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Health Care

Unraveling the Crisis in American Health Care: Part 1 of a 3-Part Series (Full Length Version)

April 30, 2013

DrJoieLifeChangeMedicine.com

HEALTH LIBRARY

 

Unraveling the Crisis in American Health Care

Joie Meissner, ND

 

The lack of access to affordable healthcare in is a national problem of massive proportion. 50.7 million Americans do not have medical insurance and millions more have insurance that is inadequate. [1] Mammoth numbers of medical bankruptcies have made them a commonplace American phenomenon. The fact that a cancer diagnosis can cost $348,000 or more and a simple slip and fall can cost $9,400 is part of the reason that millions of Americans go broke trying to pay their medical bills. Of the approximately 1.5 million annual personal bankruptcies in this country, 62% are due to medical bills and 69% of these medical bankruptcies were people who had medical insurance coverage. [2]. [3]

Ours is the most expensive health care system on earth. [4] We spend billions more on health care than other industrialized nations, nations that provide quality health care to all their citizens. Ours is the only industrialized country in the world that does not provide some type of universal health coverage to its people.  No one dies due to lack of access to health care in these other countries and yet a study done by Harvard Medical School and Cambridge Health Alliance found that nearly 45,000 Americans die annually due to lack of health care access. This is more annual deaths than are attributed to renal disease in this country.  According to this study, there is a 40% increased risk of death in uninsured American adults. [5] 

We have known for a while that there are serious problems with our health care system. We have born witness to the public outcry for health care reform and many of us we were hopeful that Obama care, the landmark legislation also known as Patient Protection and Affordable Care Act of 2010 (PPACA) was the prescription for our lack of access and affordability issues.

The intimidating complexity of topics like these tends to dull the mind into an unconsciousness belief that such issues are beyond the average person’s ability to understand. Pacified by our sense of overwhelm we accept whatever is handed to us with resignation and fear. Our skepticism of who we see as calling the all the shots, the amorphous “they” are doing this- “they” are doing that, turns inward on ourselves as we come to doubt rather than to develop our internal radar and guidance systems, radar systems we can hone and develop by simply tuning in long enough to follow the money and the mindset that guides its fate.

And what a lot of money it is. In fact, we spent roughly $2.8 trillion in 2012 on health care. This is $750 billion or 27% more than the per capita costs of health care in other developed countries. [6]

Do We Spend More Than Other Developed Countries to Pay for a Higher Performing Health Care System?

Despite the higher price of American health care, by the accounting of the World Health Organization who ranks the US health care system’s performance 37th in the world, it would appear that we are not getting a better performing health care system for all that extra money our nation spends on it. [7]

If all this extra money is not actually going towards paying for a better performing health care system, where is it going? In order to understand where all the money is and is not going we first need to take a look at some of the parts of the system that are leading to the unsustainable cost of American health care.

Lack of Governmental and Industry Price Controls → Obscene Hospital Charges and Drug Prices

Investigative reporter Steven Brill’s in his ground breaking expose published in Time magazine, “Bitter Pill; Why Medical Bills Are Killing Us”, uncovered the fact that hospitals set their fees for goods and services based on hugely inflated “chargemaster” pricing schemes that bear no relationship to costs, but which allow “non-profit” and for-profit hospitals to maintain plush surplus revenue and astronomical executive salaries.

Brill gives the following examples of unregulated hospital chargemaster pricing:

·         $150 for a bottle of acetaminophen (a generic version of the pain reliever Tylenol)

o   At Walgreens, a bottle of the same drug with the same number of tablets retails for only about $7.00

·         $77 for a box of sterile gauze pads- roughly $6 at Walgreens

·         A standard screening lab test called a CBC by chargemaster prices could cost somewhere in the neighborhood of $158 whereas Medicare would be billed only $11 for the same test.

Similar to the obscene hospital chargemaster pricing practices, US drugs are equally overpriced. Brill found that drug prices are so inflated under the current health care system that if pharmaceutical prices were controlled to the same degree that they are in other developed countries, we would save more than $90 billion annually on the drugs themselves and $25 billion/year in Medicare/tax payer savings. [8]

The pharmaceutical industry is one of the most, if not the most profitable industries in the world. Drug companies spend billions on lobbyists and millions in campaign contributions to try to game our highly “gameable” system. [9] The billions spent on Washington lobbyists by pharmaceutical and health care product industries, hospitals, nursing homes, HMOs and other health services, what Brill has termed the “health care industrial complex”, is about 3.5 billion times more than what is spent by the defense and aerospace industries. [10] 

The billions that the “health care industrial complex” spends on maintaining the obscene price tag on its goods and services amounts to nothing more than an insignificant nuisance cost when compared to the respective lush profit margins the players continue to reap.  For the pharmaceutical and hospital executives, this is simply the cost of doing business in the USA.[11]

For us, the cost of maintaining these soaring health care industry profit margins is part of the costs that jack up the price we pay for health care to the tune of $750 billion more than that of other developed nations, nations that regulate the prices of medical goods and services, nations that provide a high level of medical care to all their citizens. The citizens of these lower spending nations as a rule, do not die due to lack of access to health care and do not go bankrupt paying their medical bills.

