General misconceptions #1

 

General Misconceptions #1

(“Stuff” some people some folks think they know and probably don’t)

National health care “doesn’t work.” “Medicare for All” is too expensive”

        I’ve written at length on various aspects of universal health care, so this will be a summation. In my opinion, the measure of any health care system should be first and foremost, “How soon can I get care when I need it? Following on the heels of that is, “How good is it?” We hear fragmented “horror stories” of other nations with national health care, and a frequent topic is something like “You have to wait too long.” A better question might be “In comparable countries, what percentage of adults have quick access to a doctor or a nurse when they need it?”

        In fact, real data (not partisan bloviation and rhetoric) shows that the average number of persons in all comparable countries who were able to make same or next day appointments was 57%. Germany (53%), France (56%), The UK (57%), Australia (67%) and the Netherlands were all above that number with the Netherlands at 77%.  Health care consumers surveyed in the UK were 10% more likely to respond positively than those in the US. US was 51%, below the 57% average.  It is noteworthy that all these nations except the US have some sort of mandatory health care provision, be it private insurance or  national health care, or what have you.

        As for “wait” times: opponents of national health care are quick to cite long wait times the see physicians as if it is universally true. It varies by country and population density. The UK National Health system “shoots” for, in all cases, 15 days or less to schedule a non-urgent doctor’s appointment. At present, this year (2019), the NHS is averaging more like 16 days. Remember, this is to see a doctor in a non-emergency situation.

        I know, you’re thinking, “16 days?” Wow, we sure have it better here! Really? Try this on:  The longest US wait to see a doctor is in Boston, where the average wait is 52 days to schedule an appointment with a family physician, dermatologist, cardiologist, orthopedic surgeon or obstetrician/gynecologist.    

        Perhaps an even more relevant issue is “What percentage of initial care options was an emergency room visit vice a regular doctor visit?  Why does this matter? It matters primarily because an ER visit may well find the patient seeing a non-specialist who is totally unfamiliar with the patient’s medical history. This is especially true in these cases where the patient has no regular primary care medical professional relationship because they have no health insurance.

        Another survey was run to determine what percentage of initial care options was an emergency room visit vice a regular doctor visit. Again, results were not surprising, with the US and Canada significantly more likely for an initial care option being an ER. This is not totally unexpected in Canada, which has a very scattered population in a very large area at just around 10 persons per square mile. Many Canadians are sufficiently isolated that a local hospital is the closest as small communities cannot support a practice.  The USA, while less dense than most European nations, has more than nine times higher population density at 95 per square mile. This matters, because the US still has 16% of initial medical care incidents at ERs, while Canada is at 17%. Sweden, which has a relatively low population density (48 per square mile) with much of it rural, still uses ERs 25% less than the US. The UK has less than half the percentage of initial care ER visits as the US. 

        Some factoids (I have the data:):

  The US leads all surveyed nations in frequency of medical, medication and lab errors!

“How does the frequency of hospital admissions for preventable diseases vary by comparable nation regardless of healthcare system?”  Expressed as percentages of hospital admissions for preventable/controllable diseases the numbers are" Congestive Heart Failure: admission percentage -USA 48% higher (than average for comparable nations), Asthma – USA 110% higher (!!), Hypertension – USA 90% higher. Diabetes – USA 35% higher. So what? So, these preventable diseases are, in the uninsured sector, not seen by primary care specialists when they should be because of lack of affordable health care.

Summarizing: nations with universal health care generally do it better overall. (All the summaries and interpretations of data in the above are from a Peterson-Kaiser Health System Tracker, the section titled “Commonwealth Fund International Health Policy Survey.”)

         As for the economic predictions of financial doom and gloom for Medicare for all, they are in a word, lies. How do we know? Because, as a scare tactic, opponents consider all Medicare expenditures (adults over 65, and a large population share based on the baby boom) and use the cost average for that group as if all citizens (12year olds , 25yr olds, etc) are as expensive when, in fact, average health care expenditures for under 54 are about half of that figure, with the “under 19” group at just about $2,000. This figure also ignores the significant amount of money being spent currently by employers and individuals. If this money went to national health insurance, vice private, where profit drives cost and admin costs for multiple payers is very high, it would. for most workers and employers, be a break even, not extra cost and perhaps even less.   

        Additionally, there is great pressure from the insurance industry which lobbies strenuously against Medicare for all because the current “Medicare Advantage” plans are the producers of golden eggs. The devious part of Medicare advantage is that, for over 65 consumers, it seems like (and is) a good deal. For the rest of taxpayers, think again.   

        For a “numbers” example:  Consider my personal situation: as a Medicare aged individual, my Social Security is reduced by $144.60 monthly for Medicare Part B (hospitalization). My wife’s SS is hit the same amount, for a family total of $3470 annually. This represents insurance, still with deductibles, similar to Part A which covers doctor visits, labs, etc.

        Now: The Insurance salesman tells you that if we simply sign up with them, they will provide us with a Medicare Advantage plan which has some advantages such as reduced co-pays, “Network providers” etc. and they’ll do it if we simply cede our monthly Part B deduction to them, and they do all the paperwork. So how is that not a great deal? It depends on who you ask. For the senior on Medicare? It’s fine, for the most part, which is why many use Medicare Advantage plans. For the rest of the tax paying populace, not so much. We use a Medicare Advantage plan only because our primary care provider, who we really like, is part of a network which required us to change or leave. I also have secondary coverage as a military retiree, so I pay no copays and use Tricare’s drug plan which is superb.

        Medicare is “use based.” This means that, as a reasonably healthy individual I probably only pay for routine primary care visits (quarterly) and two semi-annual specialist visits, and labs. I’d estimate that the amount billed paid to the insurer is significantly less than $3500 (a high-end estimate) annually. If we were on Medicare that would be the amount paid to the providers. Medicare is billed only for what the patient uses.

        Medicare advantage plans, however, don’t work like that. However they managed to do it, (intense lobbying!)  Medicare advantage providers are paid a monthly amount in addition to the Part B contributions, and that contribution varies nationwide. In Sumter County, Florida where we live, that monthly figure is $956.77 per insured individual per month! The little known and far less publicized secret is that doctors working for Medicare Advantage networks make roughly the same as any doctor who accepts Medicare, so the extra money goes to….you guessed it, the insurers! No Virginia, Medicare Advantage plans are all about profit, there is no Santa Claus!

        Summarizing: while the Medicare Advantage provider does get our combined $144.60/month they are also receiving from Medicare, at taxpayer expense, an additional monthly capitation of $956.77 (2020 figure) each. This means that instead of paying for actual usage, they are getting, for Emily and me, $26,432 annually. Remember, the actual annualized average Medical expense for “over 65s” is just over $10,000 each, so the Insurer is getting about 26% in excess of costs. Not bad, huh? And, their admin costs are about 18%, compared to the UK which does the job at half that rate. Experts generally agree that overbilling under Advantage plans is also significantly worse than under Medicare. Medicare advantage plans are a Congressional valentine to the Insurance Industry which pays well for the gift.   

        None of this addresses US grotesquely overinflated drug cost, which does contribute significantly to overall spending.

        For one last point - a comparison: The UK spends (all sources) about £197 billion annually on healthcare, equating to £2,989 per person, which today is about $4100. US average health care expenditures per individual, over the same period averaged $10,739. The first several paragraphs imply we are doing less; this points out that we’re doing it at over twice the cost.