I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.
I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.
I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. Click on this link to do so.
The Issue is Access to Care, Not the Number Who Buy Insurance
As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.
The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.
Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.
In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.”
The Insurance Scam
As Kevin Zeese and I wrote last fall, the ACA is one of the biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.
And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme.
And it is a scheme, because there are no guarantees that people who have insurance will be protected from financial ruin if they have a serious health problem. It is essential to remember that nothing about the basic business model of insurance companies has changed. They exist to make a profit and they are very good at it. While they complain about the ACA, because its regulations require more work on their end to find ways around them, it has been very lucrative for them. Health insurance stock values have doubled since the law passed in 2010.
One of their major work-arounds is the use of narrow and ultra-narrow provider networks to discourage patients with pre-existing conditions from buying their plans and leave patients footing more of the bill. Narrow networks exclude at least 30% of local hospitals and ultra-narrow networks exclude at least 70%. This means that if the local cancer center isn’t included in a plan, then people with cancer are unlikely to buy that plan. To make it worse, it’s difficult for patients to determine what providers are included in different plans because the information on the insurance exchange websites has been found to be wrong half the time.
The reason for the narrow networks is that when patients don’t go to an approved health provider, they bear most or all of the costs. The limit on how much money people can be required to spend in addition to premiums doesn’t apply when patients go out of network (and the limit was removed for 2014 anyway). In practice, if someone develops a serious health condition and the hospital or health professional that treats the condition is not in their network, they will have to go without care or find a way to pay for it. And if a person has a serious accident and is taken to a hospital that is out of network, the patient will again bear the total cost. Buying insurance is a health care crap shoot.
The Race to the Bottom in Health Care Benefits
Medical bankruptcy and self-rationing, foregoing necessary care due to cost, are two products of our market-based health system and we can expect them to continue under the ACA, even as more people become insured. Supporters of the ACA often quote the slowed rise of health care spending that has been happening since the financial crash in 2008. They claim it is a sign of the law’s positive effect; however, the slowing is actually due to fewer people using health services. In 2012, 80 million people went without necessary care because of cost.
Self-rationing will continue because there has not been an economic recovery for most of us. More than 80% of people are buying lower tier health plans that require high up-front payments for care at a time when most families are living paycheck to paycheck. The number of people who are considered poor or low income is rising. And, as Paul Bucheit writes, if we updated our standards for measuring poverty to reflect the current economic realities (the costs of food, housing, health care, education, etc), the poverty threshold would be over three times higher than it is now. He adds that half of the US population owns zero wealth because of debt. It is a sad irony that people are being forced to pay monthly premiums for health insurance that will leave them without money for actual care.
And now that lower coverage plans are legal, they are accelerating the race to the bottom in employer health benefits. Employers are shifting more of the cost of health care onto employees, reducing coverage for dependents, moving employees into private insurance exchanges (which do not qualify for subsidies) and penalizing employees for poor health habits, which places the blame for health problems on the individual without acknowledging that many drivers of poor health are out of the individual’s control. While tying health care to employment is not ideal, in the US at least the employer-based plans used to provide better benefits than those on the individual market.
The Practical Solution
The solution to the ongoing health care crisis is obvious. We need to reverse direction completely and move to a national publicly-funded health insurance for everyone. Some call this a single payer or ‘Medicare for all’ plan. We are already spending enough on health care in the US to provide high quality care to everyone. It is just wrong from a standpoint of what works to continue shifting more of our health care dollars to bureaucracy instead of to care and to the private insurance industry which is designed to keep as much for itself as it can get away with. It is immoral to protect insurance company profits instead of protecting the health and wellbeing of our people.
Putting our money into the insurance industry is a step in the wrong direction. The Expanded and Improved Medicare for All Act, HR 676, in Congress, would eliminate the insurance industry and create lifelong comprehensive coverage for everyone. No matter what you choose to do about insurance, tell your Congress member to support HR 676. And if you are one of the millions who do not plan to buy insurance, join me in telling Obama why. Click here to write President Obama.
Margaret Flowers is co-director of It’s Our Economy, co-host of Clearing the FOG Radio and an organizer of the occupation of Freedom Plaza in Washington, DC. She is also with the Health Care is a Human Right campaign in Maryland.
Obamacare is unraveling, not because the administration is particularly incompetent or unlucky, and certainly not as a result of the Republicans’ unrelenting hostility to the Obama health insurance plan. Indeed, ever since the bill’s passage in early 2010, the GOP’s holy war against Obamacare has served to solidify reflexive Democratic support for what has always been a Republican-inspired bill.
The truth is, the Affordable Health Care Act is coming undone because of its own, tortured internal logic. At root, it is a fraud on the public: a scheme to subsidize and more deeply embed a private insurance system that can only make profits by denying sick and vulnerable people health care, and playing different demographics of Americans against each other. As every other industrialized country in the world has already learned, it is impossible to build a genuine, universal healthcare system on a cut-throat capitalist foundation. Private insurers make money by betting against the health interests of their customers. Obama served his corporate masters by conspiring to make tens of millions more Americans into customers of private insurers. He tried to dress up one of the greatest corporate subsidies in history as if it were a solemn national mission, a rebirth of the social compact between the American people. But of course, Obamacare is no such thing; it is a racket to prop up private insurers with public money, while allowing the profiteers to continue to run the show.
