Monday, February 6, 2023

Universal health coverage would save money. And lives. And make life a lot better for people.

Two recent Gallup polls confirm long-standing problems with the US health system. Americans Sour on U.S. Healthcare Quality finds that 

For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.” 

It is important to read that carefully; it does not say that “for the first time in two decades, Americans find problems with U.S. healthcare”. It says that for the first time fewer than half rate it as “good” or “excellent”. And “a new high”, 21%, say it is poor. This is very significant because the opinion one has about healthcare varies tremendously depending on whether one has needed it or not. If you, and your family, have been healthy, and have rarely if at all needed anything other than, perhaps, immunizations or checkups, then you are likely to perceive the system as better. Even then, you probably had some difficulty getting an appointment, getting through to find out the results of any tests you had, and difficulty communicating in general. And it likely cost a lot. If you were just a little sick, it can be irritating, frustrating, and even risk your health to some degree. But if you are really sick, and especially if you need to be in the hospital, it is very unlikely that your experience was even “fair”.

This is something that a lot of people, and a lot of pundits miss. When you don’t need health care, everything is fine, and your insurance is good and pays for all of the nothing you use; indeed even being uninsured is fine. It is just that pesky problem of it not being fine when you need it. Like anything; you don’t regret not having a down coat on a balmy Spring day, or an umbrella when it is dry. There is an old story about a traveler coming across someone whose roof is leaking in the rain. The traveler asks why he doesn’t fix it. The man responds that when it is raining it is too wet to get up on the roof, and when it isn’t, “my roof is as dry as anyone’s.” This is fine as a joke, but not as  healthcare strategy. When you or a family member is in a car accident, or gets a cancer diagnosis, or needs major (or even minor) surgery, or your newborn needs to be in the intensive care unit, is not the time to start to think about your health coverage.

And, yet, that is what many people do, are forced to do, to depend upon hope and prayer. While for some this could be in part an issue of distorted priorities – health insurance is expensive and I could be buying a nicer house or a bass boat –this is not the usual reason. It is more often “health insurance is expensive and I need to pay the rent and buy food and put shoes on my children’s feet”. And if their budget allows them to actually buy health insurance, it tends to naturally be the one that the buyer can afford – and is often inadequate, and have high patient responsibility (co-pays, maximums, and other costs). Thus “having health insurance” deludes you (and many pundits and policy makers) into thinking that you have taken care of this issue. Until you need it.

Which brings us to the results of another Gallup poll, released at the same time, “Record High in U.S. Put Off Medical Care Due to Cost in 2022”. “The latest reading, from Gallup’s annual Health and Healthcare poll conducted Nov. 9-Dec. 2, is the highest by five points and marks the sharpest year-over-year increase to date.” Not a surprise given the information above. You can put off going to the doctor for a checkup, or a cold, or a vaccine, or even for treatment for a significant chronic disease like diabetes, high blood pressure, heart disease – at least if is not bothering you too much – but it is not very wise, since ignoring such conditions is one way to get you really sick, and into the hospital, and maybe into intensive care, and maybe, even, die. However, since we don’t have a universal health program in the US, too many people simply cannot afford to get healthcare, especially anything that is costly. I am tempted to say that there is a price list, and, like buying a car or a house or a coat, you shop within your means. Except, of course, there is no price list, and you hardly ever know what a medical procedure will cost. And there are often no good alternatives to the expensive treatment; in this way it is definitely not like buying a perfectly functional, if less fancy, car.

A third important article was published in June 2022 in the Proceedings of the National Academy of Sciences USA. Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic”  by Galvani, Parpia, Pandey, and Fitzpatrick, estimates that during the pandemic a universal healthcare system would have saved 212,000 lives and $105.6B from COVID alone, in 2020 alone. This would have risen to about 338,000 lives through March 2022, as reported on in the Scientific American, and would have been on top of another $438B saved from other causes besides COVID. That is a lot of money. And a lot of lives. More than 100 times the number of lives lost in the World Trade Center attack. And (see the polls from Gallup) that is not counting the people who didn’t die, but could have. Who lost their health, their ability to work, their life savings, their ability to provide for their families.

So what is this “Universal Healthcare” thing? Some kind of pie-in-the-sky dream of liberals that would bankrupt the US? No, it is what they have in every other wealthy country in the world, and many that are not so wealthy. Those countries that don’t consider health and healthcare to be a consumer luxury, that consider it to be about people’s health rather than something for the private sector to profit from. Remember, that $105,600,000,000, and that $438,000,000,000 (2020 alone) is not going into the garbage. It is going to health insurance companies, and health care providers (by which we mean not only – or even mainly – doctors, but rather hospitals and “health systems”) and their suppliers, especially drug companies. This is detailed in the latest publication on this topic (regularly updated, and rarely improving) from the Commonwealth Fund. “U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes” shows that the US is the only wealthy country that does not guarantee health care coverage to all its people, and still spends 2-4 times as much as those other countries. The money goes, of course, to private profit. There is a name for this: corruption and graft. And words for it. Mostly obscene.

So why don’t we do something about it? We have tried – President Truman tried to get a national health insurance system in 1948. Defeated, sadly, with support from labor unions who thought it would undermine their success in getting health insurance through negotiations with employers (there’s a quaint memory). Medicare, a national health insurance system for seniors and the disabled, was passed in 1965 under President Johnson. So was Medicaid, a state/federal partnership to provide coverage for many (but certainly not all!) poor people. In 2010, under President Obama, ACA (Obamacare) was passed, which extended health coverage to many (but certainly not all!) of those left out, who were unable to afford individual health coverage but were not poor enough to get Medicaid (and in most states that is desperately poor!).  But nothing comprehensive, nothing that covers everyone, nothing that guarantees you won’t be broke and in debt at the end. Nothing that resembles the systems in any other OECD (i.e., wealthy) country.  Why?

Because private corporations make lots of money, from you, and from your employer, and from the government, and very much do not want that to go away. Indeed, as I discussed recently (Privatizing Medicare through "Medicare Advantage" and REACH: The Wrong Way to Go!, January 20, 2023), the private sector is expanding its leech-like sucking of public funds through privatization of Medicare by programs like Medicare Advantage and ACO/REACH. And are willing to spend some portion of that huge amount of money on lobbying – and making contributions to – members of Congress, to make sure that their profits are maintained at the expense of the health and lives of the American people, not to mention their money.

It is  that simple. The health and lives of people vs. the profit of corporations. Don’t be fooled by liars or obfuscators. It is time to end this incredibly expensive boondoggle that costs the lives and health of so many of us. Write your Congresspeople and demand Medicare for All, or any form of completely universal healthcare, now.

Or sooner.

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