By Jack Bernard
The Ledger-Inquirer (Columbus, Ga.), Sept. 19, 2014
Ever since Medicare (universal health insurance for old people and the disabled) came out in 1965, congressional efforts to expand it to cover the rest of us have been thwarted.
Why has this occurred? There are two basic reasons:
- Extensive lobbying by health care providers (hospitals and MDs), big Pharma, and (most importantly) the insurance industry, and
- Much of the American public has been brainwashed into incorrectly believing higher costs and lower quality will result if we have “socialized medicine” (i.e. single payer).
Even market-based reforms, much less ones involving more government, are very hard to get through Congress. In 2008, Sen. Johnny Isakson of Georgia (a more moderate GOP senator) was asked whether or not he would support the Affordable Care Act.
He declined, citing the usual canards about “socialized medicine,” even though the ACA is based on expansion of private insurance. Through 2008, his campaign was paid $600,000 by providers, big pharma and insurance firms. Lobbying money he has received from these groups is much greater now.
The lobbying payoff was also significantly higher for Sen. Max Baucus, who famously refused to let single-payer advocates speak before his committee when they were constructing what eventually became the ACA.
Until we enact true national campaign finance reform — and get a few resignations from the radically right-wing SCOTUS — we are fighting an uphill battle in Congress in regard to health insurance reform.
Of course, if enough voters become angry about the situation, single-payer legislation could possibly be enacted some day. Which brings me to part two of the equation: getting the public to understand how they are being manipulated by these politicians and interest groups via the media (Fox and talk radio).
The basic problem is communications, which is why I have been so active, writing 87 health reform op-eds and letters to the editor since the enactment of the ACA in 2009. The facts are clear, but the mainstream national media are too busy worrying about which starlet has been hacked to report them. And that should concern all of us.
Where should we look for data to prove the case for Medicare expansion? There are numerous sources, but I will cite only one for the purposes of this article.
A report came out in Health Affairs this week which compared hospital administrative overhead between the USA and six European nations and Canada. Incredibly, this study found that our hospitals, with a multitude of insurance payers, spent 25 percent of their revenue on administrative expenses. Even worse, that percentage is actually increasing!
But how are we in comparison to others? Canada, which has universal Medicare, runs 12 percent. Other nations range a bit higher, but none approach 25 percent.
We look even worse when we examine GNP. The USA spends 18 percent of its GNP on health care, whereas Canada is at only 11 percent. Other nations, like England with 10 percent, are even lower.
Plus, the proportion of health care expenditures to GNP is growing. When I was director of health planning for Georgia in the 1970s, it was just 8 percent.
Why does this matter? Because our nation is slowly falling behind other developed countries in areas such as infrastructure and education. And one primary cause is the drain that health care has on our budgets, publicly and privately. Per the report, we would have saved $74 billion if our admin costs were still at the year 2000 level. If we spent the same as Canada per capita on health care, we would have saved $154 billion.
The report further documents that many of the alternative ways put forth for “reforming” the system have unforeseen consequences. Or, at least, purposely ignored consequences.
For instance, pay-for-performance schemes become a game of who can best work the system via manipulation of coding. And they entail excessive paperwork, as any provider can attest.
What can be done about this state of affairs? Surveys have shown that Americans like Medicare, although they want adjustments to part D (pharmacy) to expand governmental negotiation of prices.
Therefore, given that the report states that our excessive costs are “driven by the complexity of the reimbursement system,” single payer via Medicare for All would be a good start toward making progress. From my viewpoint, based on facts and not “free market” theory, that strategy is the only viable way of controlling costs, assuring access and improving quality.
Jack Bernard, a retired senior executive for several national health care corporations, is also the former Director of Health Planning for the state of Georgia and former chairman of the Jasper County Republican Party; Bernard_Jack@hotmail.com.