By Jay D. Brock, M.D.
Fredericksburg (Va.) Free Lance Star, March 24, 2022
“It is well known what a middleman is: he is a man who bamboozles one party and plunders the other.”
Benjamin Disraeli’s remark from the 19th century nails it when it comes to describing the American for-profit health insurance industry and the broken multiple-payer health insurance system that is based on that industry. The system plunders the people, who face continually skyrocketing health care costs and restrictive insurance company rules when they try to get their health care; and, with its immense financial power the industry bamboozles the politicians who make the rules that favor the industry rather than our health care and health.
Defined as “intermediaries between two parties”—in this instance the entity standing between patients and their health care—middlemen have long been the target of much scorn because they charge a price for services that frequently add no significant value for what they do.
And with the for-profit American health insurance industry, what a price it is that we all pay—not just to the industry, with its yearly profits in the tens of billions of health care dollars—but in the overall costs of what it takes to accommodate a health insurance system based on that industry.
What are those costs? Start with this gem. According to a 2020 paper in The Annals of Internal Medicine, we waste 600 billion health care dollars each year just on administrative costs compared with what it would cost to run a Canadian-style single-payer system. Those 600 billion health care dollars are spent on building a bigger medical bureaucracy rather than on our health care. That figure does not include the untold other tens of billions of health care dollars wasted on marketing, overhead, excessive pharmaceutical costs, and profit (nearly $36 billion for the health insurance industry alone in 2019), costs that are essential to our current system at the expense of our health care.
To further highlight the scale of wasted dollars built into our current system, a 2020 Yale School of Public Health study published in The Lancet projects that under a government-funded, privately delivered single-payer system of health insurance, we could cover everyone with “first dollar coverage” (i.e., without those detested copays, deductibles, and other out-of-pocket costs that plague our current system) and save $450 billion (of the $4 trillion health care dollars we currently spend yearly). That study also states such a system would save 68,000 lives lost each year because, in the world’s wealthiest nation, so many of us are unable to afford timely medical care. If that doesn’t describe a failed system, nothing does.
That is a lot of waste, but waste that would be ended under an American single-payer system—where healthcare would be funded by public dollars and provided by the same privately based health care delivery system we have now. Polls show that 7 out of 10 Americans support such a system. So do 6 in 10 physicians.
The response of most Washington politicians? Full speed ahead—with our current system. Despite its costs. Despite its huge gaps in coverage, including 40+ million underinsured—they can’t afford to use their insurance—and 30 million who have no insurance.
Rather than transitioning to a new system such as one based on the single-payer concept, which even some reluctant politicians admit would be the right thing to do if we were starting from scratch, the intent of most politicians in Washington now is either to do no reform at all, or just incremental change. That means perpetuating the current system despite all its weaknesses.
Some politicians want a public option, which would just add one more layer to an onion that already has too many, and without eliminating any of the waste. Others say, let’s build on Obamacare—but subsidizing its costly premiums is already taking too many health care dollars, and its out-of-pocket costs are still unaffordable for too many. Ditto for too many folks on commercial insurance: “What good is insurance one can’t afford to use?” is a question many politicians apparently don’t bother to ask. Similarly, others are loathe to change a system where they say their constituents like their plans—but how popular can those plans really be where last year two-thirds of Americans said they worried how they could afford to pay medical bills?
Given the growing support of Americans—and their physicians—for a publicly funded, privately delivered single-payer system, people are clearly fed up with a health insurance system that has failed to make health care both universal and affordable. Americans are tired of being plundered by a system that doesn’t work for them. Now it’s time for our elected officials to stop being bamboozled and vote for real reform that puts people first: a single-payer system that works.