To explain the dauntingly massive, multi-faceted, all-encompassing reach of the U.S. health care system, Everett Page pointed to the term “reification.” It means regarding something abstract as a physical, material thing. Health care, he said, is a living, breathing organism, a giant anthropomorphous creature that crawls across the nation, constantly consuming and growing and swelling. Picture an overweight komodo dragon towering over the country, flicking its forked tongue and getting bigger every second. That’s health care.

Page is the former CEO of Matthew Thornton Health Plan, a Manchester-based health insurance company. His experience gives him a unique perspective on one of the most vilified aspects of the health care system. And, indeed, Page characterized insurers as a crew with precious little compassion for families struggling with high premiums and health care costs. “Frankly, Scarlet, we don’t give a damn,” he said.

But Page said there’s no point blaming health insurers for the myriad problems associated with a system that has left at least 45 million Americans without coverage. Insurance companies are not solely responsible for driving up prices and leaving millions uncovered, he said.

“We can beat on insurers all we want,” Page said. “The rate of growth is coming from an aging population and what’s happening within the health care system.”

Speaking to a group assembled at the Hobbs House for a health care forum hosted by the Hampton Town Democratic Committee, Page said reform must come from medical providers—not insurers. Like other expert panelists at the forum, Page agreed that reform is sorely needed, but he is skeptical of President Barack Obama’s proposal to offer a public plan option. The president hopes to sign a bill by October, but taming the aforementioned health care beast by then may prove an unrealistic goal.

“There’s no way to turn the Queen Elizabeth on a dime,” Page said.

Many other health experts, pundits, politicians and voters share Page’s skepticism. Although Obama’s overall approval rating remains high, a recent New York Times/CBS News poll shows that most citizens are doubtful of his approach on several key issues, including health care reform. The poll found that 44 percent of Americans approve of the way Obama is handling health care, while 34 percent disapprove and 22 percent have no opinion. 

Even with a solid Democratic majority in Congress, enacting serious health care reform may be the biggest challenge yet in Obama’s young presidency. But a number of non-profit groups, still inspired by Obama’s campaign call for change, are taking up the cause locally, while opponents try to thwart their efforts.
danger

That the health care system is shot full of more holes than the O.K. Corral is one point everyone can agree on. Rehashing all the problems would fill a book, but some basic numbers will provide a sense of scope.

Hampton resident Wendy Frosh, president of Healthcare Management Strategies, moderated the forum in Hampton on June 17. According to Frosh, the United States spent $2.4 trillion on health care in 2008, representing 17 percent of the nation’s gross domestic product. Health care spending is increasing at more than double the rate of inflation. At that pace, we’ll spend $3.1 trillion on health care in 2012 and $4.3 trillion in 2016.

According to the Obama administration, health insurance premiums have doubled over the last eight years, rising almost four times faster than wages. Frosh said national health care costs average out to $6,000 per family per year.

Although the United States is far outspending its comparable industrialized neighbors around the world on health care, the results are not impressive. The World Health Organization ranked the United States 37th in the world for its health care system, putting the land of the free between Costa Rica and Slovenia. The top ranking went to France, and our Canadian neighbors to the north were 30th.

Estimates on how many Americans are without health insurance range as high as 50 million or more. Subtract senior citizens, many of whom are eligible for Medicare, and the problem looks even worse. About one in three people under the age of 65 are uninsured, Frosh said.

But people without coverage still consume a significant amount of health care, and the cost is shifted just about everywhere else. About 37 percent of health care costs for uninsured people is paid out of pocket, while 26 percent is covered by government programs and charities. Another 37 percent is absorbed by health care providers. The shifting of costs is forcing insurance premiums up at a rate of about $1,000 per year for families, or $370 per year for individuals.

“The haves pay for the have-nots,” said Jud Knox, CEO of York Hospital in Maine. And people with better coverage pay for people with lousier coverage, he added. 

Contrary to public stigmas, people without insurance are not jobless loafers juicing the system. Nearly 70 percent of uninsured people have at least one family member working full time, Frosh said.

“We’re not talking about people who aren’t working. We’re talking about the bulk of our population,” she said.

On the Seacoast, many people without coverage wind up visiting the Families First Health and Support Center in Portsmouth. The center operates with aid from grants, subsidies and other fundraising initiatives, offering care for poor, homeless and uninsured patients.

Executive director Helen Taft said the faltering economy is rapidly increasing demand for services, with patient visits doubling every month.

Other uninsured residents head to the Hampton Free Medical Clinic at Hampton Beach. “The vast majority of the people we see are uninsured people,” said clinic co-founder Jay Kaminski, also a private physician in Hampton.

Dentist Peter Thomas has also treated people who can’t afford to pay for care. Although research found that 76 percent of New Hampshire residents saw a dentist last year, “we see on a regular basis a group of people who aren’t able to,” Thomas said.

Dental health problems contribute to a variety of diseases, and treating those problems early can help avert astronomical costs later on. But primary care doctors and dentists are increasingly hard to come by. 

“They’re just aren’t enough of us,” Thomas said.

opportunity

Also on hand at the forum in Hampton was Tom Bunnell, director of the Institute for Health, Law and Ethics at Franklin Pierce Law Center. Bunnell began by describing the Chinese symbol for the word “crisis.” The symbol includes two characters; the first translates to “hidden danger,” and the other means “hidden opportunity,” he said.

