Most Americans believe that we have the best healthcare
system in the world. It is a myth!
“My doctor said I needed the operation, but he didn’t know
if my insurance would approve the payment. He sent in the paperwork last week.
We still haven’t heard back.” Sound familiar?
Ten years ago, the notion that healthcare was a human right
was novel, if not a revolutionary idea. A recent Reuter’s survey, however, found
that 70 percent of Americans now support a universal single-payer health
insurance program and a Gallup poll reported that 71 percent believe healthcare
is in a state of crisis.[i]
So, what is good healthcare? A person has good healthcare
when they can see a doctor of their choice when they are sick, when they can go
to the hospital when they need to and get the procedures they need when they
need them, when they can get other professional help when they need it. Not
everyone has that kind of healthcare today.
Let’s look at the data. America has highly trained doctors,
nurses, and other medical professionals. Our hospitals are first rate. We do
amazing research that discovers cures for diseases and improves lives. Yet, our
very expensive healthcare doesn’t deliver world-class outcomes.
The US spends 17.8 percent of its gross domestic product on
health care, while other countries spend 9.6-12.4 percent, with better outcomes.[ii] Our life
expectancy is the lowest of 11 comparable countries, and going down each year. Our
infant mortality rate is among the highest in the developed world. We go to the
doctor less often and spend less time in hospitals than those in other
industrialized countries. Our prescription drugs cost twice as much as other
countries. Our administrative costs are the highest in the industrialized world,
8% vs. 1-3%.[iii]
Two-thirds of all ER visits are avoidable, at an average cost of nearly $30
billion per year.[iv]
In other words, we pay twice as much as other countries for lesser outcomes.
Why?
Our processes or systems for delivering high quality
medical outcomes are antiquated and inefficient, including how we pay for it.
Nearly half of our doctors are in private practice. How 1850s is that? A
medical office with ten doctors is small according to the AMA. Most doctors in
private practice don’t know what they will be paid for a patient’s visit
because it depends on the type of insurance involved – HMO, PPO or EPO, the
age, and gender of the patient, and the way the doctor codes the procedures. Most
insurance plans require that we use doctors and hospitals in their network.
None of those networks crosses state lines. Patients are at the mercy of the
insurance companies, who contract different fees for each procedure, with the
hospital and with the doctors.
Medicare, one of the largest customers for drugs, is
prohibited from negotiating prices.[v] The US doesn’t
regulate drug prices as the rest of the world does. Manufacturers doubled the
price of insulin from 2012-2016, with four percent annual increases since. Why?
Because they could. The current administration is trying to implement a plan
that allows drug stores and hospitals to import drugs from Canada where the
price is much lower, but still the second-highest in the world. Would it
surprise you to know that Big-pharma is fighting the idea?
In March 2010, Congress passed the Affordable Care Act
(ACA), an attempt to provide better healthcare options for those who had no
insurance, and to set new standards for all healthcare practices. People seem
to forget what medical insurance was like before ACA: no coverage for
pre-existing conditions like high blood pressure, coverage for preventative
care, no coverage after a $1million in expenses, no coverage for children after
age 19, and it goes on. The bill was a compromise, so it didn’t address all the
issues. It was a start.
A key provision of the Act required everyone in the country
to have medical insurance. It also required insurance companies to offer
comparable policies with roughly the same premiums. So much of the plan’s
provisions are burned into our way of thinking about healthcare now, that we would
not tolerate them being taken away. One political party has tried, from day
one, to eliminate the plan. It was a key provision of their platform in 2016.
In the 2018 mid-terms, it lost them the majority in the House.
Large insurance companies, Big-pharma, medical device companies,
and hospitals don’t want to change the current system, because it will impact
their bottom line. Large trade groups contribute millions of dollars to
campaign war chests, $23 million in the first quarter of 2019, large companies,
and hospitals that spend millions lobbying Congress As recently as this month a
bill passed the California Assembly that would eliminate “surprise bills”
resulting from hospital stays. It was pulled before the Senate could vote on it,
right after a huge inflow of money from hospitals, anesthesiologist, and other
medical groups.[vi]
Most of the discussion isn’t about healthcare; it’s about politics and money.
