Healthcare

A Truly Captive Market

parasites The House of Representatives, in a rare embrace of de-privatization, has just passed legislation that would put an industry out of business. If approved by the Senate, the Student Aid and Fiscal Responsibility Act will eliminate the heavily subsidized business of bank origination of federal student loans. Students would get their loans directly from the federal government and would see a huge increase in the Pell Grant program, thanks to the tens of billions of dollars saved by eliminating the subsidies.

Unfortunately, the impulse to abolish a parasitic form of private enterprise has been missing from the official debate on healthcare reform ever since Democratic leaders and the Obama Administration shunned the idea of expanding Medicare eligibility to non-seniors. Now, given the uncertain prospects for a public insurance option (a weak substitute for single payer), we are faced with the possibility that the parasites of the private health insurance industry will not only survive but will be empowered as never before.

While support for the public option has waned, the powers that be in both major parties have never wavered from their endorsement of the individual mandate—the bizarre idea that the solution to the problem of the uninsured is to force them purchase insurance. This implies that being without insurance is a personal shortcoming rather than a social problem. It makes as much sense as saying that the way to help the homeless is to compel them to buy a house.

It is true that the proposals for an individual mandate come with provisions for subsidies, yet as the plan just issued by Senate Finance Committee Chairman Max Baucus illustrates, those subsidies would not extend to many middle-income families, who might find themselves in the absurd position of having to pay penalties to the federal government for failing to buy coverage they cannot afford.

What’s wrong with the imposition of an individual mandate without a public option is more than that of inadequate subsidies. It would amount to an unprecedented move by government to compel residents to become customers of a particular set of corporations. States currently require drivers to obtain insurance for their vehicles from private carriers, but automobile ownership is not compulsory. Adoption of an individual mandate sans public option would make it a condition of being alive for the uninsured to start paying premiums to a private insurance company.

What next? Will the federal government allow the likes of WellPoint and Cigna to put private bill collectors to work harassing “deadbeats” who don’t make their mandatory payments? Since the carriers could not drop these non-paying customers, would the companies be allowed to lock them up in healthcare debtor prisons until a relative takes care of the bill?

Maybe not. But there’s a strong possibility that the furor over unaffordable mandatory coverage would prompt Congress to bring down rates by allowing insurers to offer lower-quality plans. If the public option is jettisoned along with single payer, “reform” may turn out to be nothing more than a way of making millions of Americans pay for the dubious privilege of shifting from the ranks of the uninsured into a captive market of the woefully underinsured.

Fighting Dirty on Healthcare Reform

gangs You’ve got to hand it to the health insurance corporations and their front groups for knowing how to play hardball. To protect the interests of the industry, they have been willing to spread outlandish allegations about euthanasia, gambling that the ensuing uproar will force nervous Dems to dilute their plan.

It remains to be seen whether the streetfighters ultimately prevail, but for now they have succeeded in reframing the debate. The country has been talking about pulling the plug on grandma when we should be discussing pulling the plug on the likes of Aetna, Cigna and Humana.

Unfortunately, the Obama Administration and the Democratic leadership in Congress have ruled out euthanizing the for-profit health insurance, leaving us with the alternative of a public plan that would compete with the commercial carriers and supposedly “keep them honest,” as Obama likes to put it.

Since the industry doesn’t seem interested in becoming virtuous, it has instead encouraged opposition to the public option. Apart from whatever behind-the-scenes role it has played in the town hall disruptions carried out by the rightwing lunatic fringe, the major insurers are cultivating the fifth column that is undermining the public option from within the Democratic Party. It’s widely known that members of the Blue Dog Coalition have been showered with campaign contributions from the industry. A recent Business Week cover story entitled “The Health Insurers Have Already Won” details other ways the big insurers have cozied up to and co-opted conservative Dems.

I’ve already written about the suspicious role the Lewin Group, owned by UnitedHealth Group but purportedly editorially independent, has played in the reform debate. Business Week describes how UnitedHealth itself feeds self-serving data to “information-starved congressional staff members.” The magazine depicts an especially close relationship between the company and Sen. Mark Warner of Virginia, who “echoes UnitedHealth’s contention that a so-called public option could be a ‘Trojan horse for a single-payer system.'”

The infatuation of Warner and some other Dems with UnitedHealth is all the more baffling in light of the controversy over the company’s Golden Rule Insurance subsidiary, which has repeatedly been fined by state regulators for deceptive practices. Golden Rule was one of the companies singled-out in a recent House Energy & Commerce Committee hearing on abuses in the individual health insurance market.

