Saturday, January 04, 2014

The Mess We’re In (Part III)

I promised one more entry on the topic—and it’s taken me a long time to produce it.  Not because I don’t know what I am thinking but because it is so complicated and difficult to say what I want to say.

However, it is really simple. Here are two proofs of that statement.  First, Michael Moore—with whom I agree on many things even if his excessive and sometimes faulty leaps of logic drive me nut—has written an op-ed piece in the New York Times ( entitled “The Obamacare We Deserve.”

His conclusion—Obamacare is awful.  And, as usual, he’s right.  He also says “Obamacare is a godsend.”  And, again, he’s right.

I agree with Michael Moore because we both agree on what the real solution is to the mess we’re in—a single payer system with universal coverage.  Maybe now you get a flash of why I say this problem is so complicated.  Because it’s really simple.

Some years ago, when I worked for the state medical society (which is the corollary of what the American Medical Association is on the national level) I got in a discussion with one of the physician with whom I worked closely on a major committee.  I mention the connection to the AMA intentionally—when Medicare was being developed in the mid-1960s, one of the fiercest and most vociferous opponents was the AMA.  They fought tooth and nail to defeat “socialized medicine.”  They lost, but the mindset remained very strong among physicians to oppose any type of single payer universal coverage insurance.

In the discussion with the physician leader, I said I thought we should have a single payer health insurance system in the U.S.—to which he replied—Oh, noWe wouldn’t want to ration care in this country.  To which I replied—we already do.  We ration care by who can pay.

In my previous posts on “The Mess We’re In” I pointed out that one of the things that the ACA was trying to fix was the need for universal coverage.  With provisions such as “no one can be denied coverage because of pre-existing conditions” and “everyone must secure insurance coverage,” the ACA has attempted to address universal coverage.
Perhaps the biggest factor that didn’t get fixed is the COST of health insurance coverage.  This is the argument that Michael Moore is making.  And that’s where the single payer concept has the greatest potential for success.  Medicare—that once spurned and vilified program—is a shining example.  All you need to do is look at an EOB (Explanation of Benefits) to see how health costs are crazy. A doctor or hospital may charge $1,000 for a procedure; Medicare will only allow $250 for the procedure and then actually pay 80% of that allowable cost.  True, Medicare costs are high, but that is because the aging population is growing (I am included as a beneficiary) and the cost of medicine in the U.S. is out of control.  There are some very accessible ways to “fix” the Medicare funding issue.

The biggest opponents of a single payer are…(drum roll) the insurance industry.  They are followed by all the providers who will see their compensation levels capped.  And the biggest culprit of all is the pharmaceutical industry.  When I worked for a large health insurer in our state, I was interviewed by one of the senior vice presidents of the company.  When I left that company, he kindly gave me my entire personnel file.  In it were his notes from when he interviewed me.  I found in his writing a statement to the effect that I support a single payer system—which he had circled several times and noted—that might be a problem.  It always mystified me why the largest insurer in our country—which is colored blue—didn’t step up and say WE CAN BE YOUR SINGLE PAYER.  We already have the experience nationwide.

What happens when people try to contend with the financial aspects of our health system?  They face more hassles than many other industrialized countries, according to a study conducted by the Commonwealth Fund.  See the report here:

Among their findings:
  • ·         MORE than one third of all adults in the U.S. went without care in 2013;
  • ·         About 40 percent of people—insured as well as uninsured—spent MORE than $1,000 out of pocket for care—and that did not include premiums;
  • ·         About ¼ of adults had either serious problems paying or were unable to pay medical bills;
  • ·         About one third of adults spent lots of time dealing with insurance paperwork or on disputes with denied payment;
  • ·         U.S. insurers spent twice as much per person on administrative costs;
  • ·         And, finally, the U.S. spends $8,508 PER PERSON on health care—which is $3,000 more than the second highest spender country.  (See chart at bottom of page)

So, Obamacare was not ALL the fix it was intended to be.  No doubt, many of these financial problems will continue.  People will still continue to pay high premiums, depending on which plan they can select.  They will continue to have outrageous deductibles—if you pay the first $10,000 of your care because that is what your mandated deductible is, it is hard to think that the ACA, which is short for the Affordable Healthcare Act, is very affordable.  But, then, such high premiums and high deductibles were very much in play BEFORE Obamacare passed.

As the bill was working its way through the legislative process, proponents of health system reform abandoned many of their working premises.  What they got instead was largely an insurance system designed by business, providers and the health industry.  They gave up many essential aspects to keep some basic provisions—the individual mandate (that stands in for universal coverage) and a basic set of what insurers must do.  So people can’t be denied for pre-existing conditions, and certain things must be included in all policies.

And what did the people do who got most of what they wanted in the bill?  Since the ACA passed, we have seen nothing but obstructionism—e.g. all the governors who refused to set up the health exchanges in their states OR the scores of votes in the House of Representatives to repeal Obamacare.  Of course, there was the major obstruction effort in the challenge that went to the Supreme Court—which narrowly upheld the validity of the law.  

Now we are beginning a round of legal challenges on various provisions of the required set of what must be insured.  The argument that a religious organization—say the Catholic Church—should not have to pay for health insurance for employees for something they personally oppose might be appealing.  Why would nuns have to pay for birth control?  STOP RIGHT THERE—and think about this. 

Here’s two reasons why you should not get sucked into that argument.  First, the employees who work for them might not be Catholic and thereby have no personal opposition to using birth control. And, second, where do we stop with that argument? Jehovah’s Witnesses oppose blood transfusions.  Should we allow Jehovah’s Witness employers to not pay for such coverage for their employees? Or Scientologists oppose psychiatry—so are they exempt from paying for psychiatric care for their employees?  Or Christian Scientists oppose medical care altogether.  Can they be exempt from providing any health insurance for their employees?  Get my drift?  Either it’s a mandate OR it’s not.

It has been clear to me from the day the ACA passed is that the worst fear all those who have opposed any effort at health insurance reform is this:  IT JUST MIGHT WORK

Back to my physician friend—and the AMA that opposed Medicare.  Can you imagine what things would be like today if we did NOT have Medicare?  Maybe you can imagine it, but my guess is you don’t really want to go back.  And that precisely is the promise of Obamacare—it just might work.  It’s not what we needed—not yet.  But it’s a start.

That mess we’re in—as Pogo said—we have met the enemy, and he is us.

There are so many topics I haven't covered--e.g. cost shifting:  hospitals which provide care to the uninsured but cost-shift to cover the expenses, meaning we have ALL been paying for the uninsured;  the pharmaceutical industry which charges outrageously for drugs, and even changes the prices of long-standing meds--recently inhalers, which have been off-patent for  year, suddenly jumped in price...because the drug company making them just decided to boost the price...because it could.
On and on--but I really want to write about other topics from time to time.


Harriet said...

Thank you for this, Donna. You have articulated the issues well. I agree: single payer is the way to go!

Jayne said...

Very well written, Donna. I've always said that as long as there is money to be made, there will always be major opposition to lowering costs and truly making affordable health care a right for all. It's maddening, really.

Ginnie said...

Very thorough ... I agree that ACA is not the end-all, but it sure is a start. My son (who is a type 1 diabetic) is thrilled to be able to finally get AFFORDABLE medical insurance. I had an argument with a friend recently who said her boyfriend is furious because "Obamacare is going to break me." I asked her what his income was and he makes almost $75,000 a year. When I mentioned that it's about time that the low income people finally got a break she refused to see that.
I am actually amazed that Pres. Obama was able to get it into law and hope that it is the start of a really good deal for us all.

Anvilcloud said...

It sure is tough to get some things done down there.