Take a look in the rear view mirror, and the scene in the front of you is gone. That’s what’s happening to Medicare, but is nothing compared to what is planned. Thanks to the confluence of politics and money the closest thing in the nation to universal medical care is in the process of converting to universal restriction, unless people and practitioners wake up.
Tom Price, a well thought of surgeon and Georgia congressman, will be the secretary of HHS. He is almost religiously devoted to voucherizing (read privatizing) Medicare, in part due to belief in the market as the way to provide government services, and secondly to cut the extraordinary future medical costs of an aging population. Forget the reality that costs have been relatively contained in the last few years. The plan will be to put private insurance companies front and center, ruling the roost. After all, the new leaders know the market always does better than government – look at drug company pricing. And health insurance companies have proven formidable innovators, devising a million ways to tell people no, they’re not covered, and no, we won’t pay.
However, the reality is: 1. Medicare administrative costs are about 4-5% per year. 2. Private health insurance administrative costs are 15-20%, plus an additional required profit margin of 5-10% 3. Only by cutting benefits 20% or more can Medicare be voucherized. Know well – you can only make these private plans fiscally work if you cut the hell out of benefits. And as Michael Mariano points out, politicians know it’s more politically acceptable for health insurance companies to cut benefits than “My Medicare,” where politicians fall more nakedly on the hook.
But there’s more. Handing over Medicare dollars to the “private market” lets an enlarged health insurance industry gets its hand on the big prize – elderly health care dollars. And all they have to do to keep the money is pass a small part of the profits to the legislators who shall make it possible, while pushing anti-truth PR campaigns on “universal access” that will make readers of George Orwell’s 1984 sense they have truly seen the future.
You start by talking up the “efficiency” of markets.
The Health Care Market
What do you do when you face a life and death situation? You pay what’s needed to survive. American health care economics bears more comparison to medieval guilds than it does to Adam Smith’s magical market. And those medieval guild restrictions are now being wielded by health insurance, pharmacy benefit, and pharmaceutical companies to ensure their dominant oligopolies for decades. While the public, indeed many politicians, are playing dominoes, these companies are playing chess – and winning.
Take mental health, the “canary in the coal mine” of health care and a place where I hang my hat. Everybody “knows” there’s a shortage of psychiatrists nationwide. What they don’t know is that in order to practice that trade, you generally need to be on insurance panels. Except 1. You can’t apply to them until you’ve been in practice for five years and 2. Many panels are “closed.” Shortage or not, they have “all the practitioners they want.” Sure, you can put out your shingle anywhere you like – but most of the market is cut off from you. Or you can go to work for a public agency, or better, a private group whose “exclusive” relations with insurance companies allow you to work as a panel member – but only as long as you work for them. And many of these “exclusive agents” also make new docs sign “non-competes.” So if you want to work for somebody else, you better leave town.
Yet that’s just the beginning of guild restrictiveness. Insurance companies and Medicare have added “reporting requirements” that convert physicians into checklist monkeys who turn their back on patients while they type out the required chart and “quality measures” necessary to get paid. It’s no surprise ER physicians now spend up to 44% of their time doing charts rather than patient care. Built within these “requirements” are also the need to use electronic health records that have amply proven to possess no viable cybersecurity. Industry professionals admit pretty much all the major systems have been hacked. Don’t want your most private information for sale on the dark web? Sorry, you’ve already lost that option. Physicians are being forced to use those systems or be put out of business.
The market works – for the people who control it.
Medicare and Health
There are reasons nation states almost universally use national health systems. Unlike American medical care, they recognize a useful goal – universal health. A healthy population is a more economically effective. It lives longer. It’s happier. National health care is also much, much cheaper. Look at the costs of health care in the UK and the US, then compare the national health statistics: the sane response is to weep.
Bizarrely, the US makes its single feeble attempt at universal health in the oldest. Crazy as it is, Medicare has worked better, and with greater popularity, than any other part of American health care. But it is being ground down by groups that see opportunities for enormous new profits and power, and will not stop until they to get them. In this regard, political promises of “universal access” are not merely misleading, but purely deceptive. Here voucherization is equivalent to saying everyone gets the same “fair” ten dollars to buy health care. If that care costs 50 or 100 dollars that’s too bad – you all got your 10 bucks. If you don’t have the money, you’re out of luck.
Yet we’re not quite yet out of luck. It is true that Citizen’s United made buying politicians legal – it was already cheap. But the elderly do not have to sit back and be told they’ll have their “old Medicare” when their panels will only include specialists a hundred miles away (and insurance companies lie blatantly about who is on their panels, so baldly patients are now told to contact their physicians and find out if they take the insurance that falsely lists them as providers.) We may be in a post-fact era, but know well – reality still exists. And it bites. Especially when you find out you’re not getting the medical care you need to live.