I took a brief trip to town today, and passed a sign that said “Garage Sale for cancer” along with the address. They are not raising funds for the Cancer Society. A family member has it, and they are selling off possessions to pay bills. Only in America do you see that! (I’ll grab a photo of the sign tomorrow if it is still there.)
The following are notes I took of an interview with Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Care Plan, from the Counterspin 7/6/12 broadcast:
Massachusetts passed a statewide health care plan in 2006, nicknamed “Romneycare.” It was basically a laboratory trial for what would later become “Obamacare,” or ACA. While widely held to be successful and popular, the numbers are not that impressive. It did cut the uninsured population in the state from 10% to 5% of the population. More about that later.*
Even as Romneycare is in year six now, by a 2:1 margin, members of the Massachusetts State Medical Society still favor single payer over it.
Nationally, even after passage of ACA, there will still be 26 million uninsured. By inference from past statistics, this means that there will be 26,000 deaths annually due to lack of access to health care. That is, doing quick math, about nine world trade center events. Who do we bomb about that?
*Insurance companies in Massachusetts sell skimpy products that even those who have such coverage cannot afford to use – that is, after deductibles, co-pays and uncovered expenses, people still elect for forgo treatment for illness and accidents. This trend will likely be seen nationwide, as even though ACA mandates coverage of certain preventive coverage**, beyond that there are no guidelines for provision of basic care. My own policy with Anthem Blue Cross, after passage of ACA, converted from major medical to hospitalization and mandated preventive coverage, for the same cost. Office visits are no longer covered, nor are they discounted for network membership. In effect, Anthem is discouraging doctor visits, as the math says that those visits are on top of the thousands in premiums and deductibles and co-pays that we have to cough up – so we forgo the visits.
They know this. They don’t care. That’s a radical decrease in coverage with no corresponding premium decrease, protecting investors from clients.
Consequently in Massachusetts, even after passage of Romneycare, access to health care has not improved, and medical bankruptcies have not decreased.
ACA mandates payment of $500 billion in taxpayer dollars to private insurance companies (known on the right wing as a “government takeover.” Geez, guys! Stupid stupid stupid!). That money will translate into even more political clout, giving the insurance industry even more veto power over reform. We have miles to go before we see improvements in our health care system. For so long as we rely on for-profit entities to guard the gates of the system, the system will be dysfunctional.
Woolhandler does not consider ACA a step forward, but rather a step sideways. Her motto: On to Single Payer!
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My (former, as of 8/1) carrier, Anthem Blue Cross, paid for my annual physical, as required by law, but refused to cover the cost of the office visit. I asked them how I was to have a physical without an office visit, and they seemed to neither either know nor care.
Piece of Mindful 
Nationally, even after passage of ACA, there will still be 26 million uninsured. By inference from past statistics, this means that there will be 26,000 deaths annually due to lack of access to health care.
A bit gratuitous, since these types of uninsured will probably also avoid a single payer system.
Similarly, can we expect you to complain when the single payer bureaucrat tells you they’ll pay for the physical, but not the office visit, because they are under budget pressure and need to cut back?
I don’t want to discount your criticisms here, but after we storm the Bastille and cut off the appropriate heads, do we get something better on the other side? The cruse ship seems to have the same vibe no matter how the eager crew arranges the deck chairs.
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Yes, absolutely. Once you remove private profit from health insurance, you are paying wholesale. It works in other countries very well. In spite of all the scare talk they all have basic coverage and no bankruptcies.
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I’m not as enthused as you. Even if (when?) you wring out private profit, we still spend a fat boatload on health care. What does private profit amount to in absolute terms?
People casually toss out that we should adopt country X’s health care system (Singapore! Four percent of GDP spent on health care! Get it now!) But there are the issues of culture and habit and expectations that make Singapore et al cost 20% of GDP if transplanted to the US.
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I challenge you to really investigate another country’s health care system – Switzerland, a private insurance model where they are regulated as to what they must provide and not allowed to profit on basic care; Canada, single payer and run by each province; France, a mixture of private and public; Great Britain, a government owned and run system; Taiwan, the most recent country to abandon the private insurance model; Mexico, a poor country with universal care; and the VA, our own government-owned system.
Pick one, check them all out. Stay away from right-wing think tanks, and preferably use information from sources inside those countries.
You’re much too broad-brushed for me with too little actual data to support your wide-swinging views.
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Right Said, rightsaidfred. 🙂 The average person does not know how to factor in all of the other aspects of a culture’s health when casually assuming one system is better than another. I have yet to have anyone provide any solid evidence and research that shows a socialized system of health care is any better overall than a capitalistic one.
That said, I do believe that there are some things in life that a society should ensure all citizens have reliable equal access to. Health care, clean water, shelter, protection from violators and nutrition are among them.
In the meantime, the debate on the best health care system will remain for years. The new reform laws are FAR from being socialized health care. There are some subsidies for people and businesses at lower income levels to make it more affordable to participate in health insurance. Outside of that, there are some rules that make all health insurance companies meet minimum standards in covered benefits and quality of care.