The Expanded Number of Insurance Plans and Carriers→ Excessive Administrative Costs Jack Up the Price of American Health care

Following the money trail takes us to another prime player that is responsible for jacking up the price tag of our health care system. The player in this part of story of the obscene cost of health care is our private, multi-payer insurance system. The enormous waste resulting from the substantially higher administrative costs characteristic of our private insurance system as compared to its non-privatized counterparts like Medicare or Medicaid coupled with the waste resulting from the logistical inefficiency inherent in having thousands of insurance plans and carriers, vastly inflates the price of American health care.  In our current system there are thousands of different health care plans and organizations such as PPOs and CDHPs (consumer directed health plans), HMOs, HSAs etc. Data management systems and legions of insurance representatives and billing clerks are needed handle the orchestration of administering and navigating all these different plans.

Prof. Dr. Uwe E. Reinhardt one of the nation’s leading authorities on health care economics, pointing out the excessive administrative costs in the Duke Medical System at the 2008 U.S. Senate Finance Committee Hearing on Health Care Reform, rebuked that:

 “We have 900 billing clerks at Duke. I’m not sure we have a nurse per bed, but we have a billing clerk per bed… it’s obscene.” [12]

Reinhardt gives the Canadian system an “A” as far as health outcomes and overall performance. He explains that in our current system for example, these 900 billing clerks are needed to administer claims with each type of managed care company. He says the insurers “haggle over every bill… it may take 90 days to settle one bill …They don’t have that in Canada. We spend an enormous amount of money just administering claims…it’s a huge wresting match over the payment” Citing a Harvard study, he states that in the US between 25-30% of all health care dollars goes for administration. [13]

The biggest chunk of the 25-30% we spend on administrative costs comes from the private insurance sector. Insurance companies are for-profit enterprises that achieve their prime directive by limiting expenses like claims payments and maximizing revenues like premiums and copays. A brief Google search of some of the top insurer’s legal woes fuels the concept held by many that there is a cost to benefit ratio involved in the financial decision making of such enterprises.

Click below for further details on the legal woes of insurers:http://www.huffingtonpost.com/peter-dreier/humana-profits-over-peopl_b_327311.html  and check this site under the heading entitledLegal Issues” http://en.wikipedia.org/wiki/UnitedHealth_Group

There is said to exist a balance sheet; one side of the sheet, there is the cost of claims payments and on the other side, is the cost of items such as employee’s wages, “public relations” and attorney’s fees. It has been proposed that money may be the deciding factor in the decision making process. In this view, it might be worth it to an insurance company’s balance sheet to hire a lot of employees to “haggle” over the price and to manage all the extra data that comes with having so many insurance plans even if the insurers have to raise the cost of premiums and copays to cover these added costs and even if clinics receiving claims payments have to acquire expensive computer systems, hire and pay a lot of employees and raise their fees in order to cover the costs of “haggling” to get reimbursed for their labor and in order to handle all the added data inherent in having so many different insurance plans.  

When Brill followed the money, he found that the private health insurer, Aetna, has operating/administrative costs of 29% of claims or roughly $30/claim compared Medicare’s administrative costs that are less than 1% of claims processed or only $3.80/claim. If Aetna is representative of other insurers, the cost to the insurance company of paying its legions of employees to “haggle” with the providers and to cope with the logistics involved in managing all the different types of plans is 29% of what it pays health care providers when it pays our insurance claims. Thus, if they want to maintain their profit-margins, the insurers then have an additional 29% of added costs to pass along to the consumer.  According to health care economist Gerald Friedman PhD, the average doctor in Massachusetts spends $85,000 on billing and collecting payment from insurance etc. [14] Brill reports that the increased administrative costs of private insurance get tacked on to premiums, reduced claims payment to doctors and to pay for administrative processing, accounting and to pay insurance company CEOs exorbitant salaries. [15]                                                                                                                                                            Click these links for one such example of insurance CEOs outrageous salaries: http://money.msn.com/investing/latest.aspx?post=5323ba34-2f28-434c-8b46-ea6cefe73b1ahttp://www.payscale.com/ceo-income/fortune-50 

Thus, adding to the $750 billion more that we spend compared to the industrialized countries of the world are the billions that go into paying billing clerks and all the staff that hospitals and private doctors must pay in order to get paid for their work.  The cost that hospitals and doctors pay must get passed to the American consumer in the form of higher out of pocket costs.

