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“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” Dr. Martin Luther King Jr.
“America's health care system is neither healthy, caring, nor a system.” Walter Cronkite, CBS Evening News anchorman for 19 years (1962 to 1981) and "the most trusted man in America.”
The United States is the only country of the major economic powers where medical bills are the leading cause of bankruptcy. Only in America do people live in fear of an illness resulting in financial ruin. Only in America do 30 million people, 9.0 % of the population, lack health insurance and access to normal health care.
Forty-three percent of working-age adults are inadequately insured. Plus Americans pay twice as much as Europeans for health care and score significantly lower in most measures of health.
It is indisputable that America's health care system is broken, uncaring and unhealthy. A sensible national health care program would free many people to be more productive, have more lifestyle choices and live better lives. Eighty two years ago President Franklin D. Roosevelt called this “freedom from fear” and “freedom from want.”
For Martin Luther King this meant freedom from the inequality and injustice of poverty that severely impacts many people's health.
It is self evident that real “freedom” would be a sensible, more efficient, less costly, universal national health care program. This would free businesses from the cost of employee health care benefits, making them more competitive. It would free people to change jobs, start businesses, go back to school, work part time, take care of elderly parents or follow their dreams.
It could free everyone from the bureaucratic maze of health insurance coverage, co-pays, pre-approval, in-network restrictions and denial of services. These overhead costs are a major reason we have the most expensive health care in the world.
But conservatives (Republicans and Democrats) have opposed sensible solutions for more than 100 years.
Sensible health care solutions have been branded as “socialism.” Why? There was money to be made!
Like the military-industrial-complex, the medical-industrial-complex has captured both major political parties, rigged the system and are profiting handsomely from the current costly, fragmented, unhealthy system.
Medicare and Medicaid were created in 1965 largely because insurance companies didn't want old, sick people or poor people. There was too little profit. But this didn't stop them gaming these public programs to make money.
Medicare was created with limited coverage, cost sharing and co-pays that spawned a very lucrative Medicare supplement industry. From the beginning doctors and hospitals used excessive fees, unnecessary services and fraudulent billing to rip off both programs.
The Affordable Care Act (Obama Care) has reduced the number of uninsured by about half. But it has done nothing to control growing health care costs. The subsidies provided through the health care “market places” have been a money maker for private insurances companies.
Over time the medical-industrial-complex has pushed various schemes to “manage” a recipient's Medicare and Medicaid. Health Maintenance Organizations (HMOs), private prescription drug coverage (Medicare Part D) and Medicare Advantage options (Medicare Part C) were ways to “privatize” the programs and increase profits. These schemes put insurance companies between patients and the medical services they needed.
Medicare Advantage programs are the big money maker today (see “Making money from Medicare” in the March 31, 2022, Duluth Reader). With Medicare Advantage an individual’s Medicare benefits are essentially contracted out to an insurance company. Medicare pays the company a fixed amount per patient (more than standard Medicare's fee for service model spends). The company can keep what isn't spent on patient care. This is an incentive for bureaucratic restrictions on care and denial of care.
Medicare operates with a 3% overhead. In other words 97% of Medicare dollars go to patient care and not bureaucracy. Medicare Advantage programs have an average of 15% overhead.
Although more costly, Medicare Advantage programs do provide coverage for some things Medicare does not cover. This is attractive to some seniors especially those with high drug costs. About half of Medicare beneficiaries have chosen to go with Medicare Advantage plans.
Under the Trump administration a program was begun to expand Medicare Advantage and completely privatize Medicare and Medicaid. This was called “Direct Contracting.”
This was another privatization scheme with several new money making twists:
• Auto enrollment put seniors into the program without their knowledge, understanding of the program or consent. To opt out of the program a patient had to change their primary care doctor.
• Companies only had to spend 60% on patient care, allowing up to 40% for overhead and profits.
• Companies were paid based on a “risk score” of the enrolled patient's health situation. This was easily gamed to increase the fixed payment received from Medicare regardless of the actual amount of health care the patient needed or received.
• Virtually any company could apply to become a Medicare Direct Contractor regardless of medical insurance experience or expertise. This opened the door for financial services companies to get on the gravy train.
Rather than killing this bad idea, the Biden administration has merely changed the name to ACO-REACH and continued the program. The program plans to completely privatize medicare by 2030.
On their website Physicians for a National Health Program (PNHP) says, “It would be far more cost-effective... to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system.”
This organization of 25,000 physicians advocates for an “improved” Medicare for All” They believe a national, universal, single payer health insurance program is needed to solve the health insurance mess.
PNHP says their plan “would save enough on administrative overhead to provide comprehensive coverage to the uninsured and to upgrade coverage for everyone else, thus requiring no increase in total health spending. In addition, it would put in place effective mechanisms to control costs, lowering the rate of medical inflation and making the health system sustainable for future generations. Significantly, it would restore free choice of clinician and hospital to all Americans.”
Real freedom is health care for all under a national program covering everyone.
For more see Physicians for a National Health Program (PNHP) pnhp.org. Click on “Stop Reach” to learn more about ACO-REACH. Click on “About Single Payer” to learn about how we can all have an affordable national health care program.