So, what are we to do?
Let’s study how other countries provide healthcare to their
citizens. They will surely be able to teach us what works and doesn’t,
demonstrate advantages and disadvantages to different processes, and help us
with the cultural issues. We are different from those other countries, so we
shouldn’t implement their plans wholesale. We need plans that meet our cultural
needs and our traditions. We also need healthcare we can afford.
This is an election year, so those to the right of moderate
will label any proposed change as socialism. It is an effective tactic because
so many people don’t know what socialism is and so many older people can
remember what it was in the Soviet Union and East Germany. President Trump, in
a State of the Union address said that we would not allow socialism to get a foothold in our country. I agree with him. I’m a
big fan of capitalism, knowing it has to be reined in from time to time. Harry
Truman said, “Socialism is a scareword
they hurled at every advance the people have made in the last 20 years.
Socialism is what they called public power (TVA)…social security …farm price
support … bank deposit insurance … labor organizations… anything that helps all
the people.”[vii]
While we don’t want a socialistic economic system for our
country, we already have many examples of socialized medicine, where the
government owns the hospitals and clinics and employs the doctors and nurses. The
Veterans Administration is a good example. Many large cities and counties own
and operate hospitals and clinics, and employ doctors, nurses, and other
medical professionals. The government manages many other insurance plans, which
are not socialized medicine.
Forty-four million
people already have Medicare, a single-payer insurance program. It pays hospital
and doctor bills for nearly everyone over the age of 65.[viii] Medicaid is
another single-payer insurance plan for people with low incomes that insures 72
million people, 40% of whom are children.[ix] Fifteen
million people have military insurance and about 22 million people have ACA
insurance. Put another way, 153 million Americans, 44% of the population,
already have a single-payer medical insurance plan managed by the government.
Medicare works and it is less expensive than private insurance.
Nearly 155 million people under the age of 65 have
insurance plans through their employers or that they purchased themselves. It
is very expensive and often limits the care one can receive. Examples abound of
insurance companies denying coverage for needed procedures, or Pharmacy
Management Companies denying cancer medicines to patients.[x] Most private
insurance plans require that members choose doctors and hospitals in their
network of contracted providers, with options for deductibles and co-pays.
I’m leaning very much toward the idea of a universal single-payer
health plan. Think about it. Everyone in the country is in the same health plan,
which is available in every state, not just limited area networks. Everyone
keeps their favorite doctor because there is only one insurance plan to which
all doctors must belong. Companies that provide insurance for their employees
would continue to pay in some form because they can’t afford to lose good
workers. One million workers change jobs each month and must hunt for new
doctors, and use expensive COBRA plans. Millions more stay in jobs they do not
like because they can’t be without insurance.
“They” say that major cultural changes take upwards of
twenty years to take hold. The idea of a universal single-payer insurance plan
has been working its way through our national debates for about ten years now.
It may take another ten years to implement single-payer in some form, but when
seventy percent of the people agree on an issue, the die is cast. Change is in
the wind. “The past is over.”[xi] We will
cross the Rubicon.
Part #2, Can we pay for it?
[i] CNBC article in late 2017, quoting both Reuters and
Gallup polls.
[ii] Karen Feldscher – What’s behind high U.S. health
care costs – The Harvard Gazette – March 13, 2018
[iii] Ibid
[iv] UnitedHealth Group – Study of patient costs – Reported by Axios
July 22, 2019
[v] Medicare Modernization Act of 2003
[vi] Axios – July 28, 2019
[vii] President Harry S. Truman – October 10, 1952
[viii] Peter Ubel – Forbes Magazine – November 21, 2018
[ix] Medicaid.gov – April 2019
[x] Sacramento Bee – July 10, 2019
