As tough as the debate has been, America has only just begun to disentangle itself from the health insurance industry.
Lately, I am starting to wonder if Congress should put forward an amendment requiring every health insurance policy sold in America to come with a warning label: "Caution: Health Insurance May Be Hazardous To Your Health."
This idea may seem strange at first, but when you think about it the struggle against the health insurance industry is looking more and more like the forty-year struggle against the tobacco industry that began in the early 1960s and is just now ending.
In 1964, the U.S. Surgeon General published a report linking cigarette smoking to cancer, which resulted in the 1965 Cigarette Labeling and Advertising act. Starting in 1966, every pack of cigarettes sold in the U.S. carried the warning label: "CAUTION: Cigarette Smoking May be Hazardous to Your Health." They knew back then that cigarettes killed, but the problem was that most Americans did not know it. We still thought cigarettes were good for you because the tobacco industry told us they were good for us.
Likewise with health care, as tough as the debate has been so far, America has only just begun to disentangle itself from the health insurance industry.
Part of the problem with the health care reform debate is the whole idea that health insurance is good for our health. It should come as no surprise that Americans think this way. The health insurance industry does not make obscenely huge profits by selling health insurance that keeps us healthy, but by selling us the idea that health insurance keeps us healthy--such that we keep paying for it right up to the point that our coverage is being denied.
Now we all know better. Certainly it helps to have health insurance to cover the costs of going to the doctor when we are healthy, but the moment we get sick--we now know--the health insurance industry gets busy finding a way to deny our claims, cancel our policies, and otherwise endanger our lives. In the long run, health insurance is not so healthy after all.
By 1970, a half decade of public education had resulted in stronger warning labels on cigarettes, "The Surgeon General Has Determined that Cigarette Smoking is Dangerous to Your Health." By the mid 1980s, after two decades of education, Congress passed a new law called the Comprehensive Smoking Education Act, requiring even stronger warning labels. Boxes now read,"Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy," and a host of other bone chilling predictions. Cigarettes from that point forward all but said, "Listen, pal. No matter what these jokers at big tobacco say, if you smoke these: death."
It could well be that in order to break the grip of the insurance industry on America, we need a twenty year long process of education.
Imagine if the next time you went to the doctor for a physical, at the end of the exam he turned to you and said, "You're in good shape now, but I need to warn you that your health insurance policy could endanger your life in the next ten to fifteen years." The doctor would then give you three or for pamphlets explaining the various ways that health insurance companies deny claims, cancel policies, and refuse coverage. "There is no cure for health insurance at this time, but for now we wanted to make sure that you were informed." What an eye opener that would be.
Imagine kids in schools giving book reports on the ways health insurance companies endanger American lives. Imagine goofy, "School House Rock" style cartoons where a walking, talking health insurance policy with a folksy accent explained how private insurers process reimbursement denials, how they blacklist children with leukemia, or how they cancel policies when people receiving care from brain injuries hit their coverage limits. Imagine public service posters in schools warning kids not to talk to health insurance salesman.
It took all of these approaches, plus millions of people dying from lung cancer, to break the grip of big tobacco on the American public. Government standing up to big tobacco in 1964 was just the beginning. What finally brought that industry to its knees after thirty years of public education was a combined legal and legislative strategy by the Clinton administration, resulting in historic wrongful death settlements. But even then, cigarette smoking still remained deeply entrenched in American society.
Only in the past few years have most major cities finally passed laws banning smoking in government buildings, the workplace, bars and restaurants. Forty years after the first "Caution" labels appeared on boxes, a set of state and federal policies finally took shape that once and for good curtailed the dangerous impact of cigarettes in our lives.
How many of us are prepared for a forty-year struggle against the health insurance industry? Not very many, I suspect. But we better prepare ourselves.
It may be hard to believe, but we are not much further along than the very beginning of breaking the grip of the health insurance industry on our country. Sure, the current debate has shown how the unregulated health insurance industry went awry over many decades. And yet, only now are we as a nation waking up to the horrific problems this has caused to--and will continue to cause--until we fundamentally change our understanding of it.
Of course, all of this requires the emergence of a viable, long-term alternative to health insurance in its current form--something along the lines of Medicare-for-all, but not hampered by the population formulas currently causing financial problems with the existing program. Maybe it will not take a full forty years to develop a workable solution, maybe it will take less. But even as President Obama gives speeches about the problems with health insurance and Congress sketches out the solution, we are only now completing "step one" of the battle--the step where we begin to realize a product is hazardous to our health.