U.S. healthcare still costs more, does less and penalizes businesses compared to other countries

Health Insurance Is for Everyone

By Fareed Zakaria
TIME

Two years ago, Barack Obama signed into law the most comprehensive reform of American health care since Medicare. Most of its provisions haven't been implemented yet. But the debate about it rages on at every level. Twenty-six states have filed legal challenges to it. And this month the Supreme Court will hear arguments about its constitutionality.

The centerpiece of the case against Obamacare is the requirement that everyone buy some kind of health insurance or face stiff penalties--the so-called individual mandate. It is a way of moving toward universal coverage without a government-run or single-payer system. It might surprise Americans to learn that another advanced industrial country, one with a totally private health care system, made precisely the same choice nearly 20 years ago: Switzerland. The lessons from Switzerland and other countries can't resolve the constitutional issues, but they suggest the inevitability of some version of Obamacare.

Switzerland is not your typical European welfare-state society. It is extremely business-friendly and has always gone its own way, shunning the euro and charting its own course on health care. The country ranks higher than the U.S. on the Heritage Foundation's Index of Economic Freedom.

Twenty years ago, Switzerland had a system very similar to America's--private insurers, private providers--with very similar problems. People didn't buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly. The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.

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Progressive Ponderings: Purchased Democracy

By Joe Mayer

Last week the misnamed health insurance industry finally told the truth, “The Democrats are the enemy.” They really meant that “the people are the enemy.” Democrats tried hard to keep “single payer” and the “public option” out of the health care bill by denying advocates a seat at the table. But public demands would not go away and they finally had to concede and bow to the pressure of democratic populism.

Two important and competing lessons (and probably many more) can be learned from this nearly year-long battle over fixing a dysfunctional and corrupt health care system: 1) The corporate world views democracy as an obstacle that must be overcome by using the power of money and the corruption it can purchase; 2) If citizens become strongly engaged in an issue and unrelentingly continue the process, some politicians, possibly even a majority, will eventually listen to the people who put them into office.

On health care reform, the actual health care of our citizenry hardly enters the discourse. It’s all about insurance companies who do not add one iota to national health and wellness. In fact, as the debate simmers on, the harm – death, rescissions, bankruptcies, mental breakdowns, suffering – caused by these health care imposters is made aware to more and more Americans. The real question should be “Does this industry serve any useful purpose?”

A positive outcome of this lesson in mental gymnastics is enlightened citizens. It is never mentioned and few can recall that in 1945 the health insurance industry was granted an exemption to our antitrust laws. All these years they were able to prey on the health needs of Americans by using monopolistic practices, geographically dividing the country and assigning each state to one or two companies and fixing prices with impunity.

The familiar relationship between our elected officials and their corporate purchasers is corrupt. In case after case, our “principled” defenders of the status quo are shown to have close financial relationships with deep-pocketed lobbyists and campaign contributors. Also, spouses working within the industries seeking legislative and executive favors are now commonplace. A revolving door of opportunity to cash in with a high-salaried position when leaving government service almost guarantees them becoming millionaires after leaving office. The whole system is designed to thwart democracy and sell power to the highest bidder.

We deceive ourselves when we allow politicians and their masters to get by explaining that they’re “just buying access.” Unless we call it the lie that it is and start prosecuting the sale of public office and public power our democracy will continue the farce. Campaign finance is our most important issue. The silence surrounding this issue proves its significance.

History tells us we shouldn’t be surprised – 30 pieces of silver purchased…

Bill Moyers on health insurance: Condition CRITICAL

The film CRITICAL CONDITION puts a human face on how three families face illness without health coverage. There are 47 million Americans without health insurance. But who are they? The great battle being waged over whether health insurance coverage should be mandatory for Americans has led to fallacies about who is uninsured and underinsured.

The Henry J. Kaiser Family Foundation offers these five facts about the uninsured.

• Most of the uninsured are in working families and do not have access to employer-sponsored insurance.
• More than eight in ten of the uninsured are in low- or moderate-income families.
• Most low- and moderate-income uninsured adults are not eligible for Medicaid.
• The uninsured suffer from negative health consequences due to their lack of access to necessary medical care.
• Medical bills are a burden for the uninsured and frequently leave them with debt.

Additional facts from POV'S CRITICAL CONDITION site:

• 80% of the uninsured are adults. Young adults (ages 19-24) are at greatest risk of being uninsured and make up more than one of every three uninsured adults.
• The majority of uninsured adults (75%) have gone without coverage for a period of at least one year.
• The average total annual cost of employer-sponsored family coverage in 2007 was $12,106 — seldom affordable to low-wage workers without sizable contributions from their employers.

