Why the HIV community (and everybody else) should support single-payer health care.

By Sue Saltmarsh for Positively Aware

As a peer-led agency, the Test Positive Aware Network (TPAN) has always been staffed by many HIV-positive people, as well as others who have diabetes, heart problems, sleep disorders, cancer, and a variety of other ills that make all of us concerned about our health insurance and our access to the care we need. TPAN has always provided the best insurance possible, and I don’t think any of us are unaware or ungrateful for the efforts put forth to get the most from the tens of thousands of dollars of our annual budget that go to health insurance.

A week after the first wave of “reform” laws were enacted in September, TPAN’s insurance representative came to tell us about the changes that would go into effect when our Blue Cross Blue Shield policy was renewed. No one was prepared for the shock of discovering that our usual co-pay for an office visit to any doctor would be doubled for our primary care doc and quadrupled for any specialist we saw, including HIV specialists. The percentage of coverage went down from 100% to 90% and a $1,000 “coinsurance” cost was added, thus essentially tripling our deductible. The co-pays for drug coverage also ballooned upward. For my HIV-positive colleagues, there were a lot of deer-in-the-headlights faces. One co-worker who’s fighting cancer left the room in tears, not being able to wrap her mind around the tsunami wave of medical debt she would now incur.

The health care reform law promised us several things that kicked in on September 23 including: coverage for children with pre-existing conditions; children being able to stay on their parents’ policies until they were 26; no lifetime or annual limits; 100% coverage of preventive services; and mental health “parity.”

On the night of September 23, news reports began to surface about big insurance companies (WellPoint, Cigna, Aetna, Humana, and United Health, among others) suddenly deciding not to sell children’s insurance at all. That took care of the law requiring them to cover kids with pre-existing conditions and also, depending on the policy, the law about them being able to be covered through their parents’ insurance until age 26. Days later, news came that while there might be the possibility to cover children with pre-existing conditions, the premiums would now be so high that many parents could not afford them.

While both the preventive services coverage and the annual limits on essential benefits were acknowledged by our new BCBS policy, they came with the following caveats: “Certain preventive services will be covered 100%…the insurance industry is waiting for guidance as to exactly what preventive services will be covered this way. There are some lists of services available, but there is much debate about the topic,” and “The insurance industry is still waiting for guidance as to what exactly ‘essential health benefits’ are. We do not yet know exactly what annual limits will be removed…It also appears that although dollar limits can no longer apply, carriers may use a visit or days limit.” Uh-huh. The one benefit that they haven’t figured a way to wriggle out of is the “no lifetime limit” provision, but perhaps they realize that, considering the way the rest of the changes restrict access to care and treatment, life expectancy is bound to go down anyway. The U.S. already ranks 49th in the world in terms of life expectancy – how much further down will we slide?

In November, the Centers for Disease Control and Prevention (CDC) published the findings from their analysis of the National Health Interview Survey for 2006, 2007, 2008, 2009, and the first quarter of 2010. The survey covered 90,000 individuals from 35,000 households. The findings revealed that 3 million more people “went for a year or more with no health insurance” in the first quarter of 2010 than in 2008 and that half of the uninsured were above the poverty level [thus de-bunking the myth that only the poor aren’t insured]. “One in three adults under 65 who made between $44,000 and $65,000 a year, the ‘middle income’ range, were uninsured at some point during the year.” The growing number of people without coverage “meant more people with chronic illnesses such as diabetes and asthma [not to mention HIV] were skipping or postponing care, increasing the likelihood of costly complications.” According to the report, “40 percent of Americans have one or more chronic conditions.”

Most people over age 64 have “universal coverage,” through Medicare, but older adults who skip doctor’s visits because they lack insurance “are sicker when they reach 65, which further taxes Medicare.” But there was a nugget of good news: “Public programs such as Medicaid and State Children’s Health Insurance Programs (SCHIPs) have reduced the number of children without medical insurance from ten million two years ago to 8.7 million today.” Yes, those evil, “socialist” programs have helped almost two million children.

Proponents of the Patients’ Protection and Affordable Care Act would probably urge us to wait and see how those numbers of uninsured improve as the “reform” laws are implemented. Really? As it is, millions of people will find themselves in the same boat I float in—paying thousands of dollars they really can’t afford for “coverage” that ends up resulting in inadequate or even no care. I predict the number of uninsured will continue to climb, as will the number of preventable diseases, hospitalizations, and even deaths.

I believe there’s only one way to fix this. The “free market” concept touted by Tea Partiers and “fiscal conservatives” is only available to those who can afford to participate in it. A hybrid system of private and public mechanisms will never work because those two sectors would be working at cross purposes – the private side working towards profitability and the public side working toward access. Not even the vague suggestion that we go back to the days when a patient paid his doctor directly will work unless, like in those days, docs are willing to take chickens or lawn care or car repair as payment for their services. There may be some who would be, but I somehow doubt it would be the majority, just as I doubt that doctors who are used to making $250 for a 15-minute consultation would suddenly accept making the $20 a patient like me would save up in order to have one office visit. And it’s not that I begrudge them the $250 – there is just no way I could ever pay it.

