Yes, We Can All Be Insured
By Jane Bryant Quinn
July 30, 2007 issue - Prepare to be terrorized, shocked, scared out of
your wits. No, not by jihadists or Dementors (you do read "Harry Potter,"
right?), but by the evil threat of ... universal health insurance! The more
the presidential candidates talk it up, the wilder the warnings against it.
Cover everyone? Wreck America? Do you know what care would cost?
But the public knows the American health-care system is breaking up, no
matter how much its backers cheer. For starters, there's the 46 million
uninsured (projected to rise to 56 million in five years). There's the shock
of the underinsured when they learn that their policies exclude a costly
procedure they need—forcing them to run up an unpayable bill, beg for
charity care or go without. And think of the millions who plan their lives
around health insurance—where to work, whether to start a business,
when to retire, even whom to marry (there are "benefits" marriages, just
as there are "green card" marriages). It shocks the conscience that those
who profit from this mess tell us to suck it up.
I do agree that we can't afford to cover everyone under the crazy health-
care system we have now. We can't even afford all the people we're
covering already, which is why we keep booting them out. But we have an
excellent template for universal care right under our noses: good old
American Medicare. When you think of reform, think "Medicare for all."
Medicare is what's known as a single-payer system. In the U.S. version,
the government pays for health care delivered in the private sector.
There's one set of comprehensive benefits, with premiums, co-pays and
streamlined paperwork. You can buy private coverage for the extra costs.
Health insurers hate this model, which would end their gravy train. So
they're trying to tar single-payer as a kind of medical Voldemort, ready to
destroy. Here are some of their canards, and my replies:
Universal coverage costs too much. No—what costs too much is the
system we have now. In 2005, the United States spent 15.3 percent of
gross domestic product on health care for only some of us. France spent
10.7 percent and covered everyone. The French comparison is good
because its system works very much like Medicare-for-all. The other
European countries, all with universal coverage, spent less than France.
Why are U.S. costs off the charts? Partly because we don't bargain with
providers for a universal price. Partly because of the money that health
insurers spend on marketing and screening people in or out. Medicare's
overhead is just 1.5 percent, compared with 13 to 16 percent in the
private sector. John Sheils of the Lewin Group, a health-care consultant,
says that the health insurers' overhead came to 0 billion last year, of
which billion was profit. By comparison, it would cost billion to
cover all the uninsured.
Eeeek, your taxes would go up! Maybe not, if Sheils is right. Both the
Congressional Budget Office and the General Accounting Office have
testified that the United States could insure everyone for the money we're
spending now. But even if taxes did rise, you might still come out ahead.
That's because your Medicare plan would probably cost less than the
medical bills and premiums you're paying now.
We get world-class care; don't tamper with it. On average, we don't.
International surveys put France in first place. On almost all measures of
health care and mortality, we lag behind Canada and Europe. Many
individuals do indeed get superior care, but so do people in single-payer
countries, and at lower cost.
They have long waiting times. No advanced country has waiting periods
for emergency surgery or procedures that are urgently needed. The
United States has shorter waits than Canada and England for elective
surgery. Still, queues are developing here, at the doctor's door. In a study
of five developed countries, the Commonwealth Fund looked at how many
sick adults had to wait six days or more for an appointment. By this
measure, only Canada's record was worse than ours. But waits depend on
how well a system is funded, not with the fact that it's single-payer. Many
countries that cover everyone, including France, Belgium, Germany and
Japan, report no issue with waits at all.
There's no problem; people get care even if they're uninsured. They don't.
They get emergency treatment but little else. As a group, the uninsured
are sicker, suffer more from chronic disease and rarely get rehabilitation
after an injury or surgery. They also die sooner—knowing that, with
insurance, they might have lived.
Right now, Congress is trying to bring 3.3 million uninsured children into
the State Children's Health Insurance Program. President George W. Bush
says he'll veto the expansion as "the wrong path for our nation." He
objects to "government-run health care" (like Medicare?) and says that
SCHIP "deprives Americans of ... choice" (like the choice to go
uninsured?). Buzzwords like "government run" are supposed to summon
up monsters like "socialized medicine" that apparently still lurk under our
beds. If these terror tactics work, prepare for another 46 million
uninsured.