Money Protects Money                       

Similar to the strategy used by the aforementioned parts of health care industrial complex, the insurance industry maintains its existence in the American health care system via its interweaving political and economic influence.  In additions to the billions spent on lobbying the feds, contributing to PACs and campaigns of elected officials, the insurance industry, like other parts of the health care industrial complex, retains impressive Interlocking directorates. [16] A quick internet search of top ranking insurance companies reveals that the more often than not, members of the insurance companies’ corporate board of directors are prior and/or present  members of the boards of multiple corporations and that many of them have prior or present political ties to both Republican and Democratic parties. These interweaving connections include former and/or ongoing dual relationships with other giant corporations running the gamut from processed food conglomerates like General Mills and Coca-Cola Enterprises Inc. to pharmaceutical, medical devices/equipment and laboratories all the way to news media and high finance and banking companies such as Goldman Sachs, US Bancorp and numerous other financial institutions. A few examples of these include Pfizer (drug company), Medtronic (makers of pacemakers) [click here to see more http://www.nndb.com/people/172/000124797/] Sanmina (manufacturers of MRI, CT, ultrasound and other medical equipment) [click below for more on this http://investing.businessweek.com/research/stocks/people/person.asp?personId=624323&ticker=WLP&previousCapId=19049&previousTitle=Bank%20of%20America%20Corporation] Quest Diagnostics (medical labs). Some of these insurance board members are even listed by the Notable Names Database (NNDB) as current state officials holding leadership positions on state health care commissions [click below for more on this http://www.nndb.com/people/216/000128829/] as well as a former US Secretary of Health and Human Services [click below for more on this http://www.nndb.com/people/260/000024188/] [17], [18], [19], [20], [21], [22]

Click these links to see who is on the boards of some top insurance companies:

http://www.huffingtonpost.com/peter-dreier/humana-profits-over-peopl_b_327311.html

http://www.aetna.com/investors-aetna/governance/board_of_directors.html

http://www.aetna.com/investors-aetna/governance/bio_cohen.html

 http://ir.wellpoint.com/phoenix.zhtml?c=130104&p=irol-govboard

http://www.nndb.com/company/276/000058102/

http://xnet.kp.org/newscenter/aboutkp/bios/national/bod.html

The foregoing discussion might suggest how the $750 billion extra that our country spent this year might maintain its present location within the health care industrial complex and it also suggests sources of added costs to pass along to the consumer. It does not stretch the imagination too far to hazard a guess that the billions that the health care industrial complex spends on PACs and lobbyists and other measures designed to maintain its existence get passed along to us, the American health care consumers.

While it may be true that the other industrialized countries are subject to these sorts of interlocking politico-corporate relationships, they have health care systems that routinely bargain down the price of medical goods and services; because they view health care as a public good rather than as a commercial commodity, these countries are not subject to the $30/claims that our privately run insurers impose on us.  According to health care economist Gerald Friedman PhD., the inefficiencies in our health care system which lead to its unsustainable price tag are allowed to exist because the prevailing economic view sees the free-market as the remedy to health care overspending.  He explains that the for-profit economic framework that views health care spending as waste is why we have problems ensuring that all our citizens have access to health care. [23]

The For-Profit System; Cherry Picking and Lemon Dropping

Despite the fact that notable economists like Paul Krugman PhD., Nobel Prize winning economist Kenneth Arrow PhD., and Friedman himself would strongly disagree with what Friedman asserts is the prevailing economic viewpoint, Friedman explains that the dominant economic paradigm holds that governmental health insurance promotes over-utilization of health care which, in turn, promotes wasted spending. He further asserts that this viewpoint leads the insurance carriers to engage in a practice called ‘cherry picking’ and ‘lemon dropping’ a practice which he purports results in lack of coverage for all Americans. He explains that the profit in health insurance comes from this practice of cherry picking and lemon dropping in which insurance providers discourage the sickest patients, who incur 70% of health care costs, from being able to obtain insurance while providing membership incentives to the healthiest patients who incur only 10% of these costs. [24] 

Friedman theorizes that the net effect of having mechanisms such as are built-in to the “wrestling match” over claims payments aptly characterized by Reinhardt, mechanism that require the average doctor in Massachusetts to spend $85,000 on billing and collecting payment from insurers is actually a form of lemon dropping because it forces providers to raise their rates which in turn leads to higher claims payments and ultimately to higher insurance premiums. He hypothesizes that because sicker people tend to have more financial problems, the higher premiums will drive sicker people away from seeking care.

