In November the train is leaving the station, and those working in the
health care industry, be it insurance, pharmaceuticals, device manufacturers or professional groups had better either leap aside or ride the coach car. Universal single payer health care is an unstoppable express. Will you ride that train?

As a physician involved in administration and in starting up an HMO, I know that people in the health care industry are good people just living by the rules that our democracy prescribes for us to advance our business. The government allows us to redress grievances, and so we all have tried hard as any business to influence legislation to favor our products. This is not wrong in law, nor is it morally or ethically wrong—wouldn't you agree?

Well, get ready for some real change; there is a rumble building. If you
adapt, you will do fine. But adapt you must. The results of every polling agency indicate that, after Iraq, the number one concern of the American people is the cost of health care. You all know the numbers by now. A school superintendent whom I know recently heard from his insurance agent and told to expect another "usual" 21% increase in the health policy for next year. Well, this is not a "normal or usual" condition in the minds of people buying this product. If you think it is normal, you'll miss the train.

This November, I predict a Democratic House and, maybe, if our leadership still does not exercise prudence, the Senate will turn Democratic as well. A single payer, universal health plan will be introduced in that Congress. A major sea change, it will not be the usual tweaking of health care, such as we see in the Democratic House Caucus Platform, or the Republican-driven Medicare part D drug plan. Citizens have had it with those piecemeal riggings and are pushing for an engine of real change.

Two types of plans will be introduced.

First, we will see a single payer universal plan that involves only showing a card and getting health care from a provider. The government will add an income tax, most likely around seven percent. It will basically be Medicare for all and will be an extension of the current system. Special interests in the health care field will all insist on and get their input, and, in my opinion, we all will get poorer care, more expensive care, less available care, and we will probably head for bankruptcy of this system in double time. Drugs will be purchased as per Medicare part D, with little competitive component. Doctors will howl for more money and the American Hospital Association will howl they need an increase of rates. The fifteen percent of our GDP spent on health care will rise—and it is already twice that of other industrialized countries, only for shorter life expectancy—and we will be in even more of a financial mess or—

Second, a single payer universal plan that still involves a card but is not
administered or funded by the government will be offered. There is such a proposal already laid out, and it is called Health Security America. Under this system, the government has an extremely circumscribed role: to authorize and fund start-up, and to determine the poverty level and pay the premiums of the indigent to the resulting non-profit health insurance company. We pay for wintertime fuel for the poor so that they don't freeze; the same reasoning will be advanced to health care. The non-profit corporation Health Security America, Inc. will be governed by elected citizens listening to all Americans in a hearing process, then setting premiums and coverage. A significant by-law of this corporation will be the forbiddance of long-term debt.

The insurance industry will have much more influence in the first scenario. But if you choose it, you will limp along in an extension of the current failed system. I urge you to consider the second option and invest in the greatest good for the greatest number, not just for your company. In the end, taking the long view will strengthen your business and strengthen America.

Implementing the second option will alter your game plans, but in a controlled, and more importantly, sustainable way, involving a health care policy that does not widen the budget deficit, does provide high quality care, and will cost clients at least 50 percent less than a typical premium does today. The insurance companies will sell the policy at a low mark-up and provide add-ons for those who want more than the
basic policy agreed on by all citizens. I urge you to read about it the plan’s manual, Health Security America: Fixing the health care crisis.

Riding in the Pullman car is no longer feasible. The insurance industry, the drug industry, professional groups and others will all have a berth, but of course any such change will be a bit uncomfortable. You must use your hard common sense in choosing what to do.

Fred Bannister, M.D.
Chetek, Wisconsin
July 2006

This op-ed also appeared in the Milwaukee Journal-Sentinel Online

Health Security America is the remedy.

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