By Leslie Hartley Gise, M.D.
The Maui News, March 14, 2019
How can someone come out of the Maui hospital emergency room with a bill for $5,000? It is because we have allowed medical care in this country to become a very profitable enterprise. We have 30 million people without any health insurance and, as is the case for the person in the Feb. 17 Maui News article, another 40 million with inadequate insurance.
If you had no insurance, your bill would have been even larger. Even if you have health insurance from a “nonprofit” carrier, almost 14 percent of your premiums go to “overhead,” including obscene salaries for the CEOs. Even “nonprofit” insurance companies are motivated to minimize the amount of money spent on actual care in order to fund this increasing overhead. Go into any doctor’s office and you will find more employees dealing with insurance companies than treating patients.
One path to a better system is based on expanding traditional Medicare to cover everybody. “Medicare for All” can reduce heath care costs while preserving the freedom to choose health providers. The overhead of Medicare is 2 percent. The key feature of Medicare for All is that everybody is in one risk pool. That’s the way insurance works.
Eighty percent of us are pretty healthy and don’t use much medical care, about 20 percent of the total. Twenty percent of us use the remaining 80 percent of the medical care. When we are young, most of us use less medical care than when we are older, but major medical problems can affect any of us at any time. That is why we have insurance. We pay when we are healthy because we don’t want to go bankrupt if we get sick.
Hawaii has been a leader in striving for universal coverage with the Prepaid Health Act of 1974, which is an employer mandate to provide health insurance for employees who work 20 hours a week or more. It also provided protection from pre-existing conditions. The Hawaii Legislature passed a bill to establish the Hawaii Health Authority, which is charged with creating a plan to move Hawaii toward universal health care, however it has never been implemented. That needs to change. The Affordable Care Act got more people insured, but it did not control costs. We won’t have Medicare for All in the next two years, but there are things that we can do in our state.
Voters rank health care costs as their second most important priority, just after the economy. Health care costs are the largest single sector of the U.S. economy, almost one-fifth of our gross domestic product. We pay twice as much as other developed countries and our health outcomes are worse. We are not getting our money’s worth. Profits are soaring in the private health care and pharmaceutical industries, which will fight fiercely against Medicare for All.
The U.S. Congress has a Medicare for All bill, but congressional “leadership” has never allowed it to be given a hearing much less a vote. The 2019 Medicare for All bill, HR 1384, was just introduced on Feb. 27 and it needs to be given a hearing. It also needs a new financial estimate from the Congressional Budget Office. Previous estimates have found that Medicare for All will save trillions of dollars over 10 years.
It’s been five years since the Affordable Care Act has been implemented and it was never designed to achieve universal health care. There is nothing we can do to our money-based system that will accomplish this goal. We need a better system, Medicare for All.
Dr. Leslie Hartley Gise is a clinical professor, Department of Psychiatry, John A. Burns School of Medicine University of Hawaii; staff physician, Maui Memorial Medical Center (Maui Health System); and Hawaii contact person for Physicians For A National Health Program.