The profit motive behind the mainstream practice of lemon dropping is also the impetus for many of the rules and clauses in insurance policies such as the notorious pre-existing condition clauses that denied many Americans medical insurance coverage. One of Obama care’s (PPACA’s) preeminent goals was to enact laws designed to increase coverage to the 50.7 million Americans who are currently without it such as laws that prohibit these pre-existing condition clauses and laws that increase medical coverage to the lowest income earners.  Another important goal of Obama care (PPACA) was to prevent the growing epidemic of American medical bankruptcies. One such law designed for this purpose is the PPACA law that prohibits annual or lifetime caps on insurance benefits. PPACA also enacts other laws to limit some of the other lemon dropping mechanisms used by private insurance companies.

Highpoints of Obama Care Legislation

Obama care is also known as the Patient Protection and Affordable Care Act of 2010 (PPACA) or simply ACA Affordable Care Act (and is also called Romney care by some.) PPACA was ostensibly designed to expand coverage to a greater number of Americans. It does this by the following:

  • Allocating Federal Subsidies to States that Elect to Expand Medicaid Health Insurance to Cover Americans at 133% of The Federal Poverty Level (FPL) [ $29,000 for a family of four]

Note that PPACA provides a number of opt-out/waiver options whereby states can choose not to participate in one or more components of this legislation.                  Some examples include:

o   Some southern states are talking about not electing to expand Medicaid coverage to their residents.

o   Vermont has elected to opt out of PPACA in order to implement a state single-payer plan.

  • Providing Federal Tax Credits to the Insurers of Individuals With Incomes Up to 400% FPL [≈ $88,000 for a family of four] Who Do Not Qualify for Medicaid Coverage                                                                                            The federal government will thus, subsidize policy premiums for policies which can be bought through the health care exchanges that the states (the ones that are not opting out) are required to set-up. These tax subsidies are paid directly to the insurer. Operating and administrative expenses and profits to the insurer are allowed to be no higher than 20% and in some cases 15% of the total premiums collected. In this sense, the insurance companies are allowed to profit from tax subsidies.
  • Giving Federal Tax Credits to Small Businesses with 50 or More Employees These businesses will be required to offer medical insurance to their employees working more than 30hrs/week.
  • Mandating that Insurers Allow Youths Up to 26 to Remain on their Parents’ Plans                                                                                                                      Note that parents will still have to pay the extra premium and that since youths tend not to become ill (they are cherries), the addition of youths to their parent’s policies will incur very little added cost to the insurer and thus, the insurers are predicted to profit from this legislative component of PPACA.
  • Prohibiting Insurers from Denying Coverage or Imposing Increased Premiums for Those with Pre-Existing Conditions which Encompasses a Surprising Half of All Americans [25]                                                                        Insurers will be prohibited from cancelling policies for anything other than actual fraud. (This PPACA law prevents more conspicuous forms of lemon dropping.)
  • Prohibiting Annual or Lifetime Limits on Coverage [26], [27], [28]                   Coverage caps have been responsible for many American medical bankruptcies.

·         [PPACA requires all Americans to purchase medical insurance or pay a tax penalty. CNS news citing the Internal Revenue Service (IRS), reports that PPACA’s Bronze plan in 2016 will cost $20,000 annually. The Bronze plan is PPACA’s least expensive family health insurance plan. [29] Salaries above 133% FPL (≈ $30,000 a year for a family of four) will not qualify for subsidies under PPACA.]

On its face, Obama care might appear to be all that is needed to mend our broken health care system. A closer look reveals the devil in the details. These details concern how the well intentioned PPACA laws play out in the current political climate, a climate trending towards austerity cuts in which money protects money and health care is just another commodity to be bought and sold on the “free” market. In this climate it may be impossible for PPACA to live up to its name. 