Business Week reports that the health insurers consider the battle against the public option already won and are now focusing on shaping the terms under which they will be providing new subsidized coverage. They are, the magazine says, pursuing the “aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured.”

How long will it be before Obama, having abandoned the public option, finds himself pressured by the health insurers and their surrogates to give ground on other aspects of the reform plan, such as the elimination of lifetime benefit caps? Or the prohibition on denying coverage based on pre-existing conditions?

The insurance reform effort will continue its slide toward irrelevance until Obama recognizes that he is engaged not in a boxing match with Marquis of Queensberry rules but rather a knife fight in which anything goes.

Corporate Lobbying Goes from Fake to Fraud

bonner As the Yes Men have shown with their impersonations, misrepresentation is sometimes the best way to convey a larger truth. That same lesson has been demonstrated, albeit unintentionally, by the lobbying firm Bonner & Associates, which was just exposed as having forged letters from non-profit organizations to members of Congress expressing opposition to the climate bill. In this case, the larger truth is that much of the support that corporate interests claim for their policy positions is bogus.

The story came to light thanks to the Charlottesville (Virginia) Daily Progress, which revealed that the office of Rep. Tom Perriello had received letters urging him to vote against the climate bill from two local civil rights organizations–Creciendo Juntos and the Albemarle-Charlottesville branch of the NAACP–that were discovered to be forgeries. Additional faked letters were later reported by two other members of Congress.

Soon it was revealed that the letters had been sent out by Bonner, which had been hired by Hawthorn Group to help in its work on behalf of the American Coalition for Clean Coal Electricity (ACCCE), a major coal industry front group. Bonner, which specializes in fabricating what it calls “strategic grassroots/grasstops” campaigns for large corporations, apologized for the phony letters but insisted they were the work of a rogue employee who has been terminated. This has not prevented a firestorm of criticism and calls from the likes of MoveOn.org and the Sierra Club for a Justice Department investigation of the matter.

Environmental groups are entitled to their righteous indignation, but some of this is akin to expressing shock that gambling is taking place in Casablanca. The entire point of the Astroturf work done by the likes of Bonner is to be deceptive–to give the misleading impression that there is a groundswell of support for the policy positions of big business.

The Bonner firm, founded in 1984 by former Congressional aide Jack Bonner (photo), made its name creating bogus campaigns on behalf of clients such as the banking industry (to fight proposals to lower permissible interest rates on credit cards) and the auto industry (to fight stricter fuel efficiency standards). In 1997 Ken Silverstein wrote a piece in Mother Jones describing Bonner as “a leader in the growing field of fake grassroots” lobbying.

In other words, Bonner is in the business of generating communications to members of Congress that are “real” messages from fake organizations. The current case involves fake messages from real organizations. It’s too soon to tell whether this represents a new tactic by the firm or an employee simply got confused about which aspects of the messages are supposed to be bogus. But either way, firms such as Bonner are helping large corporations co-opt political discourse.

Even more ominous are the supposedly spontaneous disruptions of town hall meetings being held by members of Congress. These confrontations are being carried out by rightwing opponents of healthcare reform–such as the group FreedomWorks–serving the interests of the for-profit medical establishment. It is bad enough when agents of business try to manipulate “civilized” communication with members of Congress; it is much worse when they begin to act like storm troopers trying to intimidate elected officials from diverging from the corporate line.

An Independent Corporate Front Group?

sheils Would a consulting company owned by Exxon be considered an impartial source of analysis on global warming, or would such a firm owned by Xe (formerly Blackwater) be regarded as a good judge of federal policy on the use of mercenaries? Probably not; in fact, they would, in all likelihood, be seen as front groups for the interests of their corporate parents.

Then how is it that one of the most influential consulting firms on healthcare policy is the Lewin Group, which is owned by a subsidiary of UnitedHealth Group, the largest of the for-profit medical insurance corporations and thus a very interested party when it comes to the current deliberations in Congress on major healthcare reform?

Lewin claims to be “objective” and “impartial,” but some of its analysis is repeatedly being used in very partisan ways by Republican members of Congress (such as John Boehner and Orin Hatch) and conservative commentators (the Heritage Foundation and Rich Lowry of National Review) to attack the idea of a public option in legislation that would seek to provide coverage to the uninsured. They typically do not mention Lewin’s relationship to UnitedHealth, which will benefit greatly if the public option is eliminated.