The bottom line may be a bitter pill for capitalists to take—health care can no longer be seen as a profit-driven industry. “Socialized” medicine is our only hope; a single-payer, government-run, tax-financed system as proposed in Congress as House Bill 676. And, really, seriously, should anyone profit from the pain and suffering of someone needing medical care?

Before you tape teabags to your forehead and start marching with your “Keep your hands off my Medicare!” sign (Hello-oo! Government-run!), take a minute to look at these numbers proposed by the sponsors of HR-676. Right now, 94% of us pay 1.45% of our annual income into the Medicare/Medicaid system. That money, plus another 3.3% of our income would be paid into a universal health care trust fund, making our total contribution 4.75% of our income. Consider this: what percentage of your income did you pay last year in premiums, co-pays, deductibles, coinsurance, drug costs, and costs that weren’t covered by your insurance? Chances are it was significantly more than 4.75%. In fact, by doing some simple calculations, you can figure out how much more money you’d have in your pocket if we had single-payer health care. Example: by the end of 2010, I will have spent $6,833 for health care. If we’d had single payer, my taxes would have gone up by $1,122 (less than I now pay in premiums alone), but my cost for health care would have been $1,615, thereby putting $5,218 back in my pocket.

Economic stimulus? Put a few thousand dollars back into the wallets of the much-mentioned-but-then-ignored middle class and no more bailouts would be necessary. Jobs? Take the cost-prohibitive element of health insurance off employers’ plates and they’d have more money with which to grow their businesses, thus leading to hiring more employees; plus, unions and management would no longer have to struggle with health insurance as a negotiation focus.

Yes, your taxes would be higher. But there will no longer be sleepless nights or tearful days worrying about how to pay the bills. If you hate your job and want to find a better one, you will no longer be trapped by the fear of losing your insurance. Are you stuck with a doctor you don’t like or trust because he or she is the only one near you “in the network?” No problem—in a single-payer system, every doctor is a network doc. Do you buy the alarmist warnings of the Right about the government “interfering” with the treatment you and your doctor decide is best for you? Yeah, like no insurance company bureaucrat has ever told someone terrified of having cancer that they can’t have an MRI because an X-ray is “just as good,” despite their doctor’s insistence that it isn’t. The fact is that insurance companies have a vested interest in keeping us sick. The government would have a vested interest in improving the health of every American—better health, lower costs, greater productivity, more tax money coming in, less spending on entitlement programs that support the unemployed, no Medicaid or separate Medicare costs, no ADAP.

In addition to the stimulus to our economy, there is also the benefit of people who are currently on disability being able to return to the work force. A colleague recently told me, “In 1992, a case manager awkwardly admitted that even though I wanted to go back to work (and was physically able to, despite my KS lesions), I would have to remain destitute so that I could qualify for disability. The prospect of being poverty-stricken and dependent on the state just simply to stay alive was even worse than being told I had AIDS. It was a living death.” How many others like him could become productive, tax-paying members of society if they weren’t chained to disability, if their health care was provided no matter where they went back to work?

As that CDC study revealed, the greater the financial barrier to access to care, the sicker people are when they finally get to a doctor. Just as ADAP advocates know only too well, without treatment, infections spread, hospitalizations increase, and complications multiply. Because the current system is more about money than about health, costs will continue to soar (as will profits) and instead of paying $4.75 of every $100 we make for health care, we will soon be struggling to pay $100 for every $4.75 we make, accumulating the kind of deficit only the government is capable of. And, as we know, no bailout will be coming our way.

This is not just a “fringe” issue anymore. There are currently at least 31 states that have established single-payer organizations. Vermont is progressing towards passing its single-payer legislation and Pennsylvania has achieved the unexpected success of gathering the support Republicans and the business community (Health Care for All Pennsylvania recently elected a Republican as its President). As health outcomes and access to medical care continue to decline, and the more people learn about the real benefits of a single-payer system, not just to individuals, but to every sector of society, the less “radical” an idea it will become, regardless of Tea Party posturing.

A distressing number of people who work in the HIV/AIDS field say that true universal health care is a fantasy that is eons away from happening, that we’d better just go along with this non-reform and try to make it work as best we can. They can’t seem to imagine a reality where ADAP funding is a moot point because ADAP will no longer be necessary or a day when no one will put off being tested because they figure they won’t be able to afford treatment anyway.

Being complacent about injustice has never righted a wrong. Just shutting up and taking whatever comes along has never resulted in progress or beneficial change.

If everyone in this country who’s struggling with a chronic medical condition of any kind bonded together to demand a single-payer health care system, we would be an awesome and undeniable tsunami of our own. We’d better stand up and ride that wave before we’re swept away.

To find out more and connect with other single-payer advocates, go to www.healthcare-now.org or your state’s single-payer organizations. In Illinois, www.ilsinglepayercoalition.org.

If you’re a health care provider, go to www.pnhp.org.