Obama Care’s Exchange Benefit Plans Are Underinsurance Plans

Insurance policies sold on the exchanges created by Obama care are only required to have actuarial values (AVs) of 60% (Bronze plan), 70% (Silver plan), 80% (Gold plan), and 90% (Platinum plan). This means that the actual health care expenses that a policy pays, on average, will be 60%, 70% and 80% respectively. [30]  For example, the purchaser of a bronze level plan can expect to pay 40% of actual medical bills even after paying the premiums. Due to their lower cost, AVs of 60% and 70% are likely to be the predominant plans chosen and these plans are highly inadequate coverage for any serious illness such as cancer. Sadly, these sorts of policies allowed under Obama care will continue to result in extensive numbers of American medical bankruptcies and will not prevent insurers from lemon dropping by shifting the costs of covering the sickest patients onto enrollees in the form of markedly increased premiums and cost sharing expenses (deductibles, coinsurance and co-pays). Obama care’s injunction against coverage caps was designed to prevent the growing number of medical bankruptcies.  However, Obama care does not prevent coverage caps from also causing health insurance premiums to rise, thus allowing the high numbers of medical bankruptcies to continue.

Based on the need to maintain profits, the cost of insuring those who need it most will lead insurer’s to other lemon dropping tactics such as the inflation of overall premiums and cost sharing expenses. Raising the cost to consumers will likely discourage sicker patients who are tend to have more financial difficulties from seeking care. Even those who qualify for Obama care’s Medicaid coverage will still have some cost sharing expenses that for them may pose a financial hardship and the increased cost sharing expenses for those who do not qualify for subsidies especially for those with serious illnesses (the lemons) may lead to bankruptcies and/or avoidance of medical care they simply cannot afford. [31]  Thus, Obama care does not prevent all these forms of lemon dropping .

We do not know how many people will sign up for the PPACA’s health care exchanges but they are likely to be more of the sicker patients. Insurance companies are predicated on making a profit which is their fiduciary obligation to their shareholders, raison d’être (a.k.a. the reason for their existence). In order to turn a profit, insurance companies have to ensure a sizeable number of people who can pay into to the insurance pool but have little need to use its resources (the cherries) to offset the cost of insuring the sicker patients (a.k.a. the lemons also known to the insurance carriers as the “uninsurable”). George Halvorson, former CEO of Kaiser Permanente, discusses the possibilities for insurance pricing under PPACA: 

 “If only the 1 percent [of the sickest patients] enroll then you have to have a $9,000-a-month premium to break even. And $9,000, if you’re wondering how valid that is, it’s not theoretical. In the pools that the federal government set out in the health law for high risk people who are uninsurable [sic]… the average cost is about $80,000. If it’s only that 1 percent that joins, well then the premium in the exchanges will need to be $80,000 a year.” [32]

Probably more than 1% of the sickest Americans will sign up for plans in the exchanges. Some healthier Americans will likely sign up as well. But, it seems likely that insurance companies who are predicated on earning profit will need to raise costs sharing expenses of their policy holders if their main profit mechanisms are defeated by Obama care’s inclusion of less health individuals.  

Under Obama care, it is projected that employers will shift the increased insurance costs to the Medicaid exchanges and some companies may also limit the number of hours that employees are allowed to work so that the employers do not need to pay the cost of insuring them.  For example, Huff post reports that Walmart is about to deny coverage to new part time hires working less than 30 hours a week. [33] Previous to the expansion of Medicaid, our employers were picking up much of our health care costs. This was the part of the health care system that many felt had been working well. In the future, employees may have increasing problems paying for health care that they previously had been able to afford.   

When the Americans that could not afford health insurance enroll in the plans available in the Medicaid exchanges they will face what many current Medicaid patients must contend with now namely, that they cannot access many types of medical care. Because of Medicaid’s low reimbursement rates to providers, too many doctors especially specialists are not willing to see Medicaid patients. The Obama administration was ostensibly intending to decrease overpayments to Medicare Advantage plan carriers, the privatized components of the Medicare system. However in the details of its implementation, instead, under the guise of increasing Medicare reimbursement to physicians, the Obama administration has actually reversed its stated policy and increased these overpayments to the private insurance carriers. According to David Himmelstein MD, these overpays will amount to $104.5 billion over the next decade. More money will be given to the multi-payer, private insurance system, but Ida Hellander MD asserts that there will be no increase in reimbursement for underpaid physicians providing medical care to Medicare patients. [34]

Not everyone who needs health care will qualify for health care subsidies under Obama care. Although Obama care enacts laws to address the problem of lack of health care access, the Congressional Budget Office and Joint Committee on Taxation estimate that at least through 2022, 30 million of the 50.7 million Americans who currently have no insurance will still have no insurance after Obama care has been implemented. Sources project an increased number of Americans will have very inadequate insurance, leaving them bankrupt should they become seriously ill. [35], [36]  

