussing voucher schemes (related to Bush’s “premium support”) and how people see its downfall in the fact that it doesn’t stabilize the health care system or provide good enough care to ensure workers’ productivity. This makes NHI attractive to some cooperate leaders and many smaller businesses. Himmelstein and Woolhandler close the essay by urging people to “break the iron curtain of media and political silence on NHI” (685), insisting people fight for NHI like Rosa Parks did for her seat on the bus.
ReplyDeletePresenting these concepts in modern day 2013, the new political climate and the installment of “ObamaCare” means that things are very different now, compared to when the article was written. ObamaCare, or the Patient Protection and Affordable Care Act, gives citizens a choice between private and public health insurance. Although this is much closer to NHI than the previous health care system, it is not what the authors are promoting. Himmelstein and Woolhandler call for a complete and immediate switch to single-payer insurance, rather than this “half and half” system that we are currently under. ObamaCare is sort of a compromise between the authors’ approach and the incrementalist approach. Instead of taking small steps toward NHI, it takes one gigantic step, but doesn’t make it the whole way. I believe Himmelstein and Woolhandler would agree that this health care system stuck in limbo does not accomplish what a full-fledged NHI system would. Although the number of people under private insurance will be significantly decreased, the huge administrative costs of these companies will still be there. The economic impact of ObamaCare is still to be determined, but according to the line of reasoning expressed in this article, it is doomed to fail.
Questions:
The article notes that "A single-payer reform would eliminate the jobs of hundreds of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers must be guaranteed retraining and placement in meaningful jobs." (682) But with so many jobs eliminated and so few opening up under the proposed NHI, this seems like a nearly impossible task. Do the authors really believe that hundreds of thousands of workers could be re-implemented into a health care system that no longer needs these jobs?
Competition is what creates the atmosphere in the current health care system that is constantly and efficiently making new medical breakthroughs. Useful drugs and effective treatments are rewarded with huge profits. Under an NHI system that doesn't use competition to its advantage, what will be the motivation behind the health care industry?
If health care is essentially free, the total cost of health care will increase. Instead of seeking medical attention when it is really needed, patients will pay a visit to the doctor over any minuscule concern they may have, and there will be no financial repercussions to doing so. We would see an increase of preventative health care, but don't you have to draw the line somewhere about what is preventative and what is superfluous?
How has the political and socioeconomic climate changed since this article was written (in 2003)? Do you think Obamacare is a more suitable plan than the complete NHI package proposed in the article? Are either of these models similar to your idea of an idea health care system?