Those seeking to shield for-profit insurers from a competing federal plan are trumpeting Lewin research purporting to show that the existence of at least some versions of a public option would result in a mass exodus from employer-provided plans with higher premiums. Lewin claims that some 119 million of the 171 million people covered by employer plans could migrate to Uncle Sam’s offering. Given the assumption that taxpayers will be subsidizing participants in the public plan, such a shift is seen as creating a fiscal disaster for the federal government and the collapse of private plans. The rabidly pro-corporate group Conservatives for Patients’ Rights uses the Lewin research in a TV ad that depicts a public plan as a bulldozer that could “crush all your other choices, driving them out of existence.”

Lewin insists that it has “editorial independence,” but it is difficult to believe that its judgments are not influenced by the identity of its corporate parents. Its immediate parent, by the way, is Ingenix, a major player in healthcare information technology, especially billing systems. Ingenix, of course, also has a vested interest in protecting the for-profit medical bureaucracy. Ingenix and its parent UnitedHealth have paid out hundreds of millions of dollars to settle class-action lawsuits stemming from investigations spearheaded by New York Attorney General Andrew Cuomo charging that Ingenix promoted a database product that allowed insurers to underpay their members when reimbursing for out-of-network expenses.

Lewin was in existence for three decades when Ingenix and UnitedHealth acquired it in 2007. It’s interesting that before that deal Lewin was often in the news in connection with reports it produced for states such as California, Hawaii and Vermont showing the potential benefits of state single-payer systems. The firm released one such report (for Colorado) after being acquired by Ingenix, but these days Lewin seems to focus more on the hazards of expanded government involvement in healthcare. Lewin Senior Vice President John Sheils (photo) told the Associated Press that “the private insurance industry might just fizzle out altogether” if a public option were enacted.

Sheils insists he is impartial, but he has been aggressive in spreading the word about the potential drawbacks of the public option. He confronted President Obama directly on the issue last week as one of the questioners in an ABC News special whose host, Charles Gibson, seemed determined to bash government involvement in health insurance.

The Lewin Group acquisition added an insignificant amount to UnitedHealth’s annual revenues but it turned out to be a valuable investment for the $80 billion insurance giant. While playing the role of a neutral analyst, the consulting firm is in reality defending the interests of its corporate parents and the rest of the for-profit health insurance business. The most effective business front group is one that believes it is independent.

Rick Scott’s Crusade to Preserve Fast-Food Healthcare

rickscott Is Rick Scott following the T. Boone Pickens playbook? Pickens is the notorious corporate raider who moved into the public policy arena with his advocacy of wind energy. Scott (photo) is the former chief executive of disgraced for-profit hospital company Columbia/HCA (now just HCA) who has inserted himself in the middle of the debate over healthcare reform.

Both men play down their controversial histories and claim they are driven by principle rather than personal gain. In the case of Pickens, the principle is laudable: he has been pushing the country to adopt renewable energy in a major way. Scott is playing a much less constructive role. He is on a mission to sabotage efforts by the Obama Administration and Congress to make affordable coverage available to all.

Scott is the public face of a new organization called Conservatives for Patients’ Rights, which has been spending heavily on TV ads to argue that the reform proposals being considered by Democrats would take away the ability of patients to make their own healthcare decisions, leaving them at the mercy of the “nanny state.” The group’s website is filled with testimonials from “victims of government-run healthcare” in Canada and Britain.

It’s tempting to laugh all this off. The problem with the reform ideas being considered by the Democratic leadership is that there is not enough government control. The most efficient alternative, single-payer or Medicare for all, has been taken off the table, and some leading Dems are even leaning toward the abandonment of a public option as one of the new coverage options that would be available to the uninsured.

Moreover, does a campaign that puts the now unpopular term “conservatives” in its name, focuses much of its media buys on Fox News and uses a tainted figurehead such as Scott really expect to win widespread appeal? Perhaps this is just another facet of the Right’s current tendency to rally only hardcore reactionaries.

Yet there is more to Scott’s crusade than ideology. He represents a portion of the commercial healthcare industry that is threatened not only by government involvement but even by measures that bring medical costs under control.

Since 2001 Scott has been involved in a privately held company called Solantic, which is a leading operator of “urgent care facilities” throughout Florida. These are standalone clinics located in shopping centers, strip malls and the Orlando airport. Some are in Wal-Mart Supercenters.

