By Jonathan D. Walker, M.D.
The (Fort Wayne, Ind.) Journal Gazette, December 24, 2018
‘Tis the season … for surgery.
It is a very busy time of year for people in the medical profession because most patients have gone through their deductibles and are now getting every possible test and surgery done before January.
This puts quite a strain on the health care system as hospitals try to keep up.
What is most striking is that this pattern is such a part of our lives that no one stops to think about how strange it is. We have all come to accept the fact that an insurance company can completely change how and when we choose to receive care, and for no good reason.
Why do we put up with a system that restricts our access to health care?
Briefly, it goes back to World War II when wages were fixed by law.
Employers needed to do something to attract employees, so the government allowed employers to provide health care as a tax-free benefit instead of more take-home pay.
It is therefore important to realize that your employer is not spending its money to provide insurance – your employer is actually using money that is essentially part of your salary to obtain insurance for you.
In other words, in addition to all the co-pays and deductibles you are paying out of pocket, you are also paying for the insurance your employer is providing.
If you were buying a car, would you willingly put up with the kind of constraints and costs you face when it comes to your health care plan?
All of these rules would make sense if they actually helped provide you with better care and helped to control overall health care costs.
But it is hard to imagine that you get better treatment with everyone rushing to get their doctor visits during December.
And as you watch your co-pays and deductibles go up, it is clear that none of these restrictions are helping to control the rising spiral of health care costs.
All these rules are simply hurdles that one has to jump to obtain health care, and if one fails to leap any given hurdle then the insurance company doesn’t have to pay.
It turns out that the responsibility for our confusing and fragmented health care system rests not just with those companies; it really lies with all of us.
Plus, those companies are filled with good people who believe they are bringing added value to the system. But we need to ask ourselves whether we agree about that added value.
Do we really want large entities – whose primary ethical responsibility is to their shareholders, not patients – to be in charge of where the money goes in our health care system?
It feels as if their primary product is confusion – about networks and deductibles, about which drugs we can use and about which ER we can take our child to without going bankrupt.
Even businesses are beginning to wonder about what exactly they get in return for all the premiums they pay for their employees.
Wendell Potter, former vice president of public relations for CIGNA, says it best: “What keeps insurance company CEOs up at night is the worry that other CEOs will eventually come to realize that they add more cost than value to our health care system.”
But there is another way.
We all pay into the insurance program known as Medicare, and that money helps people older than 65 obtain health care without going broke.
So we pay for two insurances – our personal insurance through our employer and also Medicare.
But we are forbidden by law to use Medicare insurance for ourselves. When people advocate for a single-payer system – Medicare for all – they are asking why we have to use so many different insurance companies when we could start by providing Medicare to everyone since we are all paying for it anyway.
It turns out that because Medicare is much more efficient than the for-profit insurance companies, we can be covered for much less cost.
Also, traditional Medicare doesn’t have network restrictions, and pre-existing conditions aren’t considered – everyone is accepted.
Of course, Medicare has problems, most of which stem from the fact that lobbyists have influenced the program heavily, which is why most health care reformers speak of an “improved Medicare for all.”
But this oped isn’t about convincing anyone that single-payer Medicare for all is the way to go. That is a complex subject, and each person should explore it and decide for themselves. Instead, this oped is simply to encourage our politicians to engage in an honest, data-driven discussion of single-payer health care, rather than dismiss it with inaccurate phrases and soundbites.
For instance, it has always been easy for politicians and lobbyists to shut down a conversation on single-payer with toss-off phrases such as “we can’t afford it.”
But that isn’t true.
Multiple studies have shown that a single-payer Medicare system funded by a fair and progressive tax can cover us all for less money – especially when you realize that we’ll have no more deductibles and premiums, we can bargain with drug companies, and we don’t have to pay for the huge bureaucracy those companies create.
In fact, some estimates suggest that the majority of Americans would end up with more take-home pay.
But we need to have an honest discussion about this.
Instead, we have sound bites designed to create fear, along with powerful lobbying groups (such as The Partnership for America’s Health Care Future) that are getting ready to spend millions of dollars to keep people from exploring the idea of single-payer.
And those techniques work.
Unfortunately, the history of health care reform has always been about who can create the most well-crafted slogans rather than about having an actual discussion about the issues.
The difference now is that more and more people are feeling pinched as vested interests try to maintain our needlessly complicated status quo.
So as we scramble to get our health care needs met before January, and as we watch our health care costs go up, and as we try to navigate complex rules about networks, billing and drug plans, maybe those slogans will be less effective. Maybe we can consider the benefits of expanding the one insurance we already pay for: Medicare.
Perhaps someday we’ll have a health care system that we can use, rather than a system that creates obstacles designed to keep us from getting the care we need.
Dr. Jonathan D. Walker is a retinal surgeon and assistant clinical professor with the Indiana University School of Medicine in Fort Wayne.