THE TREATMENT SEPTEMBER 8, 2009
Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.
Have you ever been in an alley fight with three muggers while your sanctimonious non-helping cousin berates your poor fighting skills from a nearby window? Me neither. I feel like I have, though, listening to the shadenfreude coming from some single-payer advocates on the sidelines of the current health reform debate.
This morning’s New York Times provides a prime example, in a short interview with Dr. David Himmelstein of Physicians for a National Health Plan. He and the group he co-founded deserve credit for their long advocacy of a single-payer plan. They deserve less credit for their unhelpful and sometimes inaccurate stance in this critical moment of the fight for both a huge progressive reform and the Obama presidency.
This morning, Himmelstein was asked about the critical problem of medical bankruptcy, a subject to which he has contributed valuable research.
A reporter asked: "Would any of the plans under discussion on Capital Hill reduce the rate of medical bankruptcies?"
Himmelstein responded: "Only the single-payer plan sponsored by Representative John Conyers, Jr. and Senator Bernie Sanders. The others pretty clearly do little or nothing for medical bankruptcy." [italics added].
Before further comment, I should say that I see considerable merit in the single-payer system Himmelstein desires. Certainly from a public health perspective, single-payer would be vastly preferable to our current system. Give me ten more progressive senators, and we’d be having a different conversation right now. In the world we actually live in, we are in a tough fight to pass imperfect, but quite valuable bills that would do a lot of good.
For all their imperfections, the bills now under debate could have a particular impact on one problem: medical bankruptcy. To see why, consider the predicament of a family of four earning $55,000 per year.
That family isn’t poor, but they aren’t affluent, either. Their income puts them at about 250% of the federal poverty line. Right now, millions of families in this income band are uninsured. Millions more are underinsured, though they don’t always know it.
Suppose someone in this family gets cancer or is in a car wreck and runs up a $300,000 bill. Right now, that family is quite likely to be crushed. Under HR3200, this family could obtain health coverage that has a maximum monthly insurance premium of about $322 per month. Moreover, their maximum monthly out-of-pocket medical expenses would be $368. And when that family member recovers, that family could continue to buy coverage without facing market discrimination based on preexisting conditions.
Is the bill perfect? No. Would it be a vast improvement over what pertains today? Yes. Would it provide significant economic help to millions of working people with modest incomes? Yes. Would it keep many families like these out of medical bankruptcy? Almost surely, the answer is yes. Whatever the virtues of a single-payer structure, many countries that don’t have it have nonetheless built strong and equitable financing systems that address this problem. Our country could do the same.
I don’t blame single-payer advocates for pushing their own bill, HR676. Still, I am am baffled by the apparent hostility with which some single-payer advocates regard current health care reforms. I am also baffled by the apparent equanimity with which some regard the prospect of these measuring going down to defeat—a defeat that would badly damage the Obama presidency.
Wake up guys. We need the help.