Listening to the Republican candidates for president, you might believe that national health insurance is really a plot to institute Soviet rule in the United States. The Republicans warn against “socialized medicine,” and the most feverish rhetoric comes from Mitt Romney and Rudolph Giuliani, both hoping that their shrillness will prove at last that they are truly and deeply right wing—and that they can avoid honest debate about the future of American health care.
For Mr. Romney, health reform is a double-edged subject. As the former governor of Massachusetts, he claims credit for that state’s new universal care program—which he calls “fabulous”—but he fears being labeled liberal. His solution is simply to ignore the actual provisions of the legislation that he signed and pretend that providing care for everyone has nothing to do with big government. “This is a country that can get all of our people insured with not a government takeover, without HillaryCare, without socialized medicine,” proclaimed Mr. Romney during a Republican debate this past spring. “We didn’t expand government programs.”
Actually, his fabulous Bay State plan is based entirely on governmental action, from mandating insurance coverage and minimum coverage requirements to subsidizing insurance and imposing fines on those who fail to comply.
Perhaps Mr. Romney needs medical attention himself, since he already seems to be suffering from Alzheimer’s disease. This isn’t the first time his capacity to recall facts about his own career has dimmed out.
As for Mr. Giuliani, he, too, sees the frightening specter of foreign ideology in proposals for universal health care, which he denounced the other day as “socialist” schemes that “would bankrupt the government.” According to him, the Democrats are conspiring to impose the same kind of systems preferred by citizens across the industrialized world. “That is where Hillary Clinton, Barack Obama and John Edwards are taking you,” he thundered. “You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care.”
The Giuliani alternative is a retread of rejected Bush administration proposals that rely mainly upon that old reliable Republican panacea, dressing up more tax cuts for the affluent as “health savings accounts.” Knowing that such a program would do little or nothing to cover more than 45 million uninsured Americans, he suggests a federal subsidy to help people buy insurance. But he won’t say how much or how he would pay for that plan.
Neither the Romney nor the Giuliani proposals would accomplish the modernization and reform that the nation needs, and neither would ever reach universal coverage. What they might achieve is a multibillion-dollar giveaway of taxpayer funds to the insurance industry. In Massachusetts, the bids for subsidized coverage from major insurance companies are already much higher than Mr. Romney predicted, and many fewer uninsured have enrolled than he expected (but those problems have been left for a Democratic governor to solve).
Honest discussion of the American health care system would begin by recognizing that government plays an important role now and will continue to do so. No candidate is proposing to do away with Medicare, Medicaid and the Veterans Benefit Administration. Despite their consistent underfunding, those systems achieve efficiencies that the private sector cannot match.
When politicians decry the health care systems in France, Britain, Canada and other industrialized countries as “socialist,” they’re insulting the intelligence of voters. They assume that nobody here knows that voters in those capitalist nations overwhelmingly support their national health systems—which happen to spend far less money per capita than ours while providing more care. Even the most conservative politicians in Europe do not dare to suggest replacing those universal public systems with a system of expensive, privatized chaos such as ours.
While health care is a highly complex matter, the reason that other countries can afford to cover all of their citizens—while spending a smaller portion of their national income than we do—is fairly simple. As a study by Physicians for National Health Program revealed, more than 30 percent of health care costs in the United States represent corporate profit and useless paperwork. Roughly 20 percent goes to insurance companies alone, which burn enormous amounts of money finding ways to deny care to their policyholders. Multiply those costs for profit and “management” by the numerous insurance companies with which every hospital and doctor must cope simultaneously, and the result is an ongoing nightmare of corporate bureaucracy and paper-shuffling waste.
Americans have endured the excessive costs, skewed priorities and terrible inefficiencies of our outmoded health care system for decades while other advanced nations surpassed us. Now our basic industries and our future solvency are threatened by our failure to address this issue realistically and fairly. We need reforms that encourage preventive care, wring out bureaucratic waste, utilize information technology and guarantee the security of every citizen. Scary talk about socialism won’t get us there.