There have been and still will be many health insurance companies in the market that are not for profit. They do not have stock holders and their decisions are not influenced by non health care industry money hounds. These health insurance companies make very little margin and it is used to reinvest in the medical care system.
Employers will remain the primary sponsors of health insurance and hopefully more employers will begin participating. Individuals and families will have subsidized access to health insurance making it affordable and allowing them to get insurance with no fear of being rejected due to pre-existing conditions.
We are all part of the solution. We have a responsibility to stay as healthy as possible and our healthcare system has the responsibility to encourage us to live healthier and care for us when we are ill or hurt.
I have a lot of hope in our future. I’m thankful that someone in politics was brave enough to do something rather than continue the current disfunction.
Peace
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The evidence that socialized medicine works is as follows: Other countries. You have to look beyond our borders! Other countries have far lower costs per capita, 100% coverage, and better outcomes. How can you not see that?
There are indeed “not-for-proift” health insurance companies in the market. Blue Cross of Montana and Kaiser Permanente come to mind. But the day the first private insurer came into the market is the day that their nfp status became irrelevant. As soon as the for-profits started turning away customers for their perverted definition of “pre-existing conditions”, the nfp’s had to do the same. If they don’t, they go out of business due to adverse selection.
So that if United Health Care refuses to insure you, Kaiser will too. The for-profits set the rules.
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Mark, I am in agreement with you on the pre-existing condition stipulations set by the for profits that lead the entire industry down that path. Unfortunately for the “for profit” players, their day in the sun is nearly over. The new mandates do not allow any fully insurance health insurance plan to deny for pre-existing nor change the price due to pre-existing. The only way that is going to work is if enough healthy risk jumps into the pool when the onslaught of people with pre-ex enter. Let’s hope it works.
As for the other socialized countries’ solutions, the data may say that they work well base on the numbers, but when you talk to the citizens of those countries and I have talked to many of them, they are not tooting the praises of their systems. Their conditions get subjectively marginalized into a queue to wait for care, they typically need to buy additional supplemental coverage to fill in the gaps as well. Employers are still participating in buying some of that additional gap insurance and others either buy it or go without. Their system is far from perfect.
Is there a perfect solution? I don’t think anyone knows but I like to think their is. I know that first and foremost it starts with the individual citizens choices on how they choose to live, eat, hydrate, exercise and rest that dictates the overall sickness and need for care of a society. If we start there, the demand on the system would decrease dramatically. Perhaps that would be the solution.
I am enjoying our conversation.
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A “preexisting condition” started out as a legitimate concern among insurers, that people would wait until they had an illness to purchase insurance. The for-profit companies perverted the term to mean “anyone who we might reasonably think might be unprofitable” and came up with a long list of conditions for which the denied coverage or rescinded policies. They then leveraged this awful practice into what became the private mandate – yes, they will do their job, they said, but only if you force everyone to pay us without giving them a public alternative. It was a grotesque flexing of muscle.
The balance of your statement is anecdotal.
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http://www.truecostofhealthcare.org/ has an interesting view of the role insurance companies play in driving up costs. Ideally, health care services should be as affordable as buying appliances, or taking a vacation. Somehow, middlemen must be sent packing. I’m watching student loans closely to see if the federal government provides meaningful long-term relief, or simply becomes just the new loan shark in the neighborhood. Our winner-take-all, political duopoly makes it hard to imagine how an American single-payer system would compare favorably to others around the world with proportionally-representative governments.
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Mark, one more point related to middle men. I am not sure what group of folks you are referring to. If it’s the stockholders then I agree, they are part of the cause for the artificial inflation in costs. You might want to lump in the pharmaceutical companies and the AMA as well.
If you are referring to insurance agents then I would disagree that they have been to blame for inflation. Insurance agent commissions are regulated by the state and capped. Agents cannot force insurance companies to increase their commissions. It is, what it is and falls into part of the admin costs. If all agents were to disappear, then the insurance companies would have to hire more internal staff, have larger offices and provide more equipment for those staff. The commission “savings” would be eaten up plus some by the additional internal costs each insurance company would have to take on. Right now, insurance companies all share the same pool of independent agents in their state so they all share part of the cost versus all of them hiring their own independent staff to sell and manage accounts.
There are a large number of terrible insurance agents out in the marketplace that seek the profits but do not educate and guide individuals and businesses adequately. It’s up to businesses and individuals to stop working with the inadequate agents and work only with those that provide them with empowerment in their insurance decision making.
Cheers.
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You’re seeing trees and not the forest. The only reason that agents exist is for pre-screening, to save the company the cost of research to deny potentially unprofitable people coverage. I don’t know, of course, but would not be surprised if they are not penalized somehow for inadequate screening, sending too many denials to the company.
Theirs is a job that should not even exist, does not exist in more civilized countries.
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