Reporter Associate: Temma Ehrenfeld
Good article! I do find the reporter has left some things out.
Medicare only pays for hospital services and up to 100 days of Skilled Nursing. Part A
If a Medicare eligible patient wants outpatient (doctor visits, etc) coverage they must pay for a premium, deductible and co-pay which is 20%.
Medicare (both A and B) coverage is very limited in its coverage. There are limits on coverage and the prevention coverage is very bad. Medicare has a time frame for diagnostic procedures (DEXA scans every 2 years, etc). Medicare patients must agree to pay for labs and procedures that Medicare will not cover. They are required to sign an a form called "advance beneficiary notice"
I just read that Medicare is planning on cutting (again) payments to physicians by 8.8% for 2008. This is another cut after last year cut. I worry about patients on Medicare. I think that more physicians will not be able to afford to take Medicare patients so they will not take new patients. Physicians have a percentage of patient types they are willing to take.
I know the only reason my mom has not had trouble finding a physician to take her Medicare is because she works at a clinic.
Medicare accounts for the huge administrative costs that physicians and hospitals must pay for. There are so many rules and regs to get any payment from Medicare/Medicaid.
There are countries that have both government run programs and allow people to buy private insurance. I like that plan. I have worked with Medicare/Medicaid for so many years that I would never want my health to be decided by them.
I hope the US can come up with a good plan to help everyone, but using Medicare as an example is not what I would look forward to.
I have been thinking (maybe it is because of all the kids we have in college right now) that the Federal government could help people who have no insurance or are under insured with student loan forgiveness for physicians.
I know that there are programs for teachers that forgive their loan amounts if they work in certain areas that need teachers. Physicians are coming out of school with 200,000 to 300,000 dollars in student loans! So many people on Medicare/Medicaid have a hard time finding a doctor that will accept this government insurance, I think it would be a bonus. Dentists too!
Just a thought. Maybe if docs had loan forgiveness the cost of healthcare would not rise so dramatically each year
My son in law starts medical school on the 6th. His tuition alone is 45000 a
year. I don't know how this is affordable to the average american family. I
know we cannot afford to pay that for him. He will have lots of student
loans to pay back. One of our docs student loan payments is over 3000 a
month. That is more than my mortgage. They have to meet these bills, pay
malpractice and overhead. The government needs to help them out so that
the indigent can get the care they need...and deserve. I agree Lorster! I know that many people think doctors are greedy and just trying to get rich, but I don't think most are. I think most are trying to help. And it is not just student loans, it can cost hundreds of thousands of dollars to buy into a practice.
I am a volunteer with a free clinic (so is my husband) in our rather small city (about 60,000). I am always amazed at the generosity of the medical community here. If we need a certain drug, I know of small pharmacies who will help out.
Great post Lorster, really go me thinking.
I have always been anti socialized medicine with all the same concerns about
quality of care, wait times, etc but I'm really taking a second look at it. I
think it could work so that we all would get covered. I just wonder if I'll see
it in my lifetime.I don't think so Lorster,
One of the reasons is the American Medical Association. They have powerful lobbying in DC. I was shocked when I found out that we will still be using the CPT coding procedure book when we finally start to use an updated ICD-10 diagnostic book that the rest of world uses. Why do we need to use an additional procedure book? The AMA is the author of it and it very profitable. And this is just about a book!
We can hope for and work towards an improved system, but I think my grandchildren may benefit from it not me.
One benefit that could come from a socialised medical system is when
health care is being paid for with taxes there's a lot more motivation for the
government to fund research, rehabilitation, and cures.
One more thing to think about is that we all pay for the uninsured - when they have a preventable health crisses. The system 'charges back' those with insurance so that hospital doors don't close.
Why is it that my insurance pays and I pay dollars for lab tests that for the uninsured would have cost 0? If the lab can stay in business for ., why can't everybody be charged ?
Health care administration eats about out of every 0 - nobody gets well from this huge chunk of money spent on paperwork. I am one of the lucky few - good health insurance from my employer. I make enough to cover what my insurance doesn't. But I live in fear that my programming job will be outsourced to India, like so many of my co-workers jobs.
Hi all again,