It is worthy of note in the debate over health care, that
one of the principal talking points made by talking heads on both sides of the issue revolves around
the issue of cost. Those on the Right would have us believe that health care
for everyone is unattainable without bankrupting the nation. On the other hand,
those on the Left would have us believe that it is an attainable goal, and the
cost shouldn’t be the determining factor.
It occurs to me that rather than spitball the possible
outcomes, we could actually look at the data available in other nations where
universal (as in single payer) health care is, and has been, in place for
decades. Before we start, let’s put one huge lie to bed right off the bat. The Affordable
Care Act is not socialized medicine in any respect. One of the first
objections one hears from the Limbaughs, Becks, Bachmanns etc. is that the President
wants the US to embrace socialized medicines, as in the UK, Canada, and other
European nations. In fact, what the ACA really does, as have many government
initiatives before it, is throw more business to private insurers, since there
is no “government” health care insurer as part of the plan. Medicare/Medicaid,
around since the 1960s is a form of socialized medicine, but beneficiaries of
Medicare pay for it while they work, while Medicaid, on the other hand is government
sponsored free health care paid for, not by recipients, but by we who pay taxes.
It is astounding the degree to which rightists oppose the
ACA, while accepting, as perfectly reasonable, the idea that they can be (and
should be) required by their state
government to purchase auto insurance as a prerequisite to driving. The concept behind the ACA is very little
different. If you want to live and work in the United States, buy health care
insurance. Just like auto insurance, there are many levels one may choose to
protect oneself, and just like auto insurance, there is a minimum standard. The
sole difference is that one can choose
not to drive, therefore avoiding the requirement to purchase insurance. If one
could guarantee their health for their lifetime and then promise to drop dead
of a stroke without incurring any medical expenses, then we might exempt them
as well. In reality, that isn’t the way it works and, just as with auto insurance, the uninsured
cost us all more money because they opt not to maintain coverage, but continue
to drive. In the same manner, there are those who continue to get sick or injured and use medical services paid for by the rest of us.
So, establishing that the ACA mandates private insurance,
and ergo is not the dreaded “Socialized Medicine,” let’s examine what
socialized medicine really is, since many obviously labor in ignorance on the
issue yet throw the name around like it was synonymous with “the plague.” I
choose to do this by examining several issues which seem to be central to the
health care discussion no matter what the system. In no particular order:
First: “What is the real cost per person for
healthcare under the various systems and what factors determine this issue?”
Again, plainly – which is cheaper and why?
Second: “If, as opponents of the ACA proclaim,
the US’s health care system is truly the “finest in the world,” what standards
are used to measure that statement; is it true, and why or why not?”
Simply put is the statement true, and how do we know?
Third:
“What is the satisfaction level of persons who live under the various
(public/private/single payer) systems of health care insurance?” In
plain speak, what percentage of persons in various nations are satisfied (and
how satisfied) with the healthcare they have?
On the first issue, cost, there are numerous factors, not
obvious to most, and grossly underplayed by the affluent.
The “under the radar” nature of much tax-financed health
spending in the United States hides the truly regressive pattern of government
funding. Highly visible Medicaid spending benefits the poor; while much less obvious, but growing, tax subsidies
benefit the affluent who are most likely to have employer-paid coverage and
whose higher marginal tax rates translate into greater tax savings. For
instance, in 1998 (some time ago, but statistically relevant to today) federal
tax subsidies alone averaged $2,357 for families with incomes above $100,000
but only $71 for families with incomes below $15,000.
Other factors relating to cost have little or nothing to do
with real medical issues, rather are tied in with the costs of doctors dealing
with a myriad of payers, formulae, paperwork and procedures. The term “single
payer” simply means that all medical billing and compensation originates from
one source. In most of Europe’s industrialized nations, that source is the
government via some form of national health care service. While the ACA does
provide for universal coverage, it certainly is not a single payer system,
since it throws all health care responsibility short of Medicare/Medicaid to
private sector insurers, and for lowest earners, provides some degree of
subsidy. Make no mistake, this is your tax dollars channeled to private
insurance corporations. Is this a good time to mention the huge profitability
of insurance carriers?
