By Mike DeRosa

One astute observer of the political world once said that every bureaucracy that has ever come to power has done so under the banner "down with bureaucracy." Health Maintenance Organizations (HMOs) are no exception to this rule. Remember when HMOs were pushed forward by corporations, politicians, and the corporate press as the solution to our high medical costs and poor service? These forces are now pushing "HMO reform" as the solution to our health care delivery system. Just about every Republican and Democratic party elected official is for "HMO reform" of one kind or another. The latest idea is to give patients the right to sue their HMO in court. Certainly a "Patient's Bill of Rights" is long over due, but what kind of patient's bill of rights? Having the right to sue your HMO because of denial of services, after your loved one dies, is not the solution.

The original idea behind the HMOs was that these organizations would be health promoters as well as organizations devoted to curing disease. They would provide preventive health services, usually in a clinic like setting, and would refer patients to affiliated hospitals and to other health services within their network when needed. The idea was to get away from the fee for service model and move toward a more comprehensive approach to health delivery. The corporations have hijacked the HMO idea and have turned it into a cash cow for their interests. They have reduced health services (especially preventive services), increased co-payments and fees, and have negatively altered the ability of doctors to practice medicine. Seeing a specialist or having continuity of care with a physician that you trust, have become very difficult in the brave new world of corporate health care.

In recent years HMOs have limited drug prescriptions in a number of different ways. The ability of doctors to prescribe drugs outside of a certain "list" established by the HMOs has been diminished. Now certain HMOs have started a "drug edit" program that will limit the quantities of specific monthly drugs given to patients. Using these cutbacks, HMOs will homogenize and micro-manage the care given to patients and force doctors to increase their paperwork to justify any deviation from the norms established by the HMOs. These norms for drugs are not necessarily based on any specific research and may reflect an HMO's ability to negotiate a discount with some pharmaceutical company. These cutbacks limit the doctor's ability to prescribe drugs based on his or her experience and practice. The new cutbacks will also cause increases in pharmacy co-payments for consumers as well as other problems. Other reductions in services, increases in paperwork, and other restrictions on healthcare are in the works.

A recent Census Bureau report indicates that the number of uninsured has risen to 16.1% or 43.4 million people in 1997. This is a half of a percentage point rise over 1996 and represents the largest rise in the uninsured in five years. Some experts say that this rise comes from newly created jobs that have no benefits, Medicaid cutbacks and push-outs, "welfare reform", and the skyrocketing cost of individually sold health care policies. This increase in the uninsured comes at a time when economic conditions are reported by the corporate press as "the best in decades."

What we are seeing is the further destruction of our health care delivery system. As Wall street investors demand more profits from HMOs and as more HMOs are taken over by larger and larger companies, increased cuts in services and benefits will have to take place.

The further commodification of our health care delivery system will only decrease the amount of money available for health care as HMOs increase their marketing and merging costs, increase stock dividends, and give titanic bonuses and golden hand shakes to upper management.

Yet the "debate" about "HMO reform" continues, and the corporate media look for solutions to the wrong questions. "HMO reform" was the only real issue to surface during the 1998 congressional election and the range of the debate was limited to three or four band-aid proposals and some mush over changing ERISA rules. What passes for political discourse in this country on this issue is truly pathetic.

No major newspaper or electronic outlet can even mention the phrase, National Health Insurance, in public. It is not allowed in the corporate press. Even worse is any mention of the Single Payer system in Canada. That's because the Canadians have a good health care system and cover everybody at about 60% of the cost of the U.S.'s for profit health care scheme. The United States spends over one trillion dollars a year on its health system and this dollar amount grows larger every year. The Canadians are culturally and historically like us, and their solution to this problem must be hidden from view. The corporations want everything and everybody to be a commodity that they control.

Recently the Green Party and the Labor Party have raised the Single Payer option as an issue. It's time for progressive parties to do an end run around the two corporate parties on the health care debate. Recently in Vermont progressives have tried to pass a Single Payer bill in the state legislature. This bill would have established a Single Payer system in Vermont. A similar bill could be raised in the coming Connecticut General Assembly. Many people, especially people with chronic diseases are hopping mad about their treatment under HMOs. National polls consistently indicate that the vast majority of the American people dislike and have negative opinions of insurance companies. Clearly this is an issue that will resonate with many voters and with consumers everywhere.

Even though a Single Payer bill would not pass immediately in our legislature in Hartford (the insurance capitol of the world), it could raise citizens' awareness of the issue. A Single Payer initiative could allow progressives an opportunity to network and build alliances with many new groups of consumers and others fed up with corporate health care. A meaningful coalition could then be built around this issue. This new alliance might have the strength to demand the attention of the press and that would help to empower people and the Single Payer option. National Health Insurance was passed in Canada when a third party, the New Democratic Party, made it a major issue in their campaigns many decades ago. This has also been the experience of other industrialized nations of the world.

I think, and many of my friends in Connecticut Green Party think that the time is ripe for this kind of effort. We cannot allow the two corporate parties in our country to continue to have the first and last word on this issue. By raising the Single Payer approach on a state wide basis we help to raise this issue on a national level. By raising this issue in a state wide arena we increase the quality of the political discourse. This can and will help us elect third party progressives who will have the power to enact National Health Insurance.