Massachusetts has the most expensive model of paying for health care that the world has to offer. It’s a model that preys on our genuine need for health care insurance to insure the short term profits of large corporations.

If the current House or Senate bills were to pass they would move from covering 84% to 96% of us, while other industrialized countries cover 100%. We spend 17% of our GDP, or 2.5 trillion dollars a year, on health care, while they spend on average 8 to 9% of GDP; this is an excess of about a trillion dollars a year for us; the excess is more than our military budget. We rank behind most industrialized countries in terms of health outcomes. All this is true, in spite of our having some of the best health care in the world. Our current system of paying for health care does not work; the proposed reforms have improvements, but do not go to the root of the problem.

No country with universal coverage relies on private, for profit insurance to finance health care. They all have a variety of single, not-for-profit systems. One version is a single payer system where taxes are funneled through a single governmental agency to pay either private or public providers of health care. Other versions are networks of not-for-profit companies that administer the payments to providers so that all play by the same rules; they are more like claims processing entities than insurance companies as we know them in this country. In this way, they cover everyone and need much less bureaucracy. Citizens spend much less on health care, have the security of no bankruptcies due to medical expenses, and have better health outcomes. It’s a partnership of government and providers that works.

For years we’ve had the ironic situation in which, while the majority of us are covered by private insurance policies, the majority of health care is financially supported by government. Tax deductions, Medicare, Medicaid, SCHIP, the VA, the NIH, Federal Employee Health Benefit Plans and other programs pick up where private insurance is unwilling or unable. Subsidies and mandates will only compound the inefficient role that government has in financing health care through a system that tries to rely on for profit insurance.

Besides spending too much, we pay dearly in other ways because of our system of paying for health care:

— Yearly, we have 45,000 of our fellow citizens dying due not to being able to afford health care.

— Hundreds of thousand of us file bankruptcy every year due to medical expenses. This just doesn’t happen in countries with a single, not-for-profit system. 75% of those filing bankruptcy due to medical expenses had insurance when they got ill.

— We don’t support good preventive and primary care.

— Providers spend far too much time and overhead fighting with insurance companies and thus less with their patients.

— We don’t have the cradle to grave coverage that gives the long term incentive to do what maximizes health.

— We do have for-profit companies competing to avoid paying for health care; they’re for profit and collecting premiums and not paying for health care is how to maximize profit.

Our electoral process leaves legislators beholden to the dollars of big corporations to finance their elections. We’ve seen energy policies, financial deregulations, and health care financing reforms that are designed for the short term profit of a few individuals and corporations. Profits have been privatized, risks socialized. This is not the partnership that works.

We have the tradition of public education, public police and fire protection, roads, public libraries, national parks and many other communitarian endeavors that have wide-spread support and benefit. Yet for several decades we have been driven by the mantra, “government is the problem, not the solution”. There is truth to the statement, when government is beholden to the short term interests of private corporations.

We now have a country in which our soldiers are four times more likely to die after getting back home due to lack of affordable health care than they were in Iraq or Afghanistan. Can we move to a government that represents the wellbeing of the many, more than the short term interests of a privileged few?

The health care reform debate of the past year is a case in point. Single payer advocates, with proven plans to spend less and cover everyone, wanted to be part of the discussion; they were excluded. A robust public option has had majority support and would contain costs; it was whittled down and now is gone. For a few weeks, the ability of those 55 and older to buy into Medicare was floated; it’s gone.

Some say the health care reform was too ambitious. By relying on a system that is way too expensive and inefficient, it was too timid. Our legislators now will face the threat of health insurance companies free to spend as much on attack ads as they please.

We can be a country that looks out for each other in terms of health care. In the process, we can have secure coverage for us all and spend half as much on health care as we do now. To do so, we need to trust that our government be of, by and for us. We must insist on it.

Bill Semple

Bill Semple

Bill Semple, LCSW, has worked in community mental health for many years and now bills insurance companies for a living. These and other experiences inspire his working to shift our reliance on for-profit insurers to a single, not-for-profit system. He is a member of Health Care for All Colorado and is working on developing a single payer citizens initiative for the State of Colorado, as the legislative process does not appear up to the task.