You can’t hide a truth that big. The Obamacare website has suffered from terminal complexity because white collar crime is usually quite complex. The web site attempts to reconcile the profit margins and various products of a universe of private insurance corporations, while at the same time pretending to serve the health needs of the people at an affordable cost. Obamacare claims to be in the business of serving both the public and corporate stockholders. But that’s mission impossible. If Obamacare is based on making profits for private corporations – if that is what keeps the system going – then the public’s health care needs will always be an afterthought. And, that will be obvious in the way that the website is organized as a sales platform that matches federal subsidies with corporate products, rather than matching people with the medical resources they need to survive and thrive.
Website complexity and failures aside, Obamacare can never become part of a national social compact, something of which all Americans can be proud. That’s because, by definition, corporate insurance schemes divide people into “winners” and “losers” – although, of course, the big winner is always the corporation. Young, healthy people know they are the fatted calves of the insurance business, and they are avoiding Obamacare like the plague. If this were really a national health care program, like Medicare for All, then most young people would join in the national health care mission. But this is just Obama working a scam for the insurance companies, and young folks know it. Anybody who manages to get access to the web site knows it.
The fatal flaw in Obamacare can’t be fixed. The best thing that could happen would be a quick and total collapse. Large majorities of Americans still support Medicare for All, but Obamacare stands in the way of a real national health plan – just as the Republican right-wingers that invented Obamacare back in 1989 intended.
Glen Ford can be contacted at Glen.Ford@BlackAgendaReport.com.
- That Popping Noise? The Obamacare Bubble! (correntewire.com)
Here I sit, in West Virginia, staring down at January 1, 2014.
That’s when my health insurance policy expires and I have a decision to make — renew or not renew?
Right now, I’m paying about $7,000 a year in premiums for a monster deductible and yearly out of pocket of about $15,000 for myself and my family.
My health insurance company informed me yesterday that my premium will be doubled to $14,000 on January 1.
I’ve been trying to get onto the Obamacare web site now for ten days to search for an alternative. No luck. I made it through four pages yesterday — then got a message saying I’d have to wait because there was too much traffic. When I clicked the continue button, it wiped out the information I had typed into the first three pages.
But even if I do get onto the exchanges, it’s probably not going to matter.
I read in a newspaper that Highmark is the only health insurance company on the exchange in West Virginia. Yesterday, I called Highmark and spent an hour on the phone with a nice young man — but the results were not good. The skimpiest plan is going to cost me more than I’m paying now for a higher deductible and out of pocket result.
Thank you Obamacare.
My insurance agent told me yesterday I had only one alternative — wait for six years until Medicare kicks in and keep fighting for single payer.
Obviously, the Democrats and anyone who defends them are not going to be of any help in the next round. They are irrevocably tied to President Obama and Obamacare and even those Democrats nominally in favor of single payer refuse to criticize it for the industry written law that it is.
I agree with Dr. Quentin Young of Physicians for a National Health Program when he says that Obamacare should have been defeated because it enshrines and solidifies corporate domination of the health care system.
But what to do next? Well, first thing is to watch a movie called Healthcare — The Movie. It’s a short documentary — 62 minutes — but packs a big punch. The movie was produced by a husband wife team — the wife Canadian — Laurie Simons — and the husband American — Terry Sterrenberg.
The movie toggles back and forth between the USA and Canada — with Americans struggling with bankruptcy, death from lack of health insurance and the dark cloud of health insurance armageddon menacing their lives from cradle to an often early grave.
The Canadians, by contrast, are living in a relative health care nirvana, thanks in large part to Tommy Douglas, a boxer and Premier of Saskatchewan who stood up to the red baiting being dished out at the time by the Canadian medical establishment. Douglas emerged victorious and his efforts resulted in the creation of Canada’s single payer Medicare for all. The movie is narrated by actor Kiefer Sutherland — Tommy Douglas’ grandson.
The film features great historic clips — including a remarkable scene where a CBC television show host asks the question — who is the greatest Canadian? And then, in reality show format, puts it up to a vote.
“After six weeks, ten finalists, and more than a million votes,” the CBC host says, “it ended tonight with one name. And I have the envelope here. The greatest Canadian as decided by you is — Tommy Douglas.”
Imagine that — the country says that Tommy Douglas, the father of single payer in Canada, is greater than its greatest hockey player — Wayne Gretzky.
Tommy Douglas’ courageous act — standing up for the people of Canada against the vicious attacks of the powers that be — has resulted in a system that delivers health care for all Canadians — no complex bills, no deductibles, no deaths from lack of health insurance, no medical bankruptcies — all funded by a progressive tax system.
The movie profiles Canadians with serious medical illness — who come out financially unscathed — no bills, no bankruptcy, no health related financial worries.
And then compares those Canadians to the suffering human beings south of the border.