There is one relevant study, done in the United States by
the Lewin Group, which analyzed the effect that would be seen in Minnesota of
single payer insurance for all citizens. We are speaking here of no one in
Minnesota paying for Health care insurance per se. This is probably also a good
time to throw out the real cost figure, nationwide for health care in the United States. How much is
good health care worth to you? $8,233 per year? That's how much (2012 figure) the
U.S. spends per person. The Lewin Group study analyzed the projected cost of
universal single payer health care in Minnesota for 2014 compared to the same
health care delivery under the ACA.
The study found that
single payer (government health care) would cover all Minnesota residents and reduce
total health spending by $4.1 billion, or 8.8 percent, in 2014, and
would save $189.5 billion from 2014-2023 over what health care costs in
Minnesota would be under the Affordable Care Act (ACA). The plan would cover most medically necessary
care with the exception of home care (excluding what is now covered by Medicare) and nursing
home care, and would eliminate most cost-sharing, except for some small co-pays
on specialty care and medications (medications for chronic conditions would be
excluded from cost-sharing). Lewin
estimated that single payer would save employers currently offering coverage
an average of $1,214 per worker, and save an average of $1,362 for
families. Employers not
currently providing coverage would pay an additional $1,963 per worker
annually. Single payer could be financed
with existing sources of taxpayer funding for health care (including subsidies
from the ACA) combined with an average 7.2 percent effective payroll tax on
employers, a 3 percent income tax on family adjusted gross income, and
cigarette ($1.00/pack) and alcohol taxes (5 cents per drink). Understand, this
is a savings to every person or entity at every level of the health care
pyramid, with no diminution of care or services. Even after the cited sources
of revenue, the savings are significantly more with a single payer system!
Another oft cited “statistic” is that the tax burden (or the
percentage of tax spent on health care) is higher in nations with single payer
systems. True? No, it isn’t. The following is a list of the average health care
spending per capita for several nations which now provide single payer health
care to all citizens: the UK - $3,483, Australia - $3,670. Canada - $4,445, Germany - $4,338. These figures are total
public and private spending in each case. Breaking it down for the UK,
for example, average per capita health care spending is $3,483 total, of which
about $200 is private spending, the rest public. The percentages of public and
private spending vary; Australia has slightly more private spending as a part
of the whole, as does Germany. If these dollar figures seem like a lot per
person, remember, the total health care spending per capita for the United
States is $8,233! That figure is about $3000 per capita more than Norway, which
is the only nation in the world which spends more public funds per capita
(about $600 more) on health care than the US. Remember, however, Norwegians
spend almost nothing in private funds.
To pound the point home, consider this. The United States
spends almost exactly $4000 of that $8,233 figure in public funding, but spends
another roughly $4,000 in private funding as well. Again, the US spends over
twice as much per capita from both public and private sources as does the UK, and
roughly 250% as much as the average for developed nations worldwide, the great
majority of which have some sort of single payer health care system.
An often heard cry from the far right is that private
industry is inherently better at administrative functions than a Government
bureaucracy. Evidence from OEDC countries shows
that the private sector is far more bureaucratic and much less efficient than
the public when it comes to providing health care. The US pays , on
average, $911 per capita per year on administrative costs, while Canada pays
$270. When considering insurance overhead costs the numbers are even more
surprising. Blue Cross/Blue Shield of Massachusetts, fairly typical of health
care insurers, employs 6,680 persons to administer benefits for about 2.5
million customers. Canada employs significantly fewer to administer benefits
for more then 28 million! (and their clients are five times as happy) Germany recently shifted dental services,
formerly publically funded, to private sector insurers and saw three times the
admin costs almost immediately.
Dealing with my second point: Obviously, if we spend all
that much more, we should be truly proud of our status as the nation with “the
best health care system in the world.” Is
it, and is it worth the money? That figure of $8223 per capita from all sources
is more than two-and-a-half times more than most developed nations in the
world, including relatively rich European countries like France, Sweden and the
United Kingdom. On a more global scale, it means U.S. health care costs now eat
up 17.6 percent of GDP.
A sizable slice of Americans -- including some top-ranking
politicians -- say the cost may be unfortunate but the U.S. has "the best
health care in the world."
Statistics might give one cause to reconsider that! We must
have more doctors’ right? Let’s compare
the US to the 33 other member nations of the Organization for Economic
Co-operation and Development (OECD) -- an international economic group
comprised of 34 member nations. It must be noted that while this includes
nations such as Norway and Sweden, it also includes Turkey, Greece, Portugal, Poland and Mexico! There are fewer
physicians per person than in most other OECD countries. In 2010, for instance,
the U.S. had 2.4 practicing physicians per 1,000 people -- well below the OECD
average of 3.1.
