Smoking kills. So does the health insurance industry. In the 20th century our tobacco industry, threatened by newly revealed associations between its product and a lung cancer epidemic, diverted public discussion from the cancer consequences of cigarettes to a multitude of highly charged and largely irrelevant issues. They succeeded so well that even now, fifty years after the first assaults, it still freely sells its dangerous products around the country with only minor packaging concessions. Now in the 21st century, our health insurance industry, similarly threatened by an impeding financial and health calamity from its product, has diverted public discussion from providing essential health care at affordable prices to a variety of distracting issues. And with similar success - the health insurance industry stills ride a crest of prosperity that is the envy of other industries. What's the difference? Tobacco only affected the 40% of the population that smoked when the cigarette-cancer association began in the 1950s and the 20% that still do. The public crusade by the tobacco industry to discredit the medical findings allowed smokers without cancer to continue smoking, encouraged young non-smokers to begin the habit, and discredited the legal claims of debilitated smokers. But our health insurance industry affects everybody. It extracts over $1,000 annually from every citizen for its own administrative costs (not entirely devoted to lobbying and profit). This industry has caused 48,000 annual deaths from inadequate access to health care. Its denial of coverage to policy holders produced most of the 700,000 annual bankruptcies in the US last year. Its monopoly of health care financing is the single most important reason that the US ranks at the bottom of public health measures among industrialized nations. And our health insurance industry succeeded as well in this century as the tobacco industry did in the last. Witness the "reforms" discussed seriously in Congress - all variations on a single theme: "Make every citizen buy our insurance at their own expense. If our prices are too high, make the government buy our insurance for them." Is this a great deal for the health insurance industry or what? What a victory for free enterprise. What a triumph for keeping the government out of essential services. But what about our health? We already outspend every other nation on health care and yet lead in not one measure of public health. Can it be that our doctors, nurses, and hospitals are that much worse than everywhere else? Our health insurance industry would have us believe so. They would have us believe that we still spend too little on insurance (their for-profit private health insurance), not because we spend too much. More government subsidies so citizens can buy more health insurance! And thank Congress for protecting us from government interference in health care! This is the best evidence of the industry's success - the intensity our Congress and their constituents devote to distracting issues - the role of government in private lives, how our American free enterprise system makes us special, whether tax dollars should fund abortion, why working people should provide free services to those who don't work, how illegal aliens sap our country's strength, the evil of socialist programs in foreign countries, and the inherent inefficiency of any government to run anything. In short, the industry successfully diverts all attention from the root problem - that our method of financing health care through for-profit private health insurance has brought American families and our government to the brink of catastrophe. Instead, the public debate is stalled on unsolvable peripheral issues. What can be done? We can refuse to be distracted. We can demand that our Congressmen focus on the task at hand - What have you done to provide essential health care to everyone regardless of ability to pay, employment status, or medical condition? We can wave aside answers that equivocate, that we'll deal with this as soon as we resolve the abortion issue, or the States' Rights issue, or the welfare abuse issue. We can insist that our representatives stay focused. With the health insurance industry spending $1.5 million each day to keep them, and us, distracted, focus is a lot to ask. But we must. We must regain the initiative. We must change the challenge confronting our Congressmen from "Make everyone purchase insurance regardless of ability to pay" to "Give essential health care to everyone regardless of ability to pay." Keep at it. Maybe Americans can fare better in their battle against the health industry behemoths in this century than we did against those of the tobacco industry in the last.
Published November 3, 2009 as the "“A doctor's view: escaping the maelstrom.” in Oregonian (on-line edition) and The Stump |
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