The existence of the company – whose president Karen Bowling used to be a Columbia/HCA marketing executive and before that a TV news anchor in Jacksonville – is predicated on the fact that traditional medical care is out of reach for a substantial portion of the population – both the uninsured and the underinsured. Its walk-in clinics treat care as an isolated and seemingly affordable purchase rather than an ongoing relationship between patient and doctor. Critics also charge that the clinics often serve mainly as a way to attract customers to the drugstores and retail outlets in which many of them are located, creating an incentive for them to prescribe medications that will be filled under the same roof.

While the clinics may be a convenient alternative for simple procedures, the industry will succeed only if its services are used also by people with a wider range of conditions, including ones that should involve ongoing monitoring. For those patients, the clinics are as distant from good medical care as fast-food joints are from healthy eating and payday lenders are from responsible banking.

The prospects for Solantic were appealing enough that private equity firm Welsh, Carson, Anderson & Stowe, which focuses on the healthcare and infotech sectors, agreed to invest $100 million in the company in 2007. Last year, Welsh partner Thomas Scully joined Solantic’s board. Scully previously served as head of the Centers for Medicare & Medicaid Services during the Bush Administration. He was at the center of a scandal for threatening to fire the chief actuary of the Medicare program if he told Congress that the industry-friendly drug benefit promoted by Bush would be much more expensive than the White House had acknowledged. After leaving the Administration in 2003, Scully first went to work as a lobbyist for the healthcare industry.

Scully, Scott and Solantic all have a strong vested interest in preserving the current system that deprives so many people of decent coverage and forces them to depend on walk-in clinics. It remains to be seen whether the Democrats are truly willing to create an alternative that frees everyone from fast-food healthcare.

A Blagojevich Senate?

singlepayer-protest President Obama and the Democratic leadership say they are serious about enacting health care reform this year, but if the current behavior of some leading Senate Democrats is any indication, we are headed for the weakest kind of change. Some of these senators seem more concerned about protecting the private health insurance industry than in creating a system that does the most to help the uninsured and the underinsured.

Having ruled out the best heath reform of all—the creation of a single payer or Medicare for All plan—the Democrats have been pushing a hybrid system in which everyone who does not already have coverage would be required to purchase it from either a private insurer (with subsidies for those with low income) or a new federal plan. The insurance industry is squawking about that public alternative, saying it would create unfair competition for their offerings.

That’s would you would expect to hear from an industry that wants to hold its long-suffering clients hostage, realizing that if people had the choice of a quality affordable public plan they would abandon the likes of UnitedHealth and Humana in a heartbeat.

What’s amazing is to read in the New York Times that supposedly liberal Sen. Chuck Schumer of New York is proposing to placate the insurers by creating a “level playing field” between the public and private plans. That would mean adhering to “principles” such as the following:

The public plan should be self-sustaining, meaning that it would pay all claims from premiums and co-payments.
The public plan should pay doctors and hospitals more than the discounted rates now provided by Medicare; and
The government should not compel doctors and hospitals to participate in the public plan just because they participate in Medicare.

Is Schumer out of his mind? His proposals would saddle a social insurance program with the drawbacks of a for-profit carrier.

Why stop with those few principles? To make it really fair, Schumer should insist that the public plan spend the same large sums on wasteful administrative costs as the private insurers and be equally ruthless about denying coverage whenever possible. He should also demand that the public plan set its rates high enough to allow lavish compensation packages for its top officials and generate surpluses equal to the billions in profits taken in by its private counterparts. And then, for good measure, the public plan should be made vulnerable to class action suits by participants and have to pay out hundreds of millions of dollars in compensation the way that industry leader UnitedHealth Group did earlier this year.

Perhaps then the public plan would be sufficiently inefficient, unresponsive and dysfunctional to provide the level playing field Schumer seeks.

Given the fealty of Democrats like Schumer to the insurance giants, it was satisfying to see him and the rest of the Senate Finance Committee, including its chairman Max Baucus of Montana, put on the spot by activists who repeatedly interrupted a roundtable discussion on expanding health coverage to protest the fact that there was not a single proponent of single payer among the 15 speakers.

Before being removed by Capitol police (photo), one of the protesters accused the committee of listening only to the views of big corporate contributors. Referring to the former governor of Illinois accused of running a pay to play administration, he asked Baucus: “Is this a Blagojevich Senate? Are you the Blagojevich Chairman?” At least Blagojevich had the decency to compromise his principles behind closed doors; Baucus and Schumer do it in plain view.

Note: The protesters represented groups such as Healthcare-NOW, Single Payer Action, and the Maryland chapter of Physicians for a National Health Program.

