Commentary

Ron Krupp: Medicare for all

Editor’s note: This commentary is by Ron Krupp, a gardener and author whose most recent book is “Lifting the Yoke — Local Solutions to America’s Farm and Food Crisis.” He lives in South Burlington.

Stephen Brill’s new book “Bitter Pill” further elaborates on his Time Magazine article in spring 2013 entitled, “America’s Bitter Pill: Why Medical Bills Are Killing Us.” Brill explains in detail why hospitals are a big part of the problem. The University of Vermont Medical Center, formerly called Fletcher Allen, offers services at prices that bear little relationship to costs. Heart bypass surgery costs $9,319 in Argentina and an average of $67,583 in the U.S. That’s why medical bills are the biggest cause of bankruptcies in the U.S.

Fletcher Allen Hospital, which calls itself a nonprofit, earned on average 5 percent more than other comparable hospitals in the country. Part of the problem is the high fee-for-service payments to medical specialists and excessive salaries to hospital administrators.

The board of directors recently decided to change the name of the hospital to the University of Vermont Medical Center at a cost of $5.7 million. Our billion dollar Vermont medical monolith now wants to spend $187 million in the construction of a seven-story addition that would provide single rooms for patients. They also want to purchase more land and buildings in South Burlington for future development.

If the University of Vermont Medical Center were truly interested in serving the community, they would first begin by providing comprehensive emergency room (ER) service. I have heard numerous complaints over the years about the ER. Around Christmas, an 84-year-old woman, who is a friend of mine, was throwing up continually in the ER. She had to wait four hours to receive any care. Another friend last summer was basically escorted out of the ER into 95 degree heat when she complained that she had not been seen after waiting three hours. She was told her name had been called and now she was at the bottom of the list. Obviously, the process failed.

Single-payer would provide cost controls through simplified administration, by eliminating much of the bureaucracy — paperwork, phone calls and more paperwork.

 

Part of the answer is to have an immediate care facility for non-emergencies located at the hospital or at a nearby location. There is a facility at the University of Vermont Medical Center Fanny Allen campus in Colchester for non-emergency urgent care. No appointments are necessary.

If we truly want to provide fair and affordable health care we would pass single-payer universal health care. Vermonters would receive high quality care at costs they can afford. In many cases, individuals who have so-called health insurance can’t afford the co-pays and deductibles that insurance companies charge. This results in many patients making the decision to go without medical care.

I’ve been told a number of times by primary care physicians that they have to spend excessive amounts of time dealing with insurance companies in order to allow their patients to receive proper medical procedures. Isn’t patient care their top priority?

Single-payer would provide cost controls through simplified administration, by eliminating much of the bureaucracy — paperwork, phone calls and more paperwork. This would result in savings of 15 percent. Single-payer financing has a number of other advantages over private health insurance. First off, it’s not-for-profit. There are not private shareholders and overpaid CEOs. In other words, corporate stakeholders would no longer be able to make enormous profits.

I’ve been told that single-payer won’t work in this country and people who need immediate care won’t get it. First off, there are 40 countries around the globe with single-payer systems including our Canadian neighbors to the north. Dr. Frank Pasley of Williston, who is now retired, worked for 30 years both in the U.S. and Canada near Buffalo, New York. He told me there was no comparison between the two systems. The Canadian model was superior. Patients of his who needed care for serious heart problems received it immediately.

I’ll conclude with the statement, “You be the judge.”


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  • Dan McCauliffe

    Mr. Krupp,

    Let me elaborate on two misleading statements that you made in this opinion piece.

    1) “That’s why medical bills are the biggest cause of bankruptcies in the U.S.”

    The myth that most personal US bankruptcies are from medical bills, has been debunked here http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth and here http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/

    This claim was originally derived from a misleading and misquoted study. For example, the study classifies uncontrolled gambling, drug addiction, alcohol addiction, death of a family member, and the birth or adoption of a child as a medical cause of bankruptcy regardless of whether medical bills were involved. The authors of the study acknowledge that if some respondents hadn’t faced health care problems, they may still have found themselves in court, filing for bankruptcy. (Two of the authors are single payer activists – Himmelstein and Woolhandler who co-founded the single payer advocacy group Physicians for a National Health Program. There is reason to believe that these authors purposefully constructed their study to exaggerate the frequency of medical bankruptcy to bolster their argument that this is a reason for the US to move to single payer health care system.)