(More here.)

VA medical care touted for high quality, low cost

"... the VA experience shows that it's possible for government to be a good player, an accountable player in that mix." — Dr. Greg Felice.

Doctors say VA care is a model of efficiency

by Lorna Benson, Minnesota Public Radio
August 18, 2009

Minneapolis — One argument against a public insurance option in the current debate over health care is that government typically isn't as efficient or proficient as the private sector. But some say that the Department of Veteran Affairs medical care is actually an excellent example of how the government is leading on health care quality and cost.

A third of the nation's 24 million veterans get their health care from the VA. Most qualify because they have an injury or illness that is in some way connected to their military service.

The Minneapolis VA has 80,000 patients who receive care at the hospital and its affiliated clinics. This year, the government is giving the medical center about $500 million to care for those vets. That's a lot of money, but that's also a lot of patients - including some with very traumatic injuries.

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Falling through the cracks in the U.S. medical system

A congressman hears from constituents

By Mark Fischenich
Free Press Staff Writer
MANKATO, MINN.
August 12, 2009 11:58 pm

The worst day wasn’t the day when Christine Carmichael of New Ulm was a teenager and learned she had rheumatoid arthritis.

It wasn’t any of the 12 days during her life when Carmichael underwent surgeries for everything from hip replacements to a perforated ulcer.

It wasn’t the day when she decided that her private insurance ($900 a month) and out of pocket costs (approximately $1,400 a month) were more than she could afford with a take-home pay of $2,500 to $3,000 a month.

It wasn’t any of the long days she worked toward building up her New Ulm interior design business, hours that totaled as many as 80 hours a week despite her rheumatoid arthritis and ankylosing spondylitis, a chronic arthritis affecting her spine.

“The day that things crashed, I’ll never forget it,” Carmichael told Congressman Tim Walz (D-Minn.) Wednesday.

It was when three of her interior design customers — suffering because of the severe economic recession — called on the same day to say they needed to put their projects on hold. After years of ever-growing premiums and out-of-pocket costs, she had little in savings.

“I ended up having to default on my house,” Carmichael said. “It went into foreclosure in December.”

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Progressive Ponderings: Who Will Write the Healthcare Contracts?

by Joe Mayer

A contract is an agreement between two or more parties creating one or more obligations that are enforceable in a court of law. A contract may be as simple as putting a quarter in a machine and receiving a gumball or as complex as buying a healthcare insurance policy.

Problems for citizen-consumers arise in our complex contracts because nearly all are written by corporate lawyers in language that is, for the general public, incomprehensible. Each of us has entered into contracts which affect us on a daily basis – telephone, cable, internet, mortgages, credit cards, warranties, service contracts, utilities, payday usury loans, multiple insurance contracts. When a corporate party defaults, cancels or changes terms we have a right to sue in court. Of course that means hiring a lawyer to defend against a team of corporate lawyers already on staff or retainer. Faced with that option most of us just give up.

When property is insured, it is straightforward and measurable. When humans are insured it is more complex. An example is disability coverage: How disabled? Who and what was the cause? 100% disability or only 10%? What is the disability worth?

The most complex of all insurance is healthcare. The human machine, besides its fantastic integrated working parts, is also governed by emotional and mental forces. Writing a contract to cover all the possible physical and mental problems, diseases and injuries that can affect the human is nearly impossible. Adding to this complexity is the daily advance in treatments, cures, and medicine that can’t be foreseen or enumerated in a policy.

One hears the term "universal coverage": What is it? Does “universal” refer to covering ALL people? Does it mean coverage for ALL medical needs? Are non-citizens a part of “universal”?

If “universal” means covering all people and mandatory coverage becomes the law without single payer or at least a public insurance option, then each of us would be forced into purchasing private health insurance. Who will write the contracts? Will they be standardized? Will there be a government watchdog, an overseer? If the contracts differ company to company, how will I choose coverage not knowing my medical or injury future? Will it be affordable? Will it have co-pays and/or deductibles beyond my financial means? What will keep a lid on escalating medical costs?

This is our current situation. For many it would continue to be a choice between living and bankruptcy, between drugs and food, between healthcare and death. These are the choices being offered by corporate America.

I recently found a listing of all attendees at the White House Healthcare Summit. Neither John Q Public nor single-payer was listed. The House Bill for single-payer is HR676, the Senate version S703. Break the corporate monopoly over our lives by contacting your representative, Senators (if you have more than one) and the White House, and ask for passage of these bills.

