OpenForum – a blog by the Health and Human Rights community

Now that the President has officially designated the ongoing health care reform efforts as “health insurance reform,” we can stop the charade that this debate was ever about “care.” Or about health, for that matter. Oddly enough, the obsession with “coverage” – a potential mechanism to facilitate access to care – has not led to a serious consideration of the private insurance industry’s raison d’être, at least not beyond the community of single payer advocates whose voices are drowned in the constant drumbeat about a supposedly American – read: “market” – solution.

How are the current proposals for health insurance reform treating an industry that siphons off roughly $10 billion in annual profits? We now have two health reform bills reported out of congressional committees (”America’s Affordable Health Choices Act” in the House and the “Affordable Health Choices Act” in the Senate – using terminology pushed by Democratic pollsters, no doubt). Neither of them meets key human rights standards, and both cast private insurance corporations in the role of gatekeepers that control people’s access to care. At the same time, opposition is mounting against all and any reform measures.

Yet there continues to be great hope among many long-time health policy advocates that will we see meaningful health reform later this year. Advocates count on this reform to solve or at least alleviate the current health care crisis, which results in an estimated 22,000 preventable deaths due to lack of insurance each year, as well as skyrocketing costs that bankrupt families and public budgets alike. Pundits optimistically point to the many new measures the reform bills introduce: reining in the “free” insurance market through tougher regulation, including through a so-called Exchange mechanism; setting up a public insurance plan; expanding Medicaid; requiring employers to contribute to costs; and mandating everyone to buy insurance. All Americans (though not all immigrants – documented or not) will get health insurance – or so the hopeful want to believe.

Their hope is born out of desperation. Most advocates are painfully aware that health care is treated as a market commodity in the United States, and that market rules are stacked against those with little purchasing power. And these are usually the very people who need health care the most: poor people and people with serious health issues. In a blatant affront to the basic human rights principle of equity, minority groups and poorer communities in rural and inner city areas suffer disproportionally from market barriers to health care.

Reminders of the insurance industry’s power are everywhere: people who lack insurance, people whose claims are denied, whose coverage is rescinded, or who pay exorbitant premiums that may – or may not – preempt catastrophic bills but do not cover actual visits to the doctor. The business model of insurance companies only works if as many healthy people as possible buy policies and pay premiums that are as high as possible, and if those same people then forgo actually using the health care covered by that policy. None of this is news to mainstream health reformers, yet hardly anyone points to the emperor without clothes: because insurance corporations can profit only by restricting access to care, they act as hostile gatekeepers rather than as vendors of a value-adding service. In one of our news media’s rare instances of bluntness, a Paul Krugman blog in the New York Times explains that “private insurance basically spends a lot of money on socially destructive activities.”

Yet both Obama and congressional leaders remain worryingly silent on the role of the insurance industry, despite their rhetorical shift from health care to health insurance reform. Hence they struggle to devise a sustainable cost trajectory for their proposed reforms, which are weighted down by the immense costs of keeping private insurance corporations in business. These costs include profits and corporate salaries, plus the even greater amounts wasted on underwriting and marketing to exclude people who might actually need care, and on claims administration to deny care to those who have already paid for it. To help meet those costs, reformers have proposed a requirement on all individuals to purchase an insurance policy, which amounts to a massive bailout for an industry that has continued to make record profits and is accountable only to its shareholders. Such public subsidies to the industry, via policyholders, constitute the greatest cost factor in any of the bills under discussion, yet they fail to guarantee access to health care for all. Even under the best proposal, people would still have to pay up to 11% of their income in premiums for a skimpy policy, on top of co-pays and deductibles. These provisions illustrate that the economic costs of sustaining the private insurance industry can only be paid through the social costs of restricting access to care to those able to pay.

Always on public relations alert, all key industry players – hospitals, pharmaceuticals and insurers – claim to have made concessions that would curb the excesses of the market and sustain the policy consensus for commodified health care. Yet smoke and mirrors cannot hide that market-based health care is inherently unable to contain costs at the same time as ensuring access to quality care for all. Even the President accepts that universal coverage is not possible without a publicly funded and administered system, such as single payer, that automatically includes everyone. Such a system would treat health care as a public good rather than a market commodity, and enable access on the basis of need, not payment. Guided by the principle that basic human needs give rise to government human rights obligations, such a public health care system would be financed collectively in order to meet people’s health needs with equitably shared resources. Instead of providing profits and benefits to a few, a rights-based system would enrich everyone living in a healthier society.