Reforming Whose Entitlements?

private-health Aside from the dubious continuation of bank-coddling bailout policies, perhaps the most dissonant domestic policy theme expressed by President Obama is “entitlement reform.” He just used the phrase again in a speech on the economy at Georgetown University. In fact, he went so far as to equate it with health care reform.

Surely, the President knows that the concept of entitlement reform has long been used by fiscal conservatives as a euphemism for making substantial benefit reductions in Medicaid, Medicare and Social Security. Time and time again, these “reformers” have used overheated rhetoric and misleading projections to try to steamroll the country into gutting these vital social insurance programs. Their effort in 2005 to privatize Social Security—fronted by George W. Bush—was met with a firestorm of opposition.

It remains unclear whether the Obama Administration plans to travel along the same path or is appropriating the rhetoric about “fiscal responsibility” to serve a more progressive agenda. It is encouraging that the Administration is willing to spend heavily on social programs as part of the Recovery Act plan for addressing the recession. But health care policy is still an open question.

Obama’s effort to unite health care reform and entitlement reform is rooted in the idea that large cost savings are possible in the medical system. In the past, it was assumed that cutting costs went hand in hand with limiting treatment or reducing the income of doctors and hospitals. Obama offers a different paradigm. He wants us to believe that investments in health information technology, such as those contained in the Recovery Act, will bring down costs by raising efficiency.

Computerization of medical records may solve the problems caused by poor penmanship among physicians, but it is hard to see it bringing down costs to any great extent. On the contrary, it has all the makings of an expensive boondoggle benefitting big service providers such as McKesson Corporation.

What President Obama and other Democratic Party leaders seem unwilling to acknowledge is that the most effective way to cut costs is to take the profit out of health coverage. A single-payer or Medicare-for-All system, such as that proposed in Rep. John Conyers’ HR 676 and promoted by groups such as Healthcare-NOW, would save hundreds of billions of dollars by eliminating the vast and oppressive bureaucracy of the private insurers. That would be real entitlement reform.

The Corporate Crime Fighting Budget

The call to boost taxes on the wealthy to start paying for healthcare reform is not the only refreshing thing about the budget outline just released by the Obama Administration. There is also a marked shift toward tighter regulation of business. Here are some features of what might be called the Corporate Crime Fighting Budget:

Cracking down on corporate polluters. The Environmental Protection Agency—a joke during the Bush Administration—is slated for a 34 percent increase in funding. This would result in a hike in the budget for core functions such as enforcement to $3.9 billion, an all-time high for the agency.

Cracking down on abusive employers. Obama wants the Department of Labor—another agency enervated by the Bush crowd—to get a smaller increase than EPA, but the additional funds are intended to rebuild DOL’s responsibilities in workplace monitoring. The budget document proposes to “increase funding for the Occupational Safety and Health Administration, enabling it to vigorously enforce workplace safety laws and whistleblower protections, and ensure the safety and health of American workers; increase enforcement resources for the Wage and Hour Division to ensure that workers are paid the wages that are due them; and boost funding for the Office of Federal Contract Compliance Programs, which is charged with pursuing equal employment opportunity and a fair and diverse Federal contract workforce.”

Prosecuting white-collar crooks. The section on the Justice Department in the budget document says that the Administration will seek [not yet quantified] “resources for additional FBI agents to investigate mortgage fraud and white collar crime and for additional Federal prosecutors, civil litigators and bankruptcy attorneys to protect investors, the market, the Federal Government’s investment of resources in the financial crisis, and the American public.”

Thwarting purveyors of tainted food. The Administration plans to “take steps to improve the safety of the Nation’s supply of meat, poultry and processed egg products and to ensure that these products are wholesome, and accurately labeled and packaged.” The proposed budget for the Agriculture Department “provides additional resources to improve food safety inspection and assessment and the ability to determine food safety risks. This will lead to a reduction in foodborne illness and improve public health and safety.” The Food and Drug Administration, which is under the auspices of the Department of Health and Human Services, would also get a hike in funding.

Restricting plunderers of national resources. The section of the budget document on the Interior Department outlines the Administration’s intention to rein in the windfalls long enjoyed by extraction companies with leases to drill and mine on public lands. The plan includes “a new excise tax on offshore oil and gas production in the Gulf of Mexico to close loopholes that have given oil companies excessive royalty relief” as well as the imposition of user fees and more realistic royalties for oil and gas drilling on federal lands.

