Health Care in the United States • An Autopsy

As one who recently experienced a five-day stay in the hospital and also received a $42,000 bill for the services rendered there, I have some acute observations about the health care debacle in the United States that is both bankrupting our nation and tearing the very fabric of our society apart at the seams.

Apart from being invoiced $1750 per day for a semi-private room and $5,130 for pharmaceuticals, which comprised nearly 1/3 of the bill; one of the items that particularly drew my attention was the $700 charge for physical therapy, which basically consisted of a girl spending a total of 15 minutes to fit my my foot with an elevated boot that looked like an old ‘Earth Shoe’ and making sure I could walk down the hall okay while wearing it.

Fortunately, because I have a good Blue Cross plan obtained through the national heath care exchange that Republicans just repealed, the hospital ‘adjusted’ the bill by $21,000 because of their arrangement with Blue Cross, who paid the hospital another $18,000 (but of course, those less fortunate without decent insurance would be on the hook for the entire $42,000, because in the USA today apparently we believe in penalizing the lowest segments of our society the worst.)

Indeed, this entire ordeal has given me considerable pause to reflect upon how totally broken our current health care system is in the United States and how fixable it truly is, provided we stop deluding ourselves about the source that is driving both costs and the bodies of those that can’t afford it up to the gates of heaven.

The Root of the Problem • Late Stage Capitalism

In the United Kingdom which has national health care system, the average resident spends $2600 per person per year on the NHS, whereas in the United States we currently spend $4600 per person on Medicare & Medicaid.  (Please note: I'm not talking simply about per person in the way of people enrolled in said program, I mean actual per capita spending based off of the TOTAL population. I.E. $4600 for every 330,000,000 people in the USA.)

If we moved to a similar ‘single payer’ system in the United States, the savings anticipated would be $504 billion per year. All Americans would be covered for all medically necessary services. Patients would regain choice of doctor and hospital, and doctors would regain autonomy over patient care. As it stands now, Americans spend over twice as much per capita on health care as the average developed country.

The million-dollar question, though, is how would it be funded? To address this, we first must recognize that approximately 50% of US healthcare is currently funded through taxes – and 50% through business and household pockets.

A single-payer system would be financed through a transfer of money that Americans and the country’s employers currently pay insurance companies. The premiums we and employers now pay insurers would be transferred to a federal program, which would be the single-payer for health care services. The cost to all of us – either through taxes or out-of-pocket expenses goes way down, with savings of over $700 billion per year, including negotiation for prescription drugs, a unified fee schedule, and greatly reduced administrative expense. It’s also important to realize that approximately 50% of U.S. healthcare is currently publicly financed.

How does this system affect doctors and hospitals?  Single-payer eliminates the need for hospitals to absorb the cost of charity care for the uninsured because everyone is insured. Single-payer also reduces needless administrative expenses and bureaucracy, substantially lowering costs.

There is a myth that with national health insurance the government will make medical decisions. In a publicly financed, universal health care system, healthcare delivery is private, not government owned. Medical decisions are left to patients and doctors, as they should be. This is true in countries like Canada, Germany, France and Spain where financing is public and delivery of care remains private. Cost containment measures are publicly managed. The total budget for healthcare is set through a public, democratic process, while clinical decisions remain a private matter between doctor and patient.

More importantly, because a single-payer universal system frees you from job-based insurance and frees employees from spending ever-increasing amounts on healthcare. Coverage is not tied to employment. And contrary to popular myth, single-payer does not raise taxes. Currently, the nickel-and-dime system of co-pays, deductibles, and out-of-pocket expenses could be replaced by employer payroll tax and individual flat tax similar to the current Medicare system, or the U.S. or state government could sell insurance. For 90% of Americans (both employers and employees), healthcare costs would be decreased.

Is Single-Payer Socialized Medicine? No. Socialized medicine is a system in which doctors are government employees and hospitals are government owned – the Veteran’s Administrations (VA) and the Armed Services hospitals are good examples of this system. In a single-payer system, the financing is public, while the delivery of care remains private.

The term “Socialized Medicine” is often used as a scare tactic to conjure up images of government bureaucratic interference in medical care. In fact, with a single-payer system, there will be more individual choice and freedom for both patients and medical professionals.

Separating Fact from Fantasy • What’s Really Going On

The United States has the most bureaucratic healthcare system in the world – with 30-35% of every healthcare dollar going to paperwork and overhead. Our current system is extremely complex and fragmented due to the thousands of different insurance plans.

In a single-payer system, the bureaucratic burden would be cut in half, resulting in $500 billion in net savings for America.

In Great Britain, for example, citizens pay a tax called National Insurance that funds various social security measures, one of which is the National Health Service, which provides free at the point of delivery healthcare based on need rather than wealth. The advantage of this system is principally that life threatening medical care will not cost you anything and you'll get it the moment you need it, while the disadvantage is that elective/non-emergency surgery/treatment can take months before you get it and your appointment can be cancelled at any time until you're literally under anaesthetic.

With the latest federal budget that seeks to increase military spending to all time highs, even if the United States doesn’t cut the military we could probably afford a universal health care system. As of 2013 the U.S. was spending 17% of it's GDP in healthcare, 6% higher than the next highest, France, at 11%, and double the third highest, Great Britain, at 8.8%.

