THE MODERN UTOPIAN

 

         HEALTH CARE REFORM DID NOT GO FAR ENOUGH. WE NEED A GLOBAL SOLUTION ...

"TO COVER EVERYONE BECAUSE HEALTH CARE IS A BASIC HUMAN NECESSITY" 

                  - Lawrence O'Donnell on MSNBC.
        NOT EVERYTHING SHOULD BE "FOR PROFIT".   SOME THINGS REQUIRE THE GOVERNMENT AND A  NON-PROFIT"  APPROACH.    -   papaphrasing Rachael Maddow


 

Here is a true story for those of you who know have to do the math:

I was in the hospital for 4 days. The hospital bill was $26,000. They sent me a letter that said,    if I did not have insurance and paid within 60 days, they would give me a 40% discount. So, that would have been $15.200. 

If I could not pay in 60 days, they would let me pay the 26K over 6 months without interest. 

After 6 months, 10% interest on the balance owed until paid. 

LUCKY FOR ME, I had Medicare and Blue Cross: 
Medicare paid 4K,
Blue Cross less than 1K,
and me $250.
The balance disappeared!  
PITY THE POOR SUCKER who does not have insurance. 
Is that a crime, or what?

HEALTH CARE IS A RIGHT, NOT A PRIVILEGE

FIRST STEP: Add a "public option" to Obamacare, even if there are limitations placed on it in the beginning.  Just get it started. Provide even more oversight on Medicare to reduce the excessive charges by hospitals, doctors and other care providers.  NEVER reduce benefits or increase the age of eligibility.
 
Eliminate ObamaCare which serves the private insurers so well.  Replace it with Medicare for Everyone!   Private health insurance could continue as optional as well as supplemental to Medicare for everyone.    People could opt out of Medicare, if they choose, although a minimum Medicare payroll tax would continue for everyone, as it is today.
 
AFFORDABLE CARE vs. MEDICARE
When folks pan the Affordable Care Act for being  nearly 3,000 pages long, here's a sensible response:
It could have been done in a page and a half if it simply declared that Medicare would cover everyone.
The concept of Medicare for All was pushed by a few lonely liberals. And it would have been, ironically,
the most conservative approach to bringing down    health care costs while maintaining quality.
- Froma Harrop, Nation of Change 2/28/13 (nationofchange.org)
 
TIME'S BITTER PILL
For this week’s issue of Time magazine, the cover story is Bitter Pill: Why Medical Bills Are Killing Us, by Steven Brill.
I wish I could get every voter in America to read that article ...he does a marvelous job of giving us the picture on just how broken the American healthcare system is   in terms of costs.  He goes into detail about how hospitals create those staggering bills. If you have  private insurance or a government plan, you don’t have to pay those prices, but what if you don’t? The billing system is out of control: $1.50 for a 1.5-cent acetaminophen pill (Tylenol). A simple niacin tablet marked up 240 times. Routine products like gauze marked up 10 times. Billing for a lamp shade? Are you serious? Double and triple billing for routine items that no insurance company or government agency will pay for, but that you will be billed for if you are on your own. You have read the stories or heard them from friends,  but Brill makes it real. We spend almost 20% of our gross domestic product on health care in the US, and  that figure continues to climb. I could quote at length from the article, but let me just excerpt six paragraphs:
Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth.   In the U.S., people spend almost 20% of the gross domestic product on health  care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries. According  to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office.    We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart. The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest   in the U.S. by 2020 are related to health care.
America’s largest city may be commonly thought of as the world’s financial-services capital but of New York’s 18 largest private employers, eight are hospitals and   four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.   The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington.  That dwarfs the $1.53 billion spent by the defense and aerospace industries   and the $1.3 billion spent by oil and gas interests over  the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington. When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%,
more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care  for the poor.
That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay   some portion of the bills covered by their insurance.  This is what’s increasingly burdening businesses that  pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses      - from John Malden's Thoughts from the Frontline 2/27/13 (wave@frontlinethoughts.com)
RF COMMENTS: I have demonstrated from personal experience how out of control health care costs are.
Difficult to change, but as John Mauldin says, a necessity. Both Medicare and Blue Cross do limit the amount of pay out to providers. Still, too excessive.
I do not what to fault anyone's "free market sensibilities" but in the case of health care, government control is necessary.  Huge profits from health services are unacceptable.
I understand that "Medicare for All" is the best solution which must be accompanied by reining in costs and perhaps adjusting the co-pay for those who can afford it. (Also, by better negotiations on prescription drugs.)
That system would take the burden off private industry  to provide health insurance. What a bonus for them! (And, for public institutions like the one I retired from - the University of California.) Also, Medicaid could be mostly, if not totally, eliminated with a sliding scale for co-payments.
Obamacare was a compromise that just muddied the water. Medicare for all would simplify health care a lot.
(Already I understand their administrative costs are only about 3%.) I would think that businesses would be overjoyed by and support Medicare for All.
 