The movie does a good job of making us Americans feel like crap compared to our cousins up north.
Check out this sequence, for example:
How many people in the United States die each year because they have no health insurance?
How many people in Canada die each year because they have no health insurance?
How many people go bankrupt each year in the United States because of medical expenses?
How many people go bankrupt each year in Canada because of medical expenses?
How many Americans do not have health insurance?
How many Canadians do not have health insurance?
How many Americans go without medical care because of costs?
How many Canadians go without medical care because of costs?
One of the stars of this film is a young American from Portland, Oregon named Lindsay Caron.
“I was a free-lance artist for a long time,” Caron says. “I gave that up to go sit in an office and file papers so that I could have health care. And it amazed me that other people in other countries never had to think about that. I kept hearing that Canada’s system was broken, and that Canadians were flocking over the border to get US care. And so I wanted to go to Canada with a camera and ask a couple hundred people. I bought a ticket up to Vancouver, Canada. I rented camera equipment. And I took my bicycle. I thought maybe I would stay in Vancouver for a couple of days and cycle on back to Portland. I ended staying there the whole week. I got up in the morning, set up a camera on the street and just start asking people questions.”
Caron finds out what polls in Canada consistently confirm — that the vast majority of Canadians would never in a thousand years give up their Medicare coverage for the nightmare south of the border.
It all came about because Tommy Douglas had the guts to stand up to the political and medical establishment and do what is right for the Canadian people.
Canada did it.
There is no reason we can’t do it.
It’s simply a matter of reordering our priorities.
Let’s put aside, for a moment, our millions of copies of Grand Theft Auto 5 and start playing a new game — Grand Theft — Health Insurance.
The goal of the game is to become a boxer, like Tommy Douglas — and fight back against the insurance industry and its Frankenstein monster — Obamacare.
Replace it with single payer.
Russell Mokhiber edits Single Payer Action.
That is undoubtedly the question that many NYT readers were asking when they read an article warning that insurance companies in the exchanges were not paying enough money to attract many doctors. At one point the piece told readers;
“Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were ‘often below our cost of doing business, and definitely below commercial rates.’”
The claim that Medicare payments are “below our cost of doing business” might seem rather dubious to readers since most doctors accept Medicare patients. The median earnings of physicians are well over $200,000 a year (net of malpractice insurance), which means they are heavily represented in the one percent. Given their extraordinary incomes, which they vigorously protect by excluding foreign and domestic competition, it seems implausible that many doctors are willing to lose money by treating Medicare patients.
It is more likely that doctors are getting less than their desired pay when they treat Medicare patients, but still pocketing far more money than the overwhelming majority workers for their time. It would have been useful to clarify this point for readers rather than letting Doctor McAneny’s assertion pass unchallenged.
- Study debunks myth of doctors fleeing Medicare (dailykos.com)
The NYT has difficulty finding pundits who can write knowledgeably about economics. Thomas Friedman made this point in his Sunday column. At one point he quotes Gary Green, the president of Forsyth Technical Community College, in Winston-Salem, N.C.:
“‘We have a labor surplus in this country and a labor shortage at the same time,’ Green explained to me. Workers in North Carolina, particularly in textiles and furniture, who lost jobs either to outsourcing or the recession in 2008, often ‘do not have the skills required to get a new job today’ in the biotech, health care and manufacturing centers that are opening in the state.
“If before, he added, ‘you just needed a high school shop class or a short postsecondary certificate to work in a factory, now you need an associate degree in machining,’ a two-year program that requires higher math, I.T. and systems skills. In addition, some employers are now demanding that you not only have an associate degree but that nationally recognized skill certifications be incorporated into the curriculum to show that you have mastered the skills they want, like computer-integrated machining.”
Actually there are simple ways to identify labor shortages. First and foremost we should be seeing rapidly rising wages. If employers cannot get the workers they need then they raise the wages they offer to pull workers away from other employers. This is how markets work. (We should also see longer workweeks and increased vacancies.)
In fact there is no major sector of the economy where wages are rising rapidly. This shows rather conclusively that workers do not have skill shortages although it may be the case that many managers are so ignorant of markets that they don’t know that the way to attract better workers is to raise wages. Of course that would suggest the need to better train managers, not workers.
At one point the piece tells readers;
“We need to reform Social Security and Medicare so they can support all the baby boomers about to retire. ….
“As Bloomberg News reported on Monday: ‘Typical wage-earners retiring in 2010 will receive at least $3 for every $1 they contributed to the Medicare health-insurance program, according to an Urban Institute study.’ That’s unsustainable.”
It would have been helpful if Freidman had also mentioned that the same Urban Institute study shows workers already paying slightly more into Social Security than they get back. Yet Friedman wants to cut benefits.
The main reason that the Medicare benefits workers receive are more than they pay in taxes is we pay more than twice as much per person as people in other wealthy countries for our health care. This is due to the fact that we pay close to twice as much for our doctors, drugs, and medical equipment. It is not due to the fact that we get better care. This might suggest the need to reduce payments to health care providers rather than cut Medicare. Of course health care providers are a powerful lobby that Friedman apparently does not want to anger.