America’s New Peculiar Institution: Health Care only for those who Can Afford it

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Source: Informed Comment

The highly respected British medical journal, “The Lancet”, recently summarized the health insurance situation in the USA:

    “Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.”

Other independent analyses by the U.S. Congressional Budget Office, the General Accountability Office, the Lewin Group, and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a M4A program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

Even with the dangerous and burgeoning coronavirus(Covid-19) pandemic, big insurance and big pharma still oppose legislation for the new Medicare for All (HR-1384/S-1129). These resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government, community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of big insurance and big pharma, industries who spent $371 million on lobbying in 2017 alone.

These industries always seek to lock us into an obsolete private insurance-based model that holds everyones health hostage to profiteering HMOs and unaccountable big insurance companies for years to come. For proponents of political expediency, the question remains, who will be lost while profiteering continues and basic principles of public health are rejected. Every year, well over 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health insurance coverage. Pandemics like COVID-19 are quickly increasing these numbers.

The COVID-19 pandemic and its economic consequences have caused the greatest losses in health insurance enrollment in U.S. history: 5.4 million laid-off workers have become uninsured. Also important to remember that all was not well before the pandemic. Nearly 28 million people were already uninsured and tens of millions more were underinsured – unable to afford the out-of-pocket costs that were not covered by insurance.

We have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. With millions losing their jobs due to Covid-19, the dangers of connecting health insurance to employment are painfully clear. Health insurance must be tied to citizenship, not employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as the health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

The real boogeymen opposing M4A are the private health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of insurance and Pharma — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma & Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House Bill H.R. 1384 or Senate Bill S.1129, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.

Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. Sooner or later the GOP/Trump will realize that they cannot lie their way past biology. Because viruses are immune to propaganda and nonsense, Covid-19 will advance regardless of the GOP’s/DJT’s denial and avarice. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, DJT and the GOP one percenters have elevated self-interest even further above life itself for the ninety-nine percent.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All legislation now filed in Congress, H.R. 1384/S.1129.


Bonus Video added by Informed Comment:

America’s Healthcare Nightmare May Surprise You (w/ Dr. Sam Metz)

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