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David Danbom, Published November 22 2009

Danbom: Health reform, yes, but

The other day I – and presumably lots of you – received a letter from Blue Cross Blue Shield of North Dakota putting in its two cents’ worth on health care. Actually, it was our two cents’ worth, since they used our premium dollars to propagandize us, but I digress.

BCBSND assured policyholders that “health reform needs to happen” but that none of the legislation currently being considered fills the bill. Prior to this, I hadn’t realized BCBSND was such a steadfast advocate of reforming our health care system.

BCBSND has now thrown in with the other health insurers in the country, some segments of the pharmaceutical industry, the U.S. Chamber of Commerce, and even congressional Republicans, all part of the “health-reform-needs-to-happen-but” coalition.

Nobody who knows anything about the various health care initiatives being considered in Washington these days would say that any of them is perfect. Legislating is a messy business. The question is whether we can do something that will improve our situation.

At present we spend twice as much on health care as a percentage of gross domestic product than any other developed country. Despite that expenditure, we rank 34th in the world in life expectancy and 29th in infant mortality. And lest we forget, 44,000 of our fellow citizens die every year because they lack insurance. It’s hard to imagine we can’t do better.

We don’t really know what the “health-reform-needs-to-happen-but” crowd would give us in place of what’s being considered. Part of the reason is that they are divided among themselves, and part of the reason is that some of them are frankly disingenuous and have no interest in any reform at all. But we can get a clue as to what their “reform” might look like by reflecting on what happened the last time the health insurers, big pharma, and the Republican Party were in the saddle. That’s when they gave us the Medicare Prescription Drug, Improvement, and Modernization Act, passed in 2003.

This legislation created Medicare Part D, the prescription drug benefit for senior citizens. It addressed a real problem, but it is important to recognize how it addressed it. Seniors participating in the program did so through private insurers offering Medicare Advantage plans. The private insurers received a government subsidy for offering these plans. In other words, the taxpayers pay private insurers to make money. Big pharma benefited from Medicare Part D, too. Not only did the drug companies expand their customer base, but the federal government was forbidden from negotiating prices with them. Walmart negotiates with pharmaceutical companies on behalf of its customers, but Uncle Sam can’t negotiate with them on behalf of taxpayers. Total estimated cost of this health care “reform”? $724 billion in the first 10 years.

So we can get some idea of what a “health-reform-needs-to-happen-but” reform package would look like. It might improve health care, lower the death and infant mortality rates, and cover more people, but it would likely do so by looting the public treasury and pouring taxpayer money into corporate pockets. Do you really prefer that to what we’re looking at now?


Danbom is a college professor of history and occasional contributor to The Forum’s commentary page.