(NOTE: This is the third in a series of articles about healthcare reform written by our colleague Joe Mayer.)

Progressive Ponderings: Will Citizens Be Allowed a Voice in Healthcare Debate?

by Joe Mayer

It’s amazing that the majority of Americans favor single-payer healthcare. Why? This is not news the tightly integrated corporate system wants to declare or promote. As the White House Summit on Healthcare approached, corporate media ignored the majority opinion.

Rep. John Conyers has a bill before Congress (H.R. 676) that proposes single-payer healthcare. Sixty-four representatives have signed on, yet this information seems to be censored. Our major news media providers are not “stand-alone” news businesses, but part of corporate conglomerates. In this situation the news division promotes other conglomerate interests, not the interests of the general public. Researching this Pondering could only be done pursuing alternate media.

The healthcare insurance industry, a parasite feeding on our healthcare system, adds additional costs – administration, advertising, high executive salaries, profits – without advancing care. This private system has failed, and attempts to reform it will only delay real reform. In fact, the industry advocates requiring every American to buy private insurance, expanding an industry despised by consumers. Motivated only by profit, this industry sells policies and then exploits the system to avoid paying claims. Sick people need advocates, not adversaries.

Government is supposed to have a role in overseeing this private insurance business, but sometimes the head overseer is ideologically against government oversight or worse yet, as we’ve witnessed, has grown up within the industry to be regulated. Remember, the banking industry supposedly had oversight; likewise the S & L industry, the mortgage industry, the commodities industry, etc. “Let the buyer beware” replaces the medical pledge, “First, cause no harm.”

Single-payer medical coverage offers several advantages. It is equitable. It is “just” for those who consider healthcare a basic human right. It guarantees access to the healthcare system without discrimination. It eliminates exceptions to payment for care since all are covered. It is appreciated by seniors with single-payer Medicare, Part D excepted. It is satisfying for citizens of other nations who have a single-payer system—whose governments would not dare cut their programs. It is favored by 59% of U.S. physicians, according to Physicians for National Health Program. It would be welcomed by industries with employer-provided healthcare plans that add to the cost of competing in the global market. (American auto manufacturers must ask approximately $1,400 more per car than Canada’s automakers.)

An interesting note: Those advocates for continuing and expanding private healthcare insurance are nearly all covered by employer-paid plans. This group includes all Congress members and government employees.

(NOTE: This is the second in a series of articles about healthcare reform written by our colleague Joe Mayer.)

Progressive Ponderings: Do We Need Private Insurers?

by Joe Mayer

The good news is that President Obama is living up to his campaign promise to reform the American healthcare system. The bad news is that President Obama is living up to his campaign promise to reform the American healthcare system without inviting the majority of Americans who desire single-payer healthcare coverage to the table.

For over two decades the majority has favored a single-payer government system. At the White House National Summit on health on March 5, of the approximately 120 participants NO single-payer advocates were invited until two days before convening.

Until our recent financial disaster, the most despised corporate industry in the U. S. was the HMO/Health Insurance/Pharmaceutical industry. Only by destroying our economic system was Wall Street able to leapfrog this threesome. Yet, the HMOs were at the Summit. The health insurance companies were there, as was the pharmaceutical industry. This is not the “change-we-can-believe-in.” Rather, it cements the health insurance and HMO industries as the solution that adds nothing to advancing our nation’s health.

A few days prior to the Summit this troika offered this compromise: If Congress and the administration pass a law forcing every American to buy private health insurance, people with pre-existing conditions would be covered and without extra cost. The most common action on Capitol Hill – democrat and republican – was to fawn and coo over this magnanimous offer. This is Blackmail! This is what the corporate takeover of government looks like! This is what money in politics purchases!

Estimates of how much the healthcare insurance industry and HMOs siphon off our healthcare dollars are as high as 31%, $.31 of every dollar without adding a doctor, a nurse, any practitioner or researcher to actually improve the health of American consumers.

United States healthcare costs about 17% of GDP (gross domestic product). This is up from 8% about ten years ago and is projected to reach 25% by the year 2025. No nation can support this magnitude of expense. No other nation spends nearly as much per capita on healthcare. The other industrialized nations, all with some sort of government healthcare, meet or exceed the outcomes of our American health system.

Until the mortgage bubble burst, healthcare costs were the number one cause of bankruptcy in the U.S.; it transitioned more people into poverty, and damaged the health of Americans by limiting healthcare access and causing mental anguish.

Do we need private insurers? Why shouldn’t the public have access to a single-payer system?

(NOTE: This is the first in a series of articles about healthcare reform written by our colleague Joe Mayer.)