This commentary is by Lee Russ of Bennington, a retired legal editor who was the lead editor/author of both the third edition of “Couch on Insurance” and the Attorneys Medical Advisor.
Everybody in Vermont has heard horror stories about health care. But each of those stories focuses on a small piece of the problem. Put those small pieces together like a jigsaw puzzle and you won’t sleep very well at night.
Vermont is short on doctors and nurses, and it’s going to get worse. Many hospitals are bleeding badly. Many patients wait absurdly long times to see a doctor, especially specialists. Over a third of Vermonters have health insurance they are reluctant to use because they can’t afford to pay the deductibles and co-pays.
Premiums on commercial health insurance are high and rising. If you’re insured through your job, your share of the premium is rising, and so are the deductibles and co-pays. If you work but don’t get insurance through your job or an employed family member, you probably are on Medicaid.
Town and school budgets are inflated by the ever-rising health insurance costs for the people who work there. Property and school taxes rise accordingly. Your income taxes reflect the need to fund the increasing Medicaid rolls.
The prices you pay for everything include health care costs in one way or another.
If you are old enough to be on Medicare, you still pay a lot of money. For me, that’s well over $3,000 a year for Medicare’s premium and deductible, the premium on a “Medigap” policy to cover amounts that Medicare doesn’t, and the cost of a prescription drug plan.
The federal government is rapidly turning Medicare over to commercial interests — middlemen — through both the Medicare Advantage option and the new “direct contracting entity” program.
Medicare Advantage is increasingly popular because the commercial insurers often have lower premiums, which they make up for by restricting your care and overcharging Medicare, bleeding the Medicare trust fund.
The direct contracting entity program will likely do the same because adding middlemen has to increase costs, decrease care, or both. It has to.
Here in Vermont, we’re several years into a health care “reform” called the “All-Payer Model,” which uses an “Accountable Care Organization” to distribute health insurance payments to doctors. If that sounds like a complicated middleman, it is.
This effort has, to date, produced no real cost savings, while soaking up many millions of tax dollars. People still have to pay their insurance premiums, deductibles and co-pays, and the all-payer model does not — was not even intended to — provide coverage for anyone.
And while Vermont remains committed to this reform, accountable care organizations are reportedly declining in popularity overall, in part because the large entities behind them are finding it more lucrative to sell their own Medicare Advantage policies.
Note that the University of Vermont Medical Center, which runs our accountable care organization, has recently partnered with the commercial insurer MVP to sell Medicare Advantage policies.
UVM Medical Center continues to expand its reach and the number of independent doctor practices continues to shrink. As insurers and others with a commercial interest in keeping this Byzantine system going work overtime to scare people away from the supposed horrors of a “single-payer” health care system, we are instead sliding toward a “single-provider” system.
Private equity firms tripled their investments in health care in recent years and reportedly now own a quarter or more of the hospitals in the U.S. They seek profit and dump “investments” they deem insufficiently profitable without concern for the impact that dumping has on people. Ambulance services owned by private equity firms have already been shown to charge higher prices and simply discontinue unprofitable services.
Over 900 companies sell health insurance in the U.S., offering thousands of different policies. A horde of additional health insurance programs are offered by the federal and state governments. This complexity and fragmentation is a major reason that, in 2019, out of every 17 health care workers, only one was a doctor, six others cared for patients as nurses, aides, etc., but 10 performed purely administrative functions.
U.S. health care spending in 2020 topped $4 trillion, accounting for just under 20% of our entire GDP. Spending in Vermont alone was $6.5 billion in 2019. Is it any wonder that more than 1.4 million Americans traveled to other countries for health care in 2017?
Every aspect of our current health care system is failing. It’s obvious to me that this failure is the result of the corruption of health care’s fundamental purpose of ensuring that people who need medical care can get that care. Our current system’s purpose seems to be largely the protection and perpetuation of the system for the benefit of those who profit from it.
This is an emergency. If we do not have the courage to address it, we will all pay the price. Timidly poking at the edges of the flaming fire will never extinguish it. The most effective solution is a publicly funded single-payer plan.