    Himmelstein and Woolhandlers argument loses clout however when one realizes that medical bankruptcy is the third leading cause of personal bankruptcy in Canada and often results from loss of employment due to illness. http://www.bankruptcy-canada.ca/bankruptcy/causes-of-bankruptcy-in-canada.htm
    Without employment you can’t pay your bills such as a car or mortgage payment. Additionally, estimates have shown that the number of personal bankruptcies per capita in Canada is about the same as in the US. So having a single payer health care system in Canada does not lead to fewer personal bankruptcies in Canada compared to the US. http://www.fraserinstitute.org/publicationdisplay.aspx?id=17163&terms=healthcare

    2) “First off, there are 40 countries around the globe with single-payer systems including our Canadian neighbors to the north.”

    You are correct in that Canada has a single payer system, but that may change as it has in other countries. The vast majority of the European health care systems are not single payer, yet offer universal access to health care services. Canada is one of the few remaining single payer health care systems in the world, and this may change as the long waiting times are harming patients and creating the need to reform the Canadian system to be more like the mixed payer systems of Europe. http://blogs.vancouversun.com/2012/08/01/will-canadas-health-care-system-evolve-into-european-parallel-private-model-charter-of-rights-case-will-decide-it/

    Even the socialist Swedes are now turning to private insurance in an effort to avoid long waiting times under their socialized health care system. http://www.thelocal.se/20140117/hospital-queues-tied-to-insurance-trend

    Only three countries in the world outlaw a parallel private health care system, Canada, Cuba and North Korea. A 2012 poll of Canadians found that a majority would prefer a mixed payer health care system over the single payer system. http://www.vancouversun.com/health/Canadians+want+choice+they+access+health+care+poll/6850577/story.html

    In a 2010 study on the European and Canadian health care systems, Canada’s single payer health system ranked poorly compared to the many mixed payer systems in Europe. Canada ranked 25th compared to 33 European countries. http://www.fcpp.org/files/1/ECHCI2010%20Final.pdf

    The 2012 Euro Health Consumer Index is available, but did not include Canada. However, there is still much to learn from this latest analysis. The results of this latest study show how consumer empowerment, and abandoning the single payer model leads to better health care system results. From the full report:
    http://www.healthpowerhouse.com/files/Report-EHCI-2012.pdf

    I strongly agree with you that we need to reform health care to make it more affordable with universal access. There are ways to do that without turning it into a government run monopoly. We should take pause and learn from the European countries that are shifting more of their health care financing away from the government toward private financing. Even a couple of provinces in Canada are now allowing private financing of some health care. This in part resulted from a Supreme Court ruling that struck down a Quebec law banning private medical insurance.

    ” The court ruled that the waiting lists had become so long that they violated patients’ “life and personal security, inviolability and freedom” under the Quebec charter of human rights and freedoms, which covers about one-quarter of Canada’s population.

    “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care,” the Supreme Court ruled.

    “In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services.””

    http://www.nytimes.com/2005/06/10/international/americas/10canada.html?_r=0

    Be careful what you wish for.

  • Bob Elliot

    The problem with single payer is that the government will underfund it like it is currently underfunding Medicaid and Medicare. That has caused a hike in what private insurance has to pay, to make up for the difference. Who will pay the underfunding gap when the government is in charge of paying for all our health care? We patients will when we have to wait for care or will be denied access to new medications and technology. This is a problem in Canada and other countries that rely on the government to pay for most of the health care.

    I could also mention the rampant fraud in the Medicaid and Medicare systems, and how poorly our state has managed its Medicaid program as covered in today’s Times Argus. http://timesargus.com/article/20150401/NEWS03/704019921

    • David Bell

      “We patients will when we have to wait for care or will be denied access to new medications and technology. This is a problem in Canada and other countries that rely on the government to pay for most of the health care.”

