hearts and minds

May 1, 2007

Paying for Health Care – But Not Getting It

Filed under: Economics,Health care crisis — Hearts & Minds @ 2:36 pm

“This ongoing experience of startling significant inequities in our society, particularly brought to my attention in the field of health care, but also evident in education, employment, criminal justice, finance, and other areas, has revealed to me a society and its leaders pathologically unable to face their responsibilities and take effective action, and who instead persistently seek to deny responsibility, hide problems, and blame the victim.” – Glenn Winter, M.D. “Caring for the Uninsured and Underinsured – A Communication from the Front Lines”

The Health Care Crisis in America is getting worse, and all of the legislators representing Ozaukee County (except Senator Russ Feingold) stand directly in the way of the health care Wisconsin and America needs. Our elected Rip Van Winkle representatives ask, “What crisis?” When pressed, they deny and fail to discuss the cause of the crisis.

What is that cause? It’s an ideology of greed, which decrees that there is not enough health care for everybody who needs it. Health care in America is becoming only for those who the gatekeepers decide deserve it. And regardless of the hand Fate deals, you don’t deserve the care if you ain’t got the dough for the gatekeeper.

In the United States, one in every six citizens has no insurance. The lack of adequate insurance, or of unlimited cash, closes the door to proper health care here. Many of those that have insurance, only discover how inadequate it is, when they need health care. That’s when they find out (from insurance technicians without medical training) about exclusionary clauses, pre-existing conditions, and lifetime or incident limits.

If you’re one of 100 million Americans without adequate or any insurance, whether by choice or not, you are playing a cruel game of Russian roulette with stakes the likes of which you better hope and pray you never learn about the hard way. Half the personal bankruptcies in the United States accompany medical costs and emergencies. And many people suffer and die from not getting needed preventive health care and checkups in time, or from inability or reluctance to pay deductibles and co-pays.

Regardless of how good or bad you think your coverage is, you confront the crisis when:

1. An employer changes or eliminates benefits to cut costs and improve position with competitors, or just makes a mistake; or insurance is no longer offered; or an insurance company changes its culture, its policy or its list of acceptable doctors, clinics, or treatment options; or cost of self-insurance becomes prohibitive. (Did I miss anything? Well, there’s two more, at least.)

2. Your marital status, or your age, or your health (!) changes (or that of a family member) and insurance coverage ends as a result.

3. You lose or change your employment, or even think about it.

We all encounter the crisis, every day, as American business and industry down-sizes, out-sources, relocates, or ceases operations due to inability to compete with companies that do not have to shoulder the exorbitant costs of private health insurance that unfairly burden American employers. We are losing jobs and business, as well as lives and health, over this crisis.

The 3 biggest, most outrageous health care myths we have to overcome are:

Myth 1: The United States has the best health care system in the world.
Truth: If you have unlimited wealth, or are among the very small percentage who have an ironclad lifetime guarantee of no-strings-attached top-drawer insurance, you (like any deposed, exiled dictator on good terms with the State Department) can get the finest health care here in the U.S. But for the rest of us, measured by all basic health care outcomes, from infant mortality rates to life expectancy, the United States has steadily fallen from number one in the world to the back of the pack of industrialized nations. The World Health Organization ranks the U.S. health care system in 37th place compared to all other countries.

Myth 2: It would cost us lots more to provide proper health care to all, than the current patchwork, fine-print and loophole-ridden system costs, that leaves so many out.
Truth: The truth is that the United States spends about twice as much per capita on health care related costs as other modern nations in the world spend, and these other nations provide universal health care with no gate-keepers and better outcomes.

Myth 3: Universal single payer health care is socialized medicine, and would eliminate patient choice of physician and care options.
Truth: The truth is that other nations provide single payer universal health care in a system with most or all health care providers being self-employed or private employees, and where health care users have full choice of physicians. (By contrast, our employer based, insurance industry supervised system, greatly restricts or even eliminates most people’s choice of physicians and treatment options).

Until Canada adopted single payer universal health care 35 years ago, their health care costs were the same as ours (less than 8 percent of GDP). Now, the U.S. spends 15% of GDP on those costs, while Canada spends 10%. One-third of the dollars spent in the U.S. on “health care” are not actually spent on health care. Eliminating the unnecessary costs of overlapping and contending corporate bureaucracies, marketing, administration, patient-specific accounting and billing, excess profiteering, and extravagant CEO compensation, would reduce overall health care costs by 350 billion dollars annually, as well as extend full coverage to all. We don’t have to duplicate Canada. But we’d be wise learning the truth about Canada and the rest of the world.

According to market theory, for-profit providers and the 1500 private health insurance plans in the U.S. are supposed to control costs. They clearly are not doing so. Instead of restraining costs they are restricting care. And they are crippling U.S. business in a global marketplace, and running good work and jobs right out of the country.

I initiated conversations this spring with both State Senators and both Assemblypersons representing Southern Ozaukee County, which reveal their attitudes and positions regarding the Health Care Crisis. Do you want to know what the people that you elect think and care and are doing about it?

Do you want a concise source of more information on the health care crisis in the U.S., and the solution? A two part series explores the Health Care crisis in a bit greater depth.