Not only do we have fewer doctors, we have fewer facilities.
The number of hospital beds in the U.S. was 2.6 per 1,000 population in 2009,
lower than the OECD average of 3.4 beds. But we must surely be healthier,
right?
While it’s true that life expectancy at birth increased by
almost nine years between 1960 and 2010,
that's still less than the increase of over 15 years in Japan and over
11 years on average in OECD countries. The average American now lives 78.7
years in 2010, more than one year below the OECD average of 79.8 years.
Remember, we are comparing a wide range of nations, some rich, some poor,
several former Soviet Socialist Republics.
So, on to the last of our three inquiries - that of user
satisfaction. If we believe our system is the best there is, shouldn’t we be the happiest people in the world
regarding health care? As it turns out, there is no shortage of surveys and studies dealing with this topic.
Canada does them , the UK does them,
fact, the EOCD and World Health organization do them, as well. One of
the most general surveys, a 2011 Deloitte Group Global Report, asked several relatively
simple questions and got some rather revelatory answers. To the question
proposition – “rate your health care system on a scale of A to F,” the
percentages who rated their systems either A or B were: Canada 50%, UK 46% ,
France 51%. The USA return was 22%, higher then only Mexico, Portugal and
Brazil! Only Mexico had more respondents who believed that “50% or more of
health care system spending is wasted.” Only Brazil and Portugal had fewer persons who
were “satisfied” with the performance of the health care system.
Let’s compare apples
to apples with our closest neighbor, Canada. Forget the anecdotal stories; by
actual surveys of Canadians, and records of the national health care system,
Canadians are more likely to receive needed care quickly. They also get more
physician visits, more immunizations, more hospital admissions and more
surgical procedures. A survey of 10 OECD countries showed that Canadians were
the most satisfied with the care they got and Americans were the least
satisfied. (data supported by the Deloitte Group Study as well.) Canadians are
five times as likely to be satisfied with the health care they receive than
Americans. Before the introduction of Canada’s Medicare (national healthcare)
infant mortality, maternal mortality, and life expectancy were worse than in
the US. Today, Canada’s infant mortality rate is 70% of the US figure, maternal
mortality in Canada is now half that of the US, and the average
Canadian lives 2 years longer than the average American!
There are numerous anecdotal
health care “horror stories” which are frequently used out of context to
slam single payer health care without the recognition that these types of
stories abound in the most privatized instances as well. One need look no
further than the fictionalized, but too realistic story in John Grisham’s “The
Rainmaker” where the private insurer’s first ploy every time is to deny a
claim. A truly meaningful statistic, in an EOCD study, is the percentage of
Americans (16%), far more than in any other OECD nation, who report having
difficulty paying medical bills and having to sacrifice other necessities to do
so.
So, in summary, the lies of the far right notwithstanding, the
Affordable Care Act is not in any way, “Socialized Medicine” It isn’t. No, it’s
not. Period. Having said all that, and considering all the facts herein, would
it be such a bad thing if it were? Would the deficit be lower if we spent half
as much of our GDP on healthcare? Would an increase in healthcare user
satisfaction by a factor of five be a bad thing?
The fact is Medicare is efficient by comparison to the
most streamlined private insurers, a fact they’ll never tell you. The fact is
that several very loud voices in the health care debate have hands in the
pockets of major insurers, which is another problematic issue. When Senator Ted
Cruz screams about the ACA, know that his wife is a high level executive with a
major Southwestern health care insurance provider. Also realize Ted Cruz was born in Canada and
has (if he wants it) free health care.
The sad truth is that the health care crisis in America will
probably not ever be resolved with only the best interests of all health care
consumers and the most economical use of public funds as the prime motivator.
As long as the same powerful lobbying interests that crucified Hillary Clinton
in 1993 and opposed and continue to oppose the ACA continue to have first dibs
on the ears of legislators, private interests will always come first, and 95%
of us will lose to the 5% who benefit from private insurance. What is perhaps
the most troubling aspect of this whole thing is that there are some persons,
very vocal in the fight, who just aren’t very bright. They take advice and
guidance from moneyed insurance interests and accept all that they are told on
face value. Pity, that!
