The Elephant in the Room

Massachusetts stands at a crucial point in the push for health care reform. Gov. Romney and the state Legislature are in agreement about passing health care legislation to extend care to more of the 750,000 uninsured in Massachusetts. A driving force for reform is retaining current federal funding for Medicaid; Massachusetts stands to lose significant federal funding if legislation to cover more of the uninsured is not in place by June 2006.

As a result, the government is tinkering with the health care insurance system to try to cover more patients who do not have insurance.

Romney, Senate President Travaglini, and House Speaker DiMasi have each proposed their ideas for this “reform,” and the Legislature will hammer out the details.

Meanwhile, everyone is ignoring the elephant in the room. That would be the private health insurance industry, which siphons off a huge percentage of the health care budget. In fact, the United States would save $200 billion per year if this elephant were eliminated.

Private health insurance through employer-based plans, which all three of these Massachusetts legislative proposals would perpetuate, funds only 19% of the health care in the United States. The other 81% comes from taxpayer-funded public programs and private spending. Yet our legislators choose to support and take care of the private insurance companies, rather than the citizens of the Commonwealth.

For example, the nation’s largest private health insurer, Wellpoint, more than doubled its earnings in the third quarter of this year. Our state and national policies have been designed, and are continuing to be fashioned right now in Massachusetts, to protect and nurture the private health insurance industry, even though more and more burdens are being placed on employers, towns, patients, doctors, and hospitals.

Employment-based health coverage segregates a large sector of primarily healthy working individuals, and places them in a low-cost and low-risk pool for the insurance companies, while the state and federal governments pick up the costs of those with significant health care needs.

And what do we get for all the money that is funneled into the private health insurance industry? We get high administrative costs and exorbitant insurance company profits, while the price of insurance keeps going up and up, and patients are required to “share” more of the costs of their health care. (For example, the CEO of Blue Cross and Blue Shield of Massachusetts earned more than $3 million in salary and benefits in 2002).

Why don’t we extend government insurance coverage to everyone, and eliminate the middlemen? Why should administrative expenses consume 30% of the health care dollar, when a government program like Medicare takes only 3%?

Single-payer health care is the name for government-funded and administered health insurance; instead of many insurance companies, the government is the single payer. The legislation for single-payer health care in our state, The Massachusetts Health Care Trust, Senate Bill 755 (S.755), would cover everyone in the Commonwealth. But S.755 is not even on the negotiating table in this go-around for health care reform in the Legislature.

This affordable and comprehensive bill is the only one that meets the five criteria of the Institute of Medicine for coverage that is (1) universal (covers everyone), (2) continuous (not tied to a job), (3) affordable for individuals and families, (4) affordable for society, and (5) equitable and patient-centered (choice of doctors and hospitals). Yet single-payer legislation is being ignored by Romney and the state Legislature.

The insurance company elephant looms large; many politicians are ignoring it. Towns can do something about their out-ofcontrol costs, and citizens can create a grassroots movement to influence their politicians to legislate real health care reform. Suzanne L. King is a practicing physician and health care reform activist based in Lenox.