Save Medicare?   Easy.
Check the article in TIME magazine demonstrating the high cost from providers and modify payments and  waste (above).
Medicare can be fixed by adjusting excess payments   and waste to providers and by making Medicare for all.
Allow Medicare to negotiate drug prices with pharmaceuticals as well. Medicare is prohibited from negotiating lower prices with pharmaceutical companies at an estimated cost of 230 Billion per year.
 
The insightful Brotherbogie Blog website  (Brotherbogie.wordpress.com) discussed
RIGHTS VS. PRIVILEGES with a bias toward health care as a privilege. 
I responded with the following comments:
I would argue that health care is, in fact, a right.  Based on secular moral grounds:  every person   has the "right to life".  If they can not afford health care, in many cases, that right is lost (death).
Of course, what you say about limited availability  of health care could create a problem. To me, the obvious answer is to increase the people available to provide health care - doctors, nurses, paramedics, etc. (Lots of unemployment that could be filled by training more health professionals.)
Of course, costs must be controlled. That is another concern that can be dealt with by rational human beings.
The USA is the only major industrialized nation without universal health care. That alone should  tell us something about who we are and how   much we care about our own citizens. 
There are some things that do not fall in the category of "for profit" . BASIC health care is one.  (Private insurers can always provide supplemental coverage for those who can afford it.) 
Many people would be dead today if we did not have Medicaid for the poor.  I am sure you get
my point.
 
SIMPLE ENOUGH:
HEALTH CARE FOR EVERYONE
There is only one reasonable solution to the problem of health care insurance in the USA.
It's also the simplest of solutions:
Medicare for Everyone funded completely by a "payroll" tax (with no cap) with the co-pay reduced for those living at or below the poverty level. 
This will only be possible if we elect a Congress with a majority of progressive thinking members.
This is a country which the Founders said should "support the general welfare."
Any reasonable definition of this is to acknowledge the health is a right, not a privilege and should be legislated as such.
 
HEALTH CARE COSTS
    Never talk about health care costs creating a "deficit".  This problem can be solved by "Medicare for all" - paid for in the same way social security is paid for. (Of course, there must NOT be a cut off of taxation at 106K which is the current problem with social security.) 
Did you know that the Medicare tax is only 1.5%?  Who do you know who would not be willing to raise this tax to 2.5% in order to have Medicare for All?  (Social Security is 7.2%!)    
 
A bigger issue can be resolved, although not easily.  We are being overcharged.  Both insurance companies and Medicare try to control changes
but they do not do it well.  (Too much political pressure?)
ARE WE BEING OVERCHARGED? 
    The main issue about costs is not Medicare, but what we pay for care.  Medicare negotiating with Pharmaciticals to bring those charges down is one example that could help. 
    Let me provide another (personal)  example:
The following is in no way a criticism of the doctors or the hospital or emergency services with which  
I have had service. They have all been great.        
    This is only a question about charges and how costs can be controlled.
    My local hospital charges over $6,000. per overnight stay. (That does not include exams and doctor's charges)  Medicare pays them about $1,000. per day. 
Is Medicare paying them too much?
    The admitting doctor in the hospital charges $400.  Medicare calculates the service @ $210.  The doctor spends less than 5 minutes with me.
He drops in each day to check on me @ $210.     He "discharges me" from the hospital and Medicare says $106. 
Is Medicare paying him too much?
    A specialist charges $600. for 3 visit in the hospital.  Medicare calculates $283.00  (Each visit lasts about 5 minutes.) 
Is Medicare paying him too much?
    My primary physician charges about $150.00 for an office visit.  Medicare calculates that he should receive $108.00   On a typical day, my doctor sees about 8 patients an hour. 
(He is a conscientious doctor, spending as much as 10 minutes with me.) He is getting over $800.00 an hour. That computes to about $6,400. in an 8 hour day. Over $100,000. per month.(He has 4 or 5 office personnel he must pay from this income as well as rent, utilities, etc.)  
Is Medicare paying too much?
    A follow up visit to another specialist, which includes a urinalysis, seen by an assistant only. Charges $127.00  Medicare calculates $77.00
Is Medicare paying them too much?
    Finally, one more example,  ambulance service (trip is .2 miles from clinic to emergency room). Charge $712.  Medicare calculates $524.
Is Medicare paying them too much?
    Most of these charges seem excessive. 
I do not know.
    Before reducing benefits, better to investigate    if payments are reflecting a reasonable standard   of living and expenses for medical personnel and facilities involved. I believe Medicare does this to some extent
 