      It is also a problem in the US and other countries where we rely on the private sector for most of our healthcare. You are not citing problems unique to our peer nations.

      ” could also mention the rampant fraud in the Medicaid and Medicare systems,”

      Presumably without making any mention of the rampant fraud in private sector healthcare.

      • Bob Elliot

        David, I found one reference that states “working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent.” If this conclusion is valid, it means fraud in the government programs is 10 times more than in the private sector. http://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/2/

        • David Bell

          “Medicare and Medicaid may be closer to 10 to 15 percent”

          First of all, fraud rates are incredibly difficult to calculate by their very nature. Second, most analysts put medicare fraud at 8-10%.

          http://www.politifact.com/truth-o-meter/statements/2013/jun/17/peter-roskam/rep-roskam-says-medicare-fraud-rate-8-10-percent/

          So, the conclusion provided by your op-ed is suspect to say the least.

          • Bob Elliot

            So your source and my source would agree that Medicare fraud is somewhere around 10%. Considering the billions of dollars spent on Medicare (and Medicaid) each year, 10% is more than a sizable amount (According to the FBI, fraud committed against government health insurance programs costs the United States over $60 billion each year.). From what I have read, fraud under private health insurance is far less than 10%. If you have sources that say otherwise, please share them. Thanks.

          • David Bell

            Bob, my source puts the upper limit of fraud at 10%. Your views it as the lower bound. That difference is significant.

            I found a reference that states “Fraud is just as prevalent in the private health insurance industry as it is with public insurance, according to a report by the George Washington University School of Public Health and Health Services, Department of Health Policy.”
            http://www.renalbusiness.com/news/2009/06/fraud-prevalent-in-private-health-insurance.aspx

            But again, I question the reliability of data on fraud numbers from any source given the inherent difficulties in estimating.

    • Vidda Crochetta

      …”the rampant fraud in the Medicaid and Medicare systems…”

      I’d like to see stats to back up the phrase “rampant fraud” in Medicaid and Medicare. Fraud, yes, rampant, no?

    • Joyce Wilson

      Bob, That is really bad with not being able to track much of the Medicaid funds in Vermont in that Times Argus article. With about 30% of the state on Medicaid, the state seems to think that this is just “free” money and seems to not make the connection that Medicaid is funded by both federal and state tax dollars. No health care is “free”.

      Our state auditor, Mr. Hoffer once again is on the “ball” with this issue, just like he was with health care transparency issue. Seems like we have a one man show fighting for Vermonters.

      The fraud in both Medicaid and Medicare is much higher than with private insurance as can be seen in the chart at the link below. It should set up a red flag when a state like Vermont is not tracking the Medicaid dollars.

      “Medicare and Medicaid fraud is, unfortunately, not an uncommon occurrence, as some dishonest individuals, companies, and large healthcare organizations attempt to “cheat the system” and bill these programs for procedures that were not performed or were performed for illegitimate reasons.”

      http://www.healthcarebusinesstech.com/healthcare-fraud/

    • sandra bettis

      Bob, if we are all paying in to the same system, it will be sustainable – when you have universal healthcare for only the poor and the rest of us are paying ‘for profit’ ins cos, who do you think is getting rich and who do you think is going broke?

  • Jon Corrigan

    My father, who worked for hospitals in NY and VT for the better part of 40 years, told us nurses, lab techs, X-ray techs etc. would routinely show up at US hospitals around the end of July. They were seeking employment here because the Canadian hospitals had run out of funds to pay them. Strange how ‘Dr. Pasley’ missed that tidbit.

  • Glenn Thompson

    From the Commentary,

    “I have heard numerous complaints over the years about the ER. Around Christmas, an 84-year-old woman, who is a friend of mine, was throwing up continually in the ER. She had to wait four hours to receive any care. Another friend last summer was basically escorted out of the ER into 95 degree heat when she complained that she had not been seen after waiting three hours.”

    IMHO, having to wait 3-4 hours in an ER is unacceptable. However, that is *FAST* compared to Canadian ER times which for whatever reason, some around here continue to praise!

    “EDMONTON – Leaked documents show not one hospital is meeting its emergency room wait-time targets so far this year, Alberta’s New Democrats say.”

