It's understandable if you thought universal health care died with the 1994 elections that put Newt Gingrich and the "Contract with America" in power.
But advocates of single-payer health care have been re-examining the idea in Ohio and across the country. While health care companies have been scaring Americans for years by shouting "socialized medicine," "health care rationing" and other phrases, a group of doctors, union members and progressives from northern Ohio have found something is amiss. For starters, they say:
·Nearly every other industrialized country has some form of universal health coverage.
·Americans spend about twice as much as nearly all of those countries do on health care, according to As Sick As It Gets, by Dr. Rudolph Mueller.
·About 30 percent of U.S. health care spending goes to administrative costs, compared to about 10 percent in other industrialized countries.
·Forty-four million Americans have no health coverage and another 30 million are under-insured.
Not like buying soup
Jerry Gordon, a retired union organizer from Cleveland, is the secretary of Single-Payer Action Network Ohio (SPAN Ohio), a grassroots group that wants the Ohio Legislature to create a universal health care system.
One way to get there is through a single-payer system. Gordon personally favors a plan that doesn't turn doctors and hospitals into state employees but turns the government into a health insurance company that collects taxes instead of premiums.
"The government would not run the health care system," Gordon says. "All the government would be is the agency for paying the bills — just like Medicare."
Of course, that means private insurance companies would lose all their Ohio business. About 1 million Americans work in the health insurance industry.
"We know there are insurance companies who will fight this tooth and nail," Gordon says. "They are going to be eliminated from the system."
SPAN Ohio is circulating a petition calling for a universal health care system in Ohio. So far it's won endorsement from 66 doctors, dozens of unions, a few members of Congress, many local governments and other groups.
Gordon wants SPAN Ohio to have branches all over the state. He's getting help from four Tristate residents — a non-practicing gynecologist, a doctor at Children's Hospital, a retired library worker and a federal employee who is a union activist. They're organizing a visit by Dr. Jonathan Ross of Toledo, former president of Physicians for a National Health Program. Ross speaks at 7 p.m. Oct. 3 in Room E-351 of the Medical Sciences Building at the University of Cincinnati College of Medicine. He is the associate chairman of internal medicine at St. Vincent Mercy Medical Center in Toledo.
It's a mistake to treat health care like a free market, according to Ross; buying health care isn't like buying soup. Patients don't decide how much health care they're going to need, how much they're willing to pay and when they're going to need it.
"The only decision you really get to make is to walk into the doctor's office," Ross says. "It's not a normal marketplace. It never will be."
Ohioans need to educate themselves about these issues, according to Bob Park, a labor organizer who studies worker safety for the National Institute for Occupational Safety and Health.
"At this point, we're really just trying to get some discussion started," Park says.
The first fundamental change is to get Americans to see health care as a right, not an optional purchase, Gordon says.
'The system is being crushed'
In the early 1990s, experts argued the rise of health maintenance organizations (HMOs) and a wave of hospital privatization would save people money.
"The notion was that getting big would lead to economies of scale," says Ross, who was medical director of the Family Health Plan, a non-profit HMO, from 1984 to 1998.
For much of the 1990s, premium increases slowed or stopped. But then double-digit annual increases returned. Part of the problem is health insurance companies don't always have patients' best interests in mind, Ross says.
"Insurance is a game of Old Maid," he says.
The trick to making money is to not treat sick patients.
Ten percent of people account for 70 percent of medical expenses and 5 percent of people account for 50 percent of medical expenses, according to Ross.
"And basically the insurance companies have lots of crafty ways to avoid them," he says.
While the nation's 1,500 private health insurance companies argue unhappy patients can take their business elsewhere, Ross says about half of U.S. workers only have one employer-backed health insurance company to sign up with.
But Ross isn't painting a complete picture of the U.S. health care system, according to Joe Bobbey, spokesman for Anthem, the nation's fifth-largest health insurance company. You can't blame insurance companies for all cost increases, Bobbey says. For example, hospitals and doctors seek fee increases and prescription drugs are increasingly expensive for an aging population.
"The question is, where is the true evidence that (single-payer) will address the issues facing health care costs?" Bobbey says.
What are the problems faced by other countries' health care systems?
"There is a high quality of health care in this country," Bobbey says.
Certain surgeries have waiting lists in Canada, but that's the government's way of measuring demand and supplying needed services, Ross says. Stories about Canadians traveling to the United States for surgery involve wealthy people jumping line rather than seeking better doctors, he says.
Gordon acknowledges a single-payer system would impose limits on care. But he points to the example of countries that already have universal health care.
"I don't mean to say there wouldn't be controls," he says.
Prescription drug prices would have to be regulated, according to Gordon.
Wouldn't the sudden influx of new patients overburden Ohio's hospitals? Two million of Ohio's 11 million residents have no health insurance.
"I think we're going to have to see about that," Gordon says.
It's easy to criticize health insurance companies about administrative costs, but some of those dollars pay for programs to remind women to get breast exams and to educate people on how to live with diabetes, according to Mohit Ghose, spokesman for the American Association of Health Plans, an industry group.
Ghose says we also need to be aware of the potential effects a single-payer system could have on health care innovations.
"We need to debate what we want to do as a nation," he says.
"So far single-payer is just a concept," Bobbey says. "There's a lot of unanswered questions about how that is going to work."
Gordon, Ross, Park and others acknowledge as much. But they also believe sticking with our current system makes even less sense.
"It just seems like the whole system is being crushed by its own weight," Park says.
For more information about single-payer health care, visit Single-Payer Action Network Ohio at www.spanohio.org, the American Association of Health Providers at www.aahp.org and Physicians for a National Health Program at www.pnhp.org.