August 17, 2019
Mickey Friedman
The Democratic debates left me depressed, despairing, and despondent. And the continuing decline of the Red Sox didn’t help.
The Dems somehow managed to mangle health care reform. Unable to tell Americans why it works. With Medicare For All pitted against Medicare For All Who Want It and Medicare for America. Give me a break. A believer in single payer Medicare For All since the Physicians for a National Health Program (PNHP) introduced their comprehensive plan, I give up. The Dems have mangled the Medicare For All idea.
Why is it so hard to focus on the attempts of the Trump Administration to take away care, yet so easy to trash the plans of other Dems? Put arrogance and ambition aside. Admit there are miles between a theoretical plan and successful legislation.
Emphasize simple facts: the US spends almost twice as much per person as other countries. $10, 224 per person per year, while Germany spends $5,728, Sweden $5, 511. Canada, that hotbed of socialism, spends $4,826 per person per year. The average of other comparable countries is $5, 280 per person per year.
The Commonwealth Fund 2016 study reveals: “the health care systems in Canada, the Netherlands, and the United Kingdom have no deductibles or cost sharing for primary care; the French system exempts low-income adults and those with chronic illnesses from cost sharing; and out of-pocket spending is capped at 1 percent of income for the chronically ill in Germany and at $123 annually in Sweden.”
As Ezekiel J. Emanuel notes in the New York Times: we’re 4 percent of the world’s population, yet account for nearly half of global drug spending. We average $1,443 per person a year on drugs. Switzerland negotiates drug prices and saves $500 per person a year, about $160 billion per year. It’s drug prices, stupid.
Republicans, insurance and pharmaceutical companies insist affordable health insurance for all will cost trillions. But neglect to say it’s possible to provide health care without charging patients for the extraordinary salaries of their executives, for the profit they make, for the growing costs of overhead.
The Center for Economic Policy Research explains “there is one avenue through which the entire insured population can lose out: overhead costs. Higher overhead costs leave consumers paying more in premiums even when they aren’t receiving more in benefits. In this sense, insurance companies with high overhead costs are similar to expensive middlemen.”
Compare overhead costs as a share of total health expenditures from 2010-2015. For Private Medicare it was 18.8%, for Private Individual and Employer-Based Insurance Plans it was 12.3% but for Public Medicare it was only 1.8%.
The Center for Economic and Policy Research concluded: “Private health insurance companies spend far more on overhead than government programs do … If the private sector could reach Medicare’s level of efficiency, overhead spending would fall to less than $20 billion, saving the American people roughly $100 billion per year.”
Emanuel points to inflated hospital costs: “Medicare and Medicaid set their own hospital prices, which have risen modestly in recent years. But hospital prices for the roughly 160 million Americans with private insurance have shot up as much as drug prices. In 1996, hospitals charged private insurance companies about 6 percent more than Medicare. In 2012, they charged 75 percent more than Medicare. A recent RAND study indicates that, on average, hospitals now charge private insurance companies 141 percent more than Medicare.” The cause? Something we know about here in the Berkshires: the merger of hospitals and creation of local monopolies.
How about administrative costs? According to the Center for American Progress “health care payers and providers in the United States spend about $496 billion on billing and insurance-related (BIR) costs.” About twice as much as other countries.
Back to my friends at PNHP: “Scotland and Canada have held hospital administrative costs to approximately 12% of their revenue versus 25.3% in the United States. Simplified, uniform billing procedures could reduce the money and time that physicians spend on billing-related documentation.”
Conveniently ignoring Social Security, Republicans and private insurance companies claim government programs just won’t work. But profit-based private companies have a vested interest in not implementing cost-cutting efficiency if it means reducing their income. Add an average profit margin for private health insurance companies of 3.2 percent to their overhead.
We pay twice as much for our health care but as the Commonwealth Fund reveals we’re more likely to have chronic conditions like arthritis, heart disease, asthma, high blood pressure or diabetes. In fact, 28 percent of Americans have multiple chronic conditions, compared to 14 percent in Britain and the Netherlands, 18 percent in France and 22 percent in Canada.
Call it what you will but it’s national healthcare, stupid.
Here’s a crazy solution. How about the Democratic candidates sit down, compromise, and agree on a plan they can explain to us? Here’s a suggestion: BestCare4All. And it’s got a nice ring to it.
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“Best Care 4 All” was first published in the August 8, 2019 issue of The Berkshire Record
For more information:
https://annals.org/aim/fullarticle/2605414/single-payer-reform-only-way-fulfill-president-s-pledge-more
Annals of Internal Medicine
18 APRIL 2017
Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs
Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
https://www.nytimes.com/2019/08/02/opinion/democrats-health-care.html?
Democrats Are Having the Wrong Health Care Debate
They should skip the argument over Medicare for All and find the best ways to tackle affordability.
Ezekiel J. Emanuel, August 2, 2019, New York Times
https://www.who.int/gho/publications/world_health_statistics/2017/EN_WHS2017_TOC.pdf?ua=1
World Health Statistics 2017
World Health Organization
http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-health-insurance-keep-rising-even-as-costs-fall-for-other-types-of-insurance
Overhead Costs for Private Health Insurance Keep Rising, Even as Costs Fall for Other Types of Insurance
Nick Buffie
06 February 2017
The Center for Economic and Policy Research
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ – item-relative-size-wealth-u-s-spends-disproportionate-amount-health
How does health spending in the U.S. compare to other countries?