Perhaps another look is necessary.  I am only asking.
 
REDUCING BENEFITS IS NOT THE ANSWER.
FIRST. WE MUST REDUCE COSTS
 (UNNECESSARY TESTS, PADDED BILLS, EXCESSIVE PAYMENTS.
I could give more examples I bet you can as well.)
 
 
MEDICARE FOR ALL - AN OPPORTUNITY
If the Democrats were smart enough, they would turn the Ryan anti-Medicare plan into a "Medicare for All'.  RIGHT NOW while Medicare is on the minds of people who favor it, with not too much of a stretch to say everyone deserves it, plus it would cut the deficit by mountains of dollars.
 
Any arguments about cost?  Just increase the current tax from 1.5% to 2.5% - tell me who would oppose paying an extra 1% for every one to be insured?  (A few crazies, the insurance giants and their bought and paid for politicians, of course.)

UNIVERSAL HEALTH INSURANCE   

To save billions of dollars each year and to reduce health care costs, everyone in America, employed or unemployed needs to be covered by health insurance.  The statistics will confirm this.*    We do not need a new system.   There is already one in place that works for the elderly and the destitute (Medicare and Medicaid). 7 million uninsured children are already eligible for Medicaid but they are not enrolled!  

We also have FEHBP (the Federal Employees Health Benefit Program) in place  insuring 9 million federal employees and their families.   We need only extend this program to include small businesses and individuals providing tax credits to make it affordable for all.  We can enroll everyone in America in an existing health benefit plan that will NOT add bureaucratic layers or added burdens on our health care providers.

 

I will betcha that Medicare is the best run and the best government run program anywhere...does everything that needs to be done. Is it perfect?  Probably not.          But, can anyone find a better alternative?
A "payroll" tax, like the one for social security, would allow this program to pay for itself.  Unlike social security, there should not be a cut off for payment.
(Anyone making more than $106,800. does not pay social security tax on that income...have you ever heard of such an unthinkable idea?  ..except for the rich,     of course...so now we know where welfare really exists - for the upper 5% in this country.)

*NOTE:   14.6% of our Gross Domestic Product is spent on health  care  yet  45 million Americans have NO health insurance.    (Japan spends 7.9%,  Great Britain which covers everyone:  spends only 7.7% - in contrast.)      Most of us have no idea how much we pay in the form of taxes or higher insurance costs  because of the uninsured.   Hospitals and doctors can not refuse patients simply because they have no insurance.   PLUS, the uninsured rarely get preventative care.  When they end up in a hospital emergency room,    the costs are astronomical and they   do not have the ability to pay.  (Hospitals provide at least 35 billion a year in uncompensated care.)   Universal health insurance does not cost us more; it will save us billions of dollars and this can      be documented.

 

THE REGULATION OF PRESCRIPTION DRUG PRICES.   

"Every other substantial country in the world has some kind of government price controls on pharmaceutical manufacturers."   - - Public Citizen Health Letter, p. 10, June 2006 

In addition,  the drug companies need some other regulations: 

1) Sen. Schumer (NY) came up will a bill to keep drug companies from ?gaming the patent system - that needs to be passed;    

2) Drug companies and/or their affiliates should be prohibited from giving funds to the FDA;  and.  

3)  Congressional oversight of the FDA needs to be boosted.