The U.S. health care crisis, Bunnell continued, represents a case of hidden danger and “blatant opportunity.”

Fixing health care, as the Obama administration has vowed to do, would also help fix the ailing economy, Bunnell explained. He said 60 percent of personal bankruptcies in the United States are tied to health care issues.

“Stabilizing the economy means stabilizing health care costs, which requires covering everyone,” he said. “Unless we cover everyone, we cannot eliminate the cost shifting that folks on this panel have been talking about.”

Chris Muns, chair of the Hampton Town Democratic Committee and former benefits manager for Raytheon and Fisher Scientific, pointed out that employers are the largest health care providers in the United States, covering about 160 million Americans.

But covering those costs is challenging for large employers and virtually impossible for many small businesses. (According to Muns, Starbucks spends more annually on health care than it does on the raw materials to make coffee). Companies that offer coverage are left with less money to increase salaries and hire new workers.

Health care reform, therefore, offers an opportunity to boost the economy and cure many of the nation’s festering financial woes.
Bunnell agrees with Everett Page that insurance companies are not the arch villains of the health care crisis. It’s unreasonable to expect insurers not to discriminate and to cover people with preexisting conditions that might have been avoided if patients had maintained better health, he said.

And herein lies another point upon which almost everyone can agree: The health care system and the Americans who use it should focus more on preventive care, thereby evading the sorts of chronic health problems that ultimately cost the most.

One of the obstacles to achieving this focus is that few doctors choose to enter primary care. “We’re going to see this worsen, because nobody’s going into primary care, because primary care physicians don’t get paid like other physicians,” Jay Kaminski said.

The idea of shifting the focus to primary care is part of a broader push to emphasize quality over quantity in the health care system. Bunnell said about one third of the nation’s health care spending could be prevented by eliminating waste within the system. That one third equates to around $750 billion—the same amount spent on the recent financial bailout. A mere fraction of that could pay for significant health care reform.

But Everett Page and Jud Knox are highly dubious of some of Bunnell’s claims. Knox said the idea that the United States could cover the cost of reform by reducing waste in the system is a myth. He added that implementing a number of major reforms all at once is likely to have several unintended consequences.

“I think we’re all gonna be wicked disappointed,” Knox said.

Nevertheless, Bunnell said, there are several reasons to believe that Obama will succeed in getting his health care proposal through Congress. He’s learned from the mistakes made by the Clinton administration in the 1990s, and he has built strong public consensus around the idea that change is necessary now. 

the push

President Obama hopes to have a health care bill on the floor of the U.S. House and Senate by late July, and on his desk by October. His push to build support for that plan has taken a similar shape to his presidential campaign last year. All around the nation, Obama volunteers are on the ground, promoting his plan to the public.

If you like your current doctor, Obama has continually promised, you will not have to change your plan. But if you are less satisfied, you will have the option of entering a public plan regulated by the government. Large employers who do not offer coverage would be required to pay into a fund to help support the public plan.

Opponents have already voiced strong concerns. Sen. Judd Gregg (R-N.H.), who has presented his own alternative health plan, pointed out that the Congressional Budget Office predicted the Democratic plan would increase spending by $1.3 trillion over the next 10 years. Gregg also contends that the plan would only cover 17 million more people, leaving tens of millions still without coverage.

“This highly partisan proposal is a massive expansion of government that will put us on track to a government-run, single-payer plan that puts Washington between you and your doctor,” Gregg said in a recent statement.

In addition to denouncements from Gregg and other Republicans, the group behind the “Swift Boat” campaign of 2004 is pumping millions of dollars into television ads against Obama’s health plan.

In the face of such opposition, groups like Seacoast for Change, Change that Works and Organizing for America are amping up their efforts to promote the plan locally. Judy Stadtman, of the Seacoast for Change Grassroots Network, has been organizing community meetings, public forums and other events to discuss health care.

“We’re just really trying to raise awareness of the principles of good health care reform, which President Obama and the Change that Works campaign really emphasize has to include the public plan option,” Stadtman said.

Seacoast for Change began as Seacoast for Obama during the presidential primary race. Many of the Obama supporters who helped him get into office have remained active during his presidency, pushing various initiatives.

“On election night, President Obama said, ‘This is not the change we’re seeking, it’s just the opportunity to make that change.’ Many of us took that very seriously as a call to action,” Stadtman said.

Ryan Williams, of the N.H. Republican State Committee, said his office is currently too focused on the state budget to take up the federal health care issue in earnest. When the budget process wraps up on June 30, however, state Republicans will begin devoting more time to opposing Obama’s plan.

“I think people are obviously looking for solutions to the issue of rising health care costs, but they don’t want a government takeover of the system and they don’t want rationing of medicine,” Williams said.

But Stadtman believes there is already strong support for a public plan option. She said most responses to Obama’s plan on the Seacoast have been favorable. “In Portsmouth, we’ve seen a real outpouring of support. There doesn’t seem to be a lot of doubt in people’s minds that health care reform is absolutely necessary.”

As the health care battle heats up, local groups will increase their presence, touting the need for reform. It could get ugly, but Obama supporters hope it will end with a full paradigm shift on health care.

“The next six to eight weeks are going to be really pivotal in getting any real comprehensive health care reform,” Stadtman said.