The best national source of accurate information is Physicians for a National Health Program. The best source of accurate information emanating from right here in southeast Wisconsin (present company excepted, of course) is the eNewsletter and web sites of retired businessman Jack Lohman.

In Wisconsin, the Miller/Benedict Universal Health Care Bill (SB51 and AB94) gives us hope and a solid law worth struggling for. Ditto for H.R. 676, the Medicare-for-All Bill introduced by U.S. Congressmen John Conyers, Dennis Kucinich, Donna Christensen, and Jim McDermott.

Don’t miss the funny, sad, riveting story in the Cannes Film Festival winning movie, SICKO, the best summertime flick of 2007.

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15 Comments »

  1. This is right on target, and people must start demanding of their political representatives the passage of a single payer plan. Before they get sick and need care.

    Unfortunately, the health care industry gives over $1.4 million annually to state politicians with the sole purpose of keeping the system broken and profitable, and so far it is working (much to the detriment of our citizens).

    The other myth that private industry is more efficient than government is also dispelled by the Medicare Advantage program. It’s the private side of Medicare and costs the government 12.5% more than traditional Medicare. But we taxpayers are generous, aren’t we?

    As a Medicare patient I wonder, why not Medicare-for-all? I see the same doctors and go to the same hospital as before I retired. Perhaps this is not what the industry wants, but it is clearly what the people need. And Medicare-for-all would be cheaper overall than the current system, and it would provide coverage to 100% of the population.

    Comment by Jack Lohman — May 2, 2007 @ 4:37 am | Reply

  2. I entirely agree with Mr. Lohman, however, must point out that Medicare provides 80% coverage. While this may suffice for the “average Joe,” people with chronic illnesses (often relegated to lower incomes by societal barriers such as health care), are not able to carry the 20% burden. For example, if “Suzy Q.” has a chronic illness that requires $5500 in medical treatment and prescriptions a month, who among us could afford the 20%? Even if there is an out-of-pocket maximum, is it feasible for lower-income people?
    Any proposed plan must consider the chronically ill and catastrophic cases. Advances in medicine have allowed more people to live, thankfully, but only if they are able to maintain expensive medical treatment.

    Comment by Melinda — May 2, 2007 @ 8:24 am | Reply

  3. Myth #4 “We have a healthcare system.” The truth is we have “sickness intervention” and it isn’t really systematic on many levels. It is a patchwork of vested interests, most of them competing with one another and seldom cooperating. We spend the vast majority of our tax and other dollars on treating diseases that instead could be prevented with relatively low cost, low tech approaches. In terms of spending, our priorities are backwards.

    A true healthcare system would place its emphasis on “health”, investing in it while taking a serious look at the effacacy of expensive, end-of-life interventions that occasionally extend a person’s life but seldom impact the quality thereof–other than prolonging the misery.

    Using the term “healthcare system” smells like an oxymoron. If we’re going to fix the problem I think we need to see it clearly.

    Comment by Howard H — May 2, 2007 @ 11:20 am | Reply

  4. Clyde replies:

    While I take your point, Howard, my focus is on reform of the existing medical care so ALL people are able to get the health care they need without the increasing disparities of care and access in the U.S. that is manifest to all who will not refuse to see. Your focus seems to imply overhauling the kind of care that is available.

    An all but insurmountable obstacle to the current reform movement of which I am a part, which is seeking to establish Universal Single-Payer Health Care (Medicare for All) is the massive power of the insurance industry, along with the recently amassed power of the for-profit HMOs and medical “care” conglomerates.

    That power to control and distort our health care system is wielded by buying and controlling legislators and the major political parties. It is buttressed and sand-bagged by what I termed “myths”, but which are, more simply, lies.

    One difficulty we face in struggling to overcome that massive power is keeping our focus while dispelling those myths. For a very particular example that speaks directly to your comment on “Paying for Health Care but Not Getting It”, please see the notes exchanged between me and (our very own) Assemblyman Gottlieb in the post, “Health Care Crisis Solution”.

    Twice in Gottliebs brief reply to me, he sought to isolate and marginalize my reform suggestions by declaring that nobody thinks it’s a good idea to completely dismantle the whole health care system in order to fix it. That is, of course, another myth that the powers-that-be employ to defeat the crying need in the United States for meaningful reform of our health care system. They imply that we nuts want to tear it all down and then try to put the pieces together from scratch. They try to make it seem, for example, that we want the government to tell the doctors and nurses how to practice medicine.

    One way used to defeat the critically needed reform of establishing single payer universal health care is to drive the reform movement way out on an isolated limb – proposing changes that are unrelated and questionable – that make people think we are wacko.

    When we are successful in obtaining comprehensive health care for all (at much less cost than the current mess we’re in) in the form of single payer universal health care, the “competing interests” and economics would no longer stand in the way of the things you suggest, such as effective preventive medicine and the availability of alternative, low-cost therapies.

    Comment by clydewinter — May 5, 2007 @ 8:12 am | Reply

  5. A health care system designed to prevent illness, while at the same time cutting out care to people who already are ill, or requiring them to pay much higher deductibles? The presenters at the health care forum, sponsored by the OCAF, were enlightening.