According to Don McCanne MD, “… the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans.” [37], [38]

Why Obama Care, the Patient Protection and Affordable Care Act, Doesn’t Protect Us from Unaffordable Health Care

Obama care cannot defeat cherry picking and lemon dropping. Health care is so expensive that even if Obama care were perfectly implemented as originally intended, it would not be able to simultaneously accommodate both the need to ensure the “uninsurable” (lemons) and the need for the insurers to make a profit. Obama care thus, cannot prevent cost shifting by employers and insurance companies from increasing premiums, deductibles, coinsurance and co-pays of enrollees to such an extent that those of us who are enrolled will in actuality, not be able to afford to use health care services.  Nor can Obama care prevent the majority of Americans from selecting the lower cost plans that most of us will be able to afford. These are the silver and bronze plans with actuarial values that will leave us bankrupt if we suffer significant ill health. In the wake of current trends towards privatization and draconian budget cuts, Obama care’s laws can even be reversed. Obama care appears to be more a helpless victim of rather than a master over the interweaving political and economic influences of the health care industrial complex.

To a large extent, Obama care fails to control the unsustainable cost of American health care because it fails to use the government’s substantial purchasing power to bargain down prices for drugs and other medical goods and services, and it fails to streamline excess administrative cost inherent in the private insurance system. [39]   This is because it does not and cannot address the basic precept held by prevailing health care economists and policy makers, namely the idea that the free-market can remedy all the nation’s health care woes. Because of this, Obama care does nothing to streamline the administrative costs inherent in a multi-payer, private insurance system. Instead, it increases both the patient pool and the tax subsidies to the multi-payer system, the system that the prevailing economic paradigm lauds as the free-market solution.

Health Care as Commodity or a Right?

Brill and others including health care economists like Kenneth Arrow, Paul Krugman and Gerald Friedman maintain that the very nature of health care being essential to life itself abrogates its ability to exist as a free-market commodity. They hold that because health care itself cannot obey the laws of supply and demand, it cannot be treated like a for-profit commodity. Common sense tells us that when we are having a heart attack, we are not going to be in any position to bargain over the cost of lab tests. Because of this, Brill insists that the health care market will always be a ‘seller’s’ market’ with the seller setting the price as far into orbit as our US promissory notes will stretch. [40]

Even years after Obama care has been fully implemented, the effects that the traditional “free”-market paradigm will continue to have on our ailing health care system are anticipated to lead to another public outcry for more health care reform. We are realizing that health care is too essential and too expensive to be treated like a commodity. The next outcry will be for something that goes beyond the for-profit-mindset:  It will herald that health care is a human right, best supported by the implementation of a single-payer health care system that can put checks and balances on interweaving political and economic influences of the health care industrial complex that perpetuate the obscene costs of American health care.

We are the only industrialized country in the world that does not provide some type of universal health coverage to its people. Gallup polls taken over that last 12 years have shown that throughout most of this time a sizeable majority of Americans have felt that it is the government’s responsibility to ensure universal coverage; most favor some form of universal health care system that leaves no one out. [41], [42] A universal health care system such as single-payer is our long awaited reform that most other developed countries have had in place for decades.

At present, states still have the opportunity to “opt-out of Obama care” and implement single-payer systems.  Movement in the direction of a single-payer health care system has begun in our country. Vermont’s version of single-payer legislation was already passed by both houses, and that state is currently applying for a waiver allowable under Obama care so that it can implement a state single-payer system. Most states have single-payer bills and there is a national bill called H.R. 676 that currently has 41 cosponsors. [43] 

The effects that single-payer health care reform would have on conventional and natural medicine including medical doctors and naturopathic physicians would be substantial. As physicians, as patients and as Americans we will want to understand the impact of a single-payer health care system on our ability to access, pay for and be paid by our health care system. We would be interested to know if the implementation of a single-payer system could counter the massive, interlocking money interests that have rendered Obama care impotent to protect us from unaffordable health care. The rewards for having tuned in long enough to follow the money and the mindset that guides it fate is that our trust in our own powers of perception has been rebooted, our internal radar and guidance systems are now awakened, honed and ready to help us discern which reforms we want in our future, the future of natural medicine and the future of American health care.  

 

Special Thanks To: Sherry Weinberg, MD, Don Bunger, Helen Thorsen CDP, Don Mitchell, MD,  Jim Squire, MD, Marti Schmidt, JD, David McLanahan, MD, Kathleen Myers, DDS, Betty Capehart, Kathleen Randall, MA  

 

Part 2 of this article“Universal Single-Payer: a Health Care Plan that Curbs Obscene Costs and Eliminates Cherry Picking and Lemon Dropping” will discuss single-payer health care reform- what it looks like, how we pay for it and give a brief overview  of current legislation.  

