Junius Fils The American People 22 August, 2011 Ladies and Gentlemen: While MEDICARE has changed over the years, its basic problem remains. It concentrates upon providing coverage to the elderly and disabled. By disabled, I mean the obviously disabled. This leaves a substantial (and growing) portion of the population with either inadequate health insurance coverage or, due to the high cost of coverage, no coverage at all. At this point, I will remind you of the TWO aspects of medical care I mentioned earlier and which were, much more eloquently, described in Starr, Paul. The Social Transformation of American Medicine, The Rise of a Sovereign Profession and the Making of a Vast Industry. New York: Basic Books, 1982. (P) on Pages3-4. Opponents of health care reform, as I mentioned in an earlier letter, have (brilliantly) succeeded in confusing the medical PROFESSION with the medical INDUSTRY. They then loudly claim that anything which involves regulation of the INDUSTRY will harm the PROFESSION. The experience of the rest of the world proves them wrong, but this has not stopped them. Opponents of reform screech early and often that the United States has THE BEST HEALTH CARE IN THE WORLD (referring to the PROFESSION and, incidentally not necessarily true) and that reform of the INDUSTRY will destroy it. A year or two ago (Ive forgotten exactly when and Im not going to bother looking it up) I stated in a letter that the best health care in the world might as well exist on the moon if you do not have access to it. At this point, some of you might want to go get a drink and sit down, for I am about to say some favorable things about Richard Nixon. Nixon was about as free-market as you can get, but, influenced by the history of his family as relates to catastrophic health care expenses, he had a certain sympathy with those suffering from them. During the Kennedy-Nixon campaign, Nixons proposed National Health Insurance Partnership Act took a regulatory approach that encouraged the private insurance market. It centered on an employer mandate where employers would either provide health insurance for their employees directly or pay taxes to insure them THROUGH A GOVERNMENT PROGRAM .Nixons plan would also provide planning grants and loan guarantees for prepaid group practices called health maintenance organizations (HMOs). (Quadagno, Jill. One Nation, Uninsured, Why The U.S. Has No National Health Insurance. New York: Oxford University Press, 2005. (P), Pages 114-115)(Emphasis added). HMOs were, initially, seen as nonprofit organizations. They did not stay that way. During Nixons second term, Nixon proposed a similar plan, again involving administration by the health care/insurance industry. Nixons self-inflicted wounds concerning the Watergate scandal, put an end to any significant health care reform during the remainder of his administration. President Ford, one of the most decent men ever to hold the office of president, did not have enough time in office to have a significant impact on the subject of health care reform Fords replacement, the much and unjustly maligned Jimmy Carter, was the next to try to fix the problem. His plan was limited to cost control and was initiated by Carters Secretary of Health, Education, and Welfare, Joseph Califano. The plan Califano devised would limit yearly rate increases to one and a half times any rise in the consumer price index, with a cap of 9 percent. Note that rate increases would STILL be allowed to be more than inflation. So that hospitals couldnt just shift costs from Medicare patients to privately insured patients to compensate, the cap would apply to all private payers as well. As soon as the plan was announced, the hospital lobby began gearing up to thwart what one industry leader called its most serious challenge. (Quadagno, Page 125) Evidently, a profit of ½% over the rate of inflation was not big enough. The plan died in committee after a massive industry campaign. Any health care reform, even the minor one of cost containment, under the Carter administration was dead on arrival. As we all know, Carter was defeated by Ronald Reagan To be continued. I am, Ladies and Gentlemen, your most humble and obedient & etc Junius, fils
