Excluding the Civic Community Excludes Life-Savers
By Ralph Nader
October 23, 2019
The lawmakers are doing it. The candidates are doing it. The mass media are doing it. All are excluding from their arenas the leading citizen groups as never before, since the early nineteen sixties. The nonprofit national advocacy/research organizations that led the way for social reforms are being shut out of the political process. These groups were pioneers in consumer rights, environmental protections, labor rights, and whistle-blower protections. These groups fought for freedom of information laws and practices and access to justice in ways that have made our country better in so many ways.
Television anchors like Judy Woodruff (The News Hour, PBS) and Chuck Todd (Meet the Press, NBC) prefer to interview reporters, political consultants or tired columnists, instead of knowledgeable civic leaders who use facts and speak truth to power.
One result of this marginalization is that the public discussion of key services and safeguards for the people is often vapid and fact-starved. For starters, the talking heads who are invited on news shows rarely, if ever, speak of the corporate crime wave, the corporate welfare scandals, or many preventable mass casualties that flow from corporate negligence and cover-ups. The few news articles on such subjects are often thin and untimely because reporters are not in regular touch with citizen groups, instead choosing to rely on irregular official leaks and occasional insider information.
Take, for example, the current discussion on Medicare-for-All or single-payer health insurance. The Democratic presidential candidates and other progressive lawmakers who support catching up with dozens of other industrial nations are not making the strongest case for this basic human right. They say that all Americans should have access to health care, referring to the unaffordable price of care.
The corporatists and some of these Democratic presidential hopefuls attack Medicare-for-All, asserting that the program would be prohibitively expensive by citing wild projections from biased think tanks. Bernie Sanders rebuts by proposing overdue restoration of higher taxes on the wealthy and big business. He asserts that whatever increases there are on the middle class would more than be made up by no longer having to pay health insurance premiums and out of pocket costs.
Moreover, most advocates of single payer do not stress the millions of ailments and injuries which persist because people cannot afford health insurance to get diagnosed and treated in a timely manner. According to the Wall Street Journal, roughly 30 million Americans are uninsured and 86 million Americans are underinsured. And about 40,000 of them die from that same deprivation each year. Such casualties due to lack of insurance do not happen in countries with universal insurance.
Furthermore, little mention is made of Canada’s far more efficient single-payer (public insurance, private delivery of care) that covers every Canadian at half the average per capita cost of that in the U.S. Canada also has free choice of doctor and hospital, in contrast to the cruel, narrow networks in the U.S.
Canada has better outcomes, less billing fraud by far and fewer casualties due to “medical error and negligence.” This is because the U.S. has a serious problem of over-diagnosis and over treatment, due to profit motives built into our chaotic, wasteful, corrupt, and profiteering system.
Single payer means one billing agent in Canada, not inscrutable bills from 1500 insurance companies with manipulated codes and discriminatory fees (for example, many hospitals charge the uninsured more in the U.S.).
In Canada, there is far less anxiety, dread, and fear about medical bills than in the U.S. Imagine what that is worth!
In the U.S. people worry that if they change jobs, they’ll lose their insurance. In Canada, physicians practice medicine, not complex bookkeeping. In the U.S., physicians plead for permission to treat their patients, while slow-paying insurance companies look out for their corporate bottom line.
The sheer administrative costs in the U.S. are, as a percentage of overall costs, more than double the administrative costs in Canada. Health care in Canada is on average less than $5000 average per capita per year; in the U.S. it has just soared over $10,000 per capita per year. Canada spends 10% of its GDP on health care and covers everyone; the U.S. is reaching 18% of GDP while leaving out tens of millions of people.
No one in Canada has to go bankrupt due to medical bills, as is the case half a million times a year in the U.S. Drug prices for the same drugs are lower in Canada than in the U.S. due to the bargaining power of Canadian single-payer system. Just in terms of correlating health care data, single payer detects what works and what doesn’t far better than the secret proprietary data of many U.S. insurance companies (which excessively compensate their executives). For example, in 2017, Aetna paid its CEO, Mark Bertolini, nearly $59 million as compensation (see the Hartford Courant article published on April 7, 2018). These salaries and compensation packages come out of your pockets, as do the co-pays, deductibles. The maddeningly complex fine-print exclusions add insult to injury.
In the U.S. people resort to GoFundMe campaigns to collect money for major operations that cost far more than they would in Canada. After all, to get the same procedures all Canadians have to do is show their Medicare card which is given to them at birth.
At the extreme, people in the U.S. commit minor crimes just to go to jail to get health insurance. Recently, a couple in their seventies in Washington state took their lives due to being so overwhelmed by their soaring medical bills.
These and other examples further illustrate the advantages of a single-payer system. These numerous points were conveyed in a printed pamphlet personally delivered to dozens of members of Congress (see “25 Ways the Canadian Health Care System is Better than Obamacare for the 2020 Elections” and singlepayeraction.org). Some of these deliveries were followed by my personal calls. To date, not one office, other than Congressman Jamie Raskin’s, acknowledged receipt. Nor have any of these lawmakers or the presidential candidates used such obvious arguments in this pamphlet or other available materials to rebut or to explain. Rarely do any media outlets present the overwhelming advantages of a single-payer health care system.
Recently, liberal columnist, Mark Shields appeared on the PBS News Hour and mindlessly characterized single payer as being too expensive.
When Medicare was established in 1965, the elderly had no trouble giving up their private health insurance plans that could at any time have been weakened, dropped, or not renewed. Just as today, workers with private company plans can be forced to accept less coverage or be laid off without any coverage. Mr. Shields seemed to have forgotten the fear that workers have about the unilateral power of companies to change the rules and delay or limit the benefits.
The foregoing case for a single-payer health insurance system is just one example of how corporate power prevails when there is media and political exclusion of the informed and experienced civic community. Speak up, people!