    The Wisconsin Health Care Partnership Plan focuses on employees, and appears to have a flat buy-in cost for those who are unemployed or self-employed. This does not consider the economic hardship imposed on people who have serious or prolonged illnesses, part of the “Partnership’s” rationale for needing reform.

    The Wisconsin Health Plan was presented as a low-cost solution for preventive health care, allowing for a high-deductible plan for more comprehensive care. Despite the presenter’s insulting insistence that this plan does not punish people with chronic illnesses, if people who require comprehensive care (people with chronic or serious illness) are required to pay significantly more than others, on top of their likely loss in income (according to statistics and any intelligent person’s sense), they are being punished financially for their health care condition. The scariest component of this debate is reform for the sake of providing care to healthy people and throwing those with illnesses behind a wall built on stereotypes and prejudice. After all, should people who need “assistance” obtaining or maintaining medical care be classified differently than others? The assistance would not be needed if everybody were treated the same. The Partnership may say the policy would just charge different amounts for preventive v. comprehensive care, but the effect would tell a different story. It is a thinly veiled, covert attempt to cut costs by reducing or eliminating enrollees with chronic or serious illnesses. Further, the same people would be herded to lower economic classes with untold circumstances on a multitude a societal factors. Call it whatever you please, it is a form of classism.

    The Wisconsin Health Security Act is the only plan presented at the forum that treats ALL citizens equally, providing medical care to ALL, evening the field, as some may say. Perhaps that is what is of concern to some people. How horrible it would be for them to have a “sickly” person in the next office or rise to their social circles.
    This may sound extremist, but the Partnership plan does economically penalize seriously or chronically ill people, and people who are sick very often make others uncomfortable. My interpretation is not a stretch and is supported by members of Academia. Indeed, Eugenics is a powerful example of employing such forms of superiority.

    Preventive care is important and should be funded. Comprehensive care is important and should be funded as well. We all deserve all necessary care.

    Comment by Melinda W — May 8, 2007 @ 7:27 pm | Reply

  6. Clyde,
    It is always refreshing to read about your advocacy for single payer universal health care especially in the part of the state where you are located. I am involved in the Coalition for Wisconsin Health and we too support single payer universal health care. We also support Healthy Wisconsin and we think it is a significant step in the right direction. It will cover all residents of the state not covered by Medicaid, Medicare and Badger Care. It has a comprehensive set of health benefits which are the same as those of state legislators, it doesn’t discriminate against persons with preexisting conditions, it continues if you change jobs or loose your job, it covers self employed persons and it continues even if your have a change in marital status. It costs less than what is now spent on health care in Wisconsin because it eliminates complexity and restricts administrative overhead. Lastly it is not free but it is affordable for individuals and employers. For more information go to the Citizen Action of Wisconsin website and click on Healthy Wisconsin Resource Center. If you belong to a group that would like to know more about Healthy Wisconsin email me and we will send a volunteer to speak to your group and answer their questions. Thanks, jimkellerman@charter.net

    Comment by Jim K — July 27, 2007 @ 12:35 pm | Reply

  7. Some of us are just stuck without insurance. The monthly cost to insure my wife is possible if we give-up one of our vehicles, but we wouldn’t see any real benefit until we had paid a yearly 2500 deductible. It doesn’t make sense!

    Comment by Ronald M — October 9, 2007 @ 11:51 am | Reply

  8. My husband has always worked for hospitals. His position was eliminated from one hospital but thankfully he became employed at another.

    But, as an employee for the new hospital, for 6 months we were a family of 5 who were “insured” but not really insured. The failure of the insurance company to pay anything for “preexisting conditions” really killed us financially. We all had “preexisting conditions” like most people do. My youngest son has asthma and had to go to the ER one morning as a result of a bad attack. The result? Medical bills in the thousands that have gone to collections. And we were paying out hundreds in insurance at the time! The list goes on and on……..Yes, the INSURED UNINSURED.

    I have said for a long time that health care in America is a CRIME. It sort of reminds me of the days when those on top of the steel and railroad industries were making the bucks at the cost of everyone else.

    Every time I turn around…….hospitals are building bigger better facilites. Ironically, I see the same with churches….got to have that bigger better building. At whose expense?

    Is it really about caring for the sick or competing for money?

    As citizens of Ozaukee County, my husband and I both work good paying jobs. Yet the deductibles, copays, and other nonsense keep us from enjoying the fruit of our labor. The amount of money that we have spent for health insurance, copays, deductibles, and uncovered preexisting conditions has been a nightmare.

    The red tape is a huge issue! If I want to fight something, I know that I need to block out 1/2 day to go through the hoops of talking with people. One day, I spent 1/2 day dealing with a medical collection that turned out to be someone in Milwaukee with my son’s same name! It wasn’t even our bill to begin with!

    Something must be done and soon!

    Comment by Angela M — November 13, 2007 @ 10:39 pm | Reply

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    Pingback by Choice for A Change in Ozaukee and Washington counties « hearts and minds — August 7, 2008 @ 10:09 am | Reply

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