Controlling drug and healthcare price gouging. The general framework for healthcare reform released by the Administration as part of the budget document contains plans to slow down the growth in Medicare costs. This includes a proposal to force providers of privatized coverage under the name of Medicare Advantage to participate in competitive bidding. Medicare drug costs would be reined in by tightening oversight of Part D spending and by preventing brand-name pharmaceutical companies from paying generic drug producers to keep their low-cost products off the market.

To these should be added tax proposals that would put an end to various boondoggles that have enriched oil companies, hedge funds and other anti-social elements. Some of Obama’s proposals (especially regarding healthcare) do not go nearly far enough, but the budget as a whole represents a major break from the priorities of the Bush Administration. Though you would hardly know that from the geeky, matter-of-fact way it is being promoted by Budget Dirtector Peter Orszag (photo).

Budget documents are, of course, merely wish lists conveyed by the executive to the legislative branch. In the short term, the main impact of Obama’s blueprint will be to launch a massive wave of business lobbying. Now it is up to Congress to resist the entreaties of those paid persuaders and make it clear that the days of unchecked corporate giveaways have come to an end.

Nationalization Would Be Good for Our Health

Nationalization—a term alien to most Americans taught to believe in the ideology of a free market—is now at the center of a public discussion on how to address the ongoing crisis of the country’s major financial institutions. For most observers, nationalization is viewed as an unfortunate and temporary step that would be taken to restore troubled banks to health and then turn them loose on the market again.

Yet perhaps we shouldn’t be thinking in such narrow terms. If the taboo against government ownership is disappearing, now might be the time to consider applying that solution to another industry that causes Americans a great deal of grief: for-profit health insurance.

Long before the banking system became a national embarrassment, health insurance companies—especially health maintenance organizations—were a leading symbol of market forces running amok. A wave of consolidation put the industry under the control of a handful of huge for-profit corporations whose business plans are based on the denial of as much care as possible. Despite being hit with a variety of class action lawsuits filed on behalf of patients and healthcare providers, their practices remain largely unchanged.

Calls for healthcare reform have grown, yet mainstream analysts insist that private insurers have to remain a central part of any new system. Although it is the norm in most other developed countries, the conventional wisdom is that government-managed coverage—the single-payer approach long advocated by groups such as Physicians for a National Health Program—is unthinkable here.

That’s not because single-payer isn’t feasible. On the contrary, it’s the for-profit system that leaves a lot to be desired in the efficiency department. Consider this: According to their latest financial statements, the five largest private U.S. health insurers—UnitedHealth, WellPoint, Aetna, Humana and Cigna—together spent more than $36 billion on marketing, administration and other non-medical costs last year. This represented 19 percent of their total costs, which doesn’t include the administrative costs they impose on doctors, hospitals and other healthcare providers. By contrast, in Canada’s government-run single-payer insurance system, administration accounts for only 3.4 percent of total costs.

If the five big U.S. private insurers were that efficient, they would be spending only about $7 billion a year on non-medical costs. In other words, they are wasting nearly $30 billion a year on functions that do little to promote the physical well being of their subscribers. In fact, a large portion of the waste represents their efforts to reduce care and thereby raise profits, which for the five totaled more than $8 billion last year despite a difficult economic environment.

A great deal of the waste among private insurers reflects the huge workforce—totaling more than 200,000 at the top five firms—they employ to operate their immense bureaucratic machine. Imagine how much better our system would be if most of those 200,000 people were retrained to be healthcare providers rather than deniers, and the billions in wasteful spending went toward lowering premiums and improving care. Some researchers have estimated that the replacement of the multiplicity of private and public payers into a single national system would eliminate $350 billion a year in wasteful expenditures.

In his speech to Congress this week, President Obama was emphatic about moving on healthcare reform soon, but he was vague about details. Vast sums are being spent to at least partially nationalize banks. Why not use some of those funds to take over the health insurers that create their own form of financial distress?

It is an auspicious time to take the plunge. Thanks to the slumping stock market, the stock prices of the big insurers are cheap. The total market capitalization of the big five is currently only about $74 billion. For far less than what has been spent giving dubious capital infusions to banks, the federal government could buy out all the shareholders of the large insurers and move their subscribers into a federally operated system—perhaps an extension of Medicare—that could use cost savings to remove restrictions on coverage and enroll the uninsured.

I know there are a lot of complications, but this may be a rare opportunity to cast away old assumptions about what is possible and seek radical rather than patchwork reform. Nationalization of shaky banks may prove to be a futile effort; the federal takeover of private medical insurance would pave the way to a more humane and effective healthcare system.