 

Part 3 of this article-“How Natural Medicine May Fare in the Universal Single-Payer Plans that Are Currently Being Proposed” will discuss how natural medicine, naturopathic physicians and their patients would be affected by the single-payer health care plans that have been proposed with special emphasis on single-payer campaigns in Washington State.  

 

 

Works Cited


[1] DeParle, Nancy-Ann. “The Affordable Care Act Helps America’s Uninsured.” The White House Blog. 16 Sept. 2010. http://www.whitehouse.gov/blog/2010/09/16/affordable-care-act-helps-america-s-uninsured Web. 14 Apr. 2013.

[2] Tamkins, Theresa. “Medical Bills Prompt More Than 60 percent of U.S. Bankruptcies” 5 June. 2009 CNNHealth.com http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/) Web. 14 Apr. 2013.

1 Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[4] “FACTBOX: Healthcare Costs in U.S. vs. Rest of World.” Reuters 1 June 2009: http://www.reuters.com/article/2009/06/01/us-healthcare-costs-sb-idUSTRE5504Z320090601 Web. 14 Apr. 2013.

[5] Cecere, David. “New Study Finds 45,000 Deaths Annually Linked to Lack of Health Coverage.” Harvard Gazette 17 Sept. 2009: n. pag. http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ Web. 14 Apr. 2013.

[6] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[7] World Health Organization. “World Health Organization Assesses the World’s Health Systems.” The World Health Report 2000 – Health systems: Improving performance-Press Release. 21 June 2000: n. pag. http://www.who.int/whr/2000/media_centre/press_release/en/  Web. 14 Apr. 2013.

[8] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[9]Blumenthal, Paul. “Auction 2012: How Drug Companies Game Washington”. Huffington Post 27 Apr. 2013 http://www.huffingtonpost.com/2012/02/01/auction-2012-drug-companies-lobby_n_1245543.html Web. 28 Apr. 2013.

[10] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[11] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[12] “Single payer health care: who is it good for?” obamesque.wordpress.com. 8 Mar 2009. http://obamesque.wordpress.com/2009/03/08/single-payer-health-care-who-is-it-good-for/ Web. 14 Apr. 2013.

[13]Magnus, Edie. “How the U.S. Measures Up to Canada’s Health Care System.” World Focus 28 Jan. 2009. http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/Web. 14 Apr. 2013.

[14] Friedman, Gerald Ph.D. “Why Economists Have Been Wrong about Healthcare.” Telephone communication. 7 Apr. 2013.

[15] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[16]Dreier, Peter. “Humana: Profits Over People.” Huffington Post  20 Oct. 2009 http://www.huffingtonpost.com/peter-dreier/humana-profits-over-peopl_b_327311.htmlWeb. 28 Apr. 2013.

[17]Peter Dreier, Peter. “Humana: Profits Over People.” Huffington Post 20 Oct. 2009 http://www.huffingtonpost.com/peter-dreier/humana-profits-over-peopl_b_327311.htmlWeb. 28 Apr. 2013.

[18] “UnitedHealth Group.” Notable Names Database (NNDB). http://www.nndb.com/company/276/000058102/ Web. 28 Apr. 2013.

[19] Aetna Corporate Governance: Board of Directors page Aetna http://www.aetna.com/investors-aetna/governance/board_of_directors.htmlWeb. 28 Apr. 2013.

[20]Board of Directors page.  WellPoint http://ir.wellpoint.com/phoenix.zhtml?c=130104&p=irol-govboard Web. 28 Apr. 2013.

[22] “Executive Biographies; Kaiser Foundation Hospitals and Health Plan.” Kaiser Permanente News Center http://xnet.kp.org/newscenter/aboutkp/bios/national/bod.htmlWeb. 28 Apr. 2013.

[23] Friedman, Gerald Ph.D. “Why Economists Have Been Wrong about Healthcare.” Conference call. 7 Apr. 2013.

[24] Friedman, Gerald Ph.D. “Why Economists Have Been Wrong about Healthcare.” Conference call. 7 Apr. 2013.

[25] “At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform.” HealthCare.gov. http://www.healthcare.gov/news/reports/preexisting.html  Web. 14 Apr. 2013.

[26] Weinberg, Sherry K. M.D. E-mail communication. 22 Mar. 2013.