    “NDP Leader Rachel Notley says the numbers show some patients have to wait 20 hours or more in most of the province’s major hospitals.”

    http://globalnews.ca/news/1898073/not-one-alberta-hospital-meeting-emergency-care-benchmark-targets-ndp/

    And here is another one!

    “Many Canadians get their first-ever glimpse today of their own hospital’s emergency wait times to see a doctor, and some of the waits are disturbingly high.”

    http://www.cbc.ca/news/health/hospital-er-times-reveal-some-disturbing-waits-1.2767867

    I’d strongly recommend especially for the elderly to just call an Ambulance! I don’t know if it is done in Vermont? Out in Arizona, one can set up a service contract with a local Ambulance service and during an medical emergency can just call the service and get transported to the hospital of their choice! Those brought in by ambulance gets immediate attention!

    As for Single Payer. Anyone who believes the medical problems in the US will be ‘magically’ fixed by letting the government run the US Healthcare system is not living in reality!

    • sandra bettis

      Medicare, Medicaid and military insurance all work much better than our ‘for profit’ system. And, guess what, they are administered by…….the govt!!!!

  • Walter Carpenter

    “The myth that most personal US bankruptcies are from medical bills, has been debunked here http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth and here http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/

    Of course, this study would debunk this as a myth. The American Enterprise Institute is a conservative think tank, no doubt well funded by interests would like to see this myth be believed as fact.

  • Walter Carpenter

    “This is a problem in Canada and other countries that rely on the government to pay for most of the health care.”

    The real problem is that people can use the health care system in Canada. They are not blocked from using it by high deductibles and co-pays like we are here

    “I could also mention the rampant fraud in the Medicaid and Medicare systems,”

    Is it just with the Medicaid and Medicare systems? Private insurance has no frauds and is always perfectly managed? Our health non-system would collapse without Medicare/Medicaid.

    • Yes Walter…many Americans have blinders on concerning other advanced countries’ universal health care and the fact that they spend approximately half of what we spend (8%GDP vs. 17%GDP) and have better results!( Check CIA World Fact Book life expectancy. Also without Medicare, we would be ranked even lower.)
      Here in Vermont 1 in 7 have put off doctors’ visits due to cost not to mention 1 in 7 have had the pleasure of being contacted by a collection agency… ad nauseam, ad infinitum, and we still don’t have universal coverage!
      I guess you can take them to the well but can’t make them drink.

      • Glenn Thompson

        What is ‘advanced’ by having to wait several hours in a Canadian ER?

        • sandra bettis

          Have you been to an American ER? And then you get the (ridiculous) bill afterwards!

  • Dan Carver

    The real problem: People neglect their health for years, which allows problems to manifest. Then they want the latest and greatest technology and drugs to fix their health issues, yet, they themselves, do not want to be bothered to make any changes to their habits.

    I’ve known smokers, who in their early 50s had heart attacks, they swore of cigarettes, yet a year later they are puffing again.And they complain about their health insurance premiums.

    Sorry, but the non-smoking health conscious people ar eht only ones with a “right” to complain about health insurance. The folks making poor health habits are getting a deal – while driving up costs!

  • David Schoales

    Well said Ron. Clear and true. Illegitimi non carborundum.

  • Kathy Callaghan

    “Only three countries in the world outlaw a parallel private health care system, Canada, Cuba and North Korea”. Yes, we really ought to set ourselves up with a health care system that emulates the one in these countries. They are so progressive and enlightened. When will single payer advocates realize that single payer doesn’t work and a mixed payer system does?

    • sandra bettis

      Cuba has one of the best medical systems in the world – during the Ebola outbreak, the USA sent the military – Cuba sent doctors. Their medical system and medical school (free, by the way) are widely respected. Health care ‘for profit’ does not work. There is a reason that all other ‘enlightened’ countries have abandoned it.

      • William Hays

        So, Sandra, move to Cuba. Don’t look for medical care there: all their doctors are in Africa.

  • sandra bettis

    Single payer universal health care is the only solution to this for-profit insurance company mess we are in. Not one person or family should have to go thru bankruptcy for medical bills.