Friday, 8 November 2019

Lee Russ: Take back health care - VTDigger

Lee Russ: Take back health care

Editor’s note: This commentary is by Lee Russ, of Bennington, who is a retired true editor and freelance writer.
Opponents of Medicare for All like to scare people by warning about a “government takeover” of health care.  Let’s get serious: American health care was taken over long ago by insurance companies and other commercial interests. We need to take health care back from them.
What does that mean exactly? Start with the fact that the health care “industry,” and it is an industry, has so much money at stake that it can afford to drown our legislators in money. The top Republican and the top Democrat on the U.S. Senate committee that deals with health care took in well over half a million dollars each in contributions from the pharmaceutical and health products industries between 2011 and 2016. The Center for Responsive Politics says that in 2016 alone the drug industry’s 1,300 lobbyists spent $244 million influencing federal legislators.  The health insurance industry managed to spend only $145 million that year through its 850 lobbyists.
When these lobbyists bend the ears of legislators, what are they after, what is the primary message they convey?  It isn’t about providing health care to everybody who needs it. It isn’t about making sure that people whose lives depend on a drug can afford to buy that drug. It isn’t even about how much health care costs the country, and what that means for the overall economy. It’s about protecting the business interests — the profits — of the commercial entities that have health care in a chokehold: the middlemen (insurers, pharmacy benefit managers, etc.), the manufacturers (of drugs, machines, implants, etc.) and the corporations and investment companies that own more and more medical practices and hospitals. Their concern is the health of their firms, not the health of the people.
It’s been like this for many years now, getting worse each year as health care gets more and more expensive, and elusive, for ordinary people. We are at the point that the chair of Vermont’s Green Mountain Care Board, Kevin Mullin, publicly announced that the rates requested by health insurers in their 2019 filings “are not affordable. We acknowledge they are not affordable.” But it didn’t matter because, as Mullin said, “at the same time we can’t put a company out of business.”
The commercial takeover has reduced American health care to a maddening money pit. Paperwork and billing suck up huge sums. Health insurance premiums are tied to the amount of money insurers will have to pay out to doctors and hospitals. The fees doctors and hospitals charge include money to compensate for the gargantuan amounts of time they employ on paperwork and administration — 18.5 hours a week for internal medicine doctors, 13.2 hours for dermatologists, per a unique survey. Much of that time is spent dealing with the insurance companies.
Once doctors and hospitals submit their bills to the insurance companies, the insurer spends time evaluating, processing and rejecting or approving claims. All this administrative time also gets built into the insurance company premium.
This absurd pile of paperwork, negotiation, and behind-the-scenes activity that has nothing to do with medical care is far more expensive than most people know. A medical journal characterize this year concluded that in 2017, “U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita (34.2% of national health expenditures).” In Canada, which operates a single payer health care system in which insurance has a minor role, administration costs only $551 per capita.
Prescription drugs with ever-increasing prices also contribute to ever higher premiums. So do medical implants and other kinds of medical equipment produced by manufacturers with actual or near monopolies.

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And high premiums have impacts that most people don’t think about. Some premiums are paid by individuals, some by employers. Amounts paid by employers get factored into the cost of the products and services they sell.  Amounts paid by individuals reduce how much money they have available to pay for the goods and services.
If the individual or employer is a government unit, the money spent on premiums comes from taxes paid by everybody. The higher the premium, the higher the tax needed. This tax gets factored into the household budgets of taxpayers, further reducing the amount of money available to pay for goods and services.
Individuals also spend considerable amounts of unpaid time dealing with the medical bills they receive for amounts that are not covered by their insurance (assuming they have insurance). Is the amount billed accurate? Is the amount really not covered by the insurance?  Exactly how do they go about finding out?
Both individuals and employers put in unpaid amounts of time figuring out whether they should keep or change their health insurer, keep or change the type of policy they have, and adjust features of the policy like deductibles and co-pays.
Elevating commercial interests over health care has produced endless harm and misery for Americans. Some consequences are obvious. The 2018 Vermont Household Health Insurance Survey counterfeit that 3% of Vermonters concept age 65 were uninsured. Another 36% were insured but had trouble getting care when they needed it because they really couldn’t afford their deductibles and copays.  Medical debt, frequently contributing to bankruptcy, is common. Medical debt leading to suicide is not unheard of, and, in a final stroke of irony/absurdity, the medical care associated with suicide attempts may not be covered by health insurance.
Americans now go to great lengths, and to foreign countries, to get health care they can afford. This phenomenon is celebrated as “medical tourism.” And “In 2017, more than 1.4 million Americans sought health care in a variety of countries around the world” according to an article in the American Journal of Medicine. Things are so bad that the state of Utah has a “Pharmacy Tourism Program” that pays for some state employees to travel to Mexico and Canada, by air, just to fill prescriptions for expensive medicines. Seriously.
As if commercial interests didn’t have enough of a stranglehold on health care, just weeks ago NBC reported that “Private equity firms now control many hospitals, ERs and nursing homes.” That characterize asked what is surely a rhetorical question: “Is it good for health care?” What do you think?
We need to take health care back from the commercial interests that are strangling it and us. And we cannot take it back without the government acting in our stead.
It’s the only way for health to outrank profits in America.
I believe in Democracy. And the only way to have a Democracy is to have journalism. We are discovering that journalism is the essential ingredient to a healthy Democracy. And I have discovered that the journalism needs to be funded. That's why I spend so much time supporting VTDigger and their work. It is the definition of "Essential."

Kevin Ellis, VJT Board Member

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