[27]Amadeo, Kimberly. “What Is Obamacare?” About.com Guide. http://useconomy.about.com/od/healthcarereform/f/What-Is-Obama-Care.htm Web. 14 Apr. 2013.

[28]Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[29] Cover, Matt. “IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family.” CNSNews.com. 31 Jan. 2013. http://cnsnews.com/news/article/irs-cheapest-obamacare-plan-will-be-20000-family Web. 14 Apr. 2013.

[30] Levitt, Larry and Claxton, Gary. “What the Actuarial Values in the Affordable Care Act Mean”. Focus on Health Reform. Apr. 2011 http://www.kff.org/healthreform/upload/8177.pdf  Web. 14 Apr. 2013.

[31] McCanne, Don, MD. “Quantitative Assessment of ACA Underinsurance.” Dr. McCanne’s Quote of the Day. 27 Apr 2012 PNHP http://pnhp.org/blog/2012/04/27/quantitative-assessment-of-aca-underinsurance/ Web. 14 Apr. 2013.

[32] Appleby, Julie and Tran, Alvin. “Halvorson: Premium Costs In The Exchanges Will ‘Depend Entirely’ On Participation; The KHN Interview.” Kaiser Health News. 1 Nov. 2012. http://www.kaiserhealthnews.org/Stories/2012/November/02/halvorson-q-and-a.aspx Web. 14 Apr. 2013.

[33]Hines, Alice. “Walmart’s New Health Care Policy Shifts Burden to Medicaid, Obamacare.”1 Dec. 2012  Huffington Post http://www.huffingtonpost.com/2012/12/01/walmart-health-care-policy-medicaid-obamacare_n_2220152.html Web. 28 Apr. 2013.

[34]Himmelstein, David MD,  Hellander, Ida, MD and Zarr, Robert  “Update on the ACA’s implementation and Medicare Advantage Giveaways” PNHP Telephone communication. 25 Apr. 2013

[35] Gregory, Paul Roderick. “Government Study Finds Obama Care Leaves Thirty Million Uninsured.” Forbes 22 Feb. 2013. http://www.forbes.com/sites/paulroderickgregory/2013/02/22/government-study-finds-obama-care-leaves-thirty-million-uninsured/ Web. 14 Apr. 2013.

[36] DeParle, Nancy-Ann. “The Affordable Care Act Helps America’s Uninsured.” The White House Blog. 16 Sept. 2010. http://www.whitehouse.gov/blog/2010/09/16/affordable-care-act-helps-america-s-uninsured Web. 14 Apr. 2013.

[37] Physicians for a National Health Program. “The number of uninsured Americans now exceeds 50.7 million people according to the Census Bureau.  Won’t the Obama health plan cover them?” PNHP http://www.pnhp.org/facts/single-payer-faq#obama-plan-uninsured

[38] McCanne, Don, MD. “Quantitative Assessment of ACA Underinsurance.” Dr. McCanne’s Quote of the Day. 27 Apr 2012 http://pnhp.org/blog/2012/04/27/quantitative-assessment-of-aca-underinsurance/ Web. 14 Apr. 2013.

[39] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[40] Brill, Steven. “Bitter Pill; Why Medical Bills Are Killing Us.” Time 181.8 (4 Mar. 2013): 16-55. Print.

[41] Healthcare System Poll”. Gallup. 14 Apr. 2013. http://www.gallup.com/poll/4708/healthcare-system.aspx  Web. 14 Apr. 2013.

[42] Sullivan, Kip. J.D. “Two-Thirds of All Americans Support Medicare for All.” PNHP Single Payer: Facts and Myths. http://www.pnhp.org/sites/default/files/docs/2011/Kip-Sullivan-Two-thirds-support-medicare-for-all.pdf  Web. 28 Apr. 2013.

[43] Library of Congress. “H.R.676 – Expanded & Improved Medicare for All Act-113th Congress (2013-2014)”. LOC-Congress.Gov. http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors   Web. 14 Apr. 2013.

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Discussion

2 thoughts on “Unraveling the Crisis in American Health Care: Part 1 of a 3-Part Series (Full Length Version)

  1. Hello Visitor to Life Change Medicine,
    Can you please elaborate on your comments regarding the single-payer article “Universal Single-Payer Health Care’s Envisaged Intersection with Natural Medicine: Part 3 of a 3-Part Series”?

    Posted by 9x05 | November 25, 2013, 8:21 pm

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  1. Pingback: Universal Single-Payer Health Care’s Envisaged Intersection with Natural Medicine: Part 3 of a 3-Part Series (Full Length Version) | Dr. Joie Life Change Medicine - November 7, 2013

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