Given that this 17% is only the public funds (aka your tax dollars) dedicated to healthcare, that doesn't take into account insurance premiums, out of pocket expenses, or the roughly 1.8 million households that went into medical related bankruptcy in 2013. Don't forget for most people a major medical expense isn't just a possibility it's an inevitability.

I'm not saying France or Great Britain’s health care options are the best option, or that there aren't problems in those systems, however I think either system would be significantly better than the haphazard assortment the U.S. currently has.

Medicare and Medicaid already equal more tax dollars per capita than Canada presently pays to cover everyone. This is because the old and poor account for 90% of healthcare expenses simply because the old and poor tend to comprise a disproportionate share of the sick and dying. Consequently, it would cost almost nothing to extend Medicare to everyone left.

But the core reason that isn’t happening in the USA is because too many powerful players such as the insurance industries lose out, even if the majority wins.  The insurance companies lose out in this scenario because they become redundant (meaning they earn $0 and patients get the savings).

The doctors and hospital CEOs and Pharma who now have to negotiate with a single payer (meaning they earn less and patients get the savings), and all those people working jobs coding and negotiating and doing actuarial and advertising and marketing work also become obsolete, inefficient, and redundant.

Consequently, the second we move to a Single Payer system and get rid of competition in the marketplace by insurance companies, millions of people will need new jobs because they’ve become obsolete – but let’s face it, their jobs are literally pointless right now and it is the greater good of patients and the general public that would be reaping the savings.

The truth is, in the US, tech is still not a big hiring sector and never was, whereas with Healthcare it's huge. For every manufacturing job the US lost, it replaced it with a healthcare job. It's basically super bloated and inefficient on purpose and the biggest jobs program since the defense department.

And the only reason employment has grown at all in America is that instead of sane healthcare, we created the world's largest administrative kludge of a Rube Goldberg machine that requires millions of people to turn cranks that do nothing to get it to "work."

Basically, we've turned healthcare into a huge private sector bureaucracy that requires more people to work on office and paperwork than actual healthcare delivery. And we're doing it to education right now as we speak. That's why your college has 27 Assistant Associate Deputy Deans for Student Engagement or whatever, but can't afford a single real tenure track full time professor to teach your course...or to keep the sociology department open, or whatever nonsensical cuts they maneuver.  Universities are becoming a big jobs program too; but we’ll save that topic for another time.

Essentially, we seem to be out of ideas for useful things to have people do, so we invent mandatory form CQ-1289-B and require that the official department office manager ensure that all receipts to be reimbursed be taped to an 8.5"x11" white sheet of paper and photocopied with originals and three attachments and that gets faxed and uploaded to the secure server prior to receiving approval from the finance director, controller, and department head to clear the way to enter the online workflow process system® of the accounts payable department so they can fill out form CQ-1289-J "Intent to make payment," and send it to the bank so they can cut a check and mail it back to the office manager so that within 6 weeks you can get reimbursed for a $12 dollar sandwich you bought while on the road doing a "recruitment talk" powerpoint to 3 kids in an empty lecture hall at a high school down the road.

I think you get the point, because that's the new realty of what we call "work" for millions of people. It's so obviously massively inefficient and silly and everybody knows it that it's basically exactly like the Emperor's New Clothes. Shows like "The Office" could not exist if pointless jobs weren't so obviously relatable. But it's worse in the United States because the US has the least worker protections, and the highest benefit costs, so industry fled the fastest.

Well, you can't just let people not work. The system isn’t designed for that. But you also can't let them go massively unemployed everywhere. That breaks it too. Capitalism pretty much requires that the unemployment rate has to be between 5% and 20% or so, or it breaks. And there's no desire to spend capital to actually build anything useful for the public.

So what do you do? You have Congress create a shitload of bureaucracy. But people hate government, especially on the right. So you build private sector bureaucracy. We figured that out after WWII. The right was all angry at FDR's public jobs programs, so Eisenhower fixed that by building out the highways through the Defense Department budget and requiring a security clearance to do almost anything in Government, thereby creating a huge bureaucracy and a giant pile of jobs that cannot be outsourced.

Then, once Eisenhower saw how Defense Contractors handled it and got huge, he warned about the 'military industrial complex' on his way out the door. But it was too late. Too big. No rolling it back at that point. But it worked okay, and was humming along, until everything went topsy-turvy in the 1960s and things were supposed to work for people who weren't white too. That was new. So you get civil rights and voting rights, and maybe as importantly, immigration law changes to stop being overtly racist and only allowing Europeans in in any great numbers.

But the economy was booming then, and the Vietnam War soaked up a lot of 'surplus labor,' and many more kids went to college for the first time, and Johnson banged through Medicare and Medicaid in the process, so they sort of got around it. Remember that gen X and millennials and boomers paid for Medicare their whole lives. Older people who worked before 1970 just sort of 'got it' for free.

And now, dear reader, we are at the stage we are today – basically, with a health system that is limbo and a Congress that is held hostage to insurance companies and big pharmaceutical giants.

In order to fix a problem, first you need to understand the nature of the problem. And once the solution becomes this apparent, the question then comes down to whether society and the people that comprise it possess the will and courage to make the needed solutions happen.

Never forget that ultimately, people have the power. With the issue of health care in the United States, the choice is simple:  move to single payer or watch the entire system collapse under the weight of its own hubris.