Editor’s note: This commentary is by Lee Russ, of Bennington, who is a retired legal editor and freelance writer.
[W]e all know that the U.S. spends far more on health care than any other country. The medical Journal JAMA reported that the U.S. spent $2.1 trillion to diagnose and treat health problems in 2013, a year in which global GDP was $75.47 trillion — our health care spending amounted to 2.8 percent of the planet’s total GDP. And that doesn’t count the costs associated with things other than “diagnosis and treatment,” like insurance company profits and administrative costs.
What do we get for that absurdly large amount of money? Well, the 2019 edition of the Bloomberg Healthiest Country Index ranks the U.S. 35th out of the 169 countries considered. Canada ranks 16th; Cuba 30th. The ranking is of overall health, not health care specifically, but it’s right in line with a depressing number of reports that do focus on health care and consistently find the U.S. lags behind most other wealthy countries in quality of health care despite spending an appreciable portion of the planet’s GDP on it.
All those countries ranked ahead of us have a commonsense system of universal health care. Everyone can get health care when they need it, whatever their income and however sick they might be. They don’t have to file for bankruptcy because they have the misfortune of getting really sick.
Nor do they stay up nights juggling bills in order to pay for the health care they need, like so many Vermonters do. Vermont’s 2018 Vermont Household Health Insurance Survey reports that more than a third of Vermonters under 65 are “underinsured.” They have health insurance that does not cover their medical needs because of, for example, high deductibles, co-pays, or exclusions from coverage. These Vermonters — more than 100,000 by my crude estimate — are the ones juggling all those bills in the middle of the night. They are the ones who often get sicker because they try to avoid going to the doctor to save money. They are the ones who sometimes die because of the delay in getting care.
Where does all that health care money go? Most people don’t realize how much money we pour down the sewer of administrative costs which does nothing to improve our health. Medical offices in the U.S. drown in insurance paperwork; in Canada, with single payer, they don’t. A Commonwealth Fund study reported that Ontario doctors’ offices spent 2.5 hours per week per doctor on administrative tasks related to health plans. In the U.S., that figure was 20.6 hours. For a four-doctor office, that’s 10 hours in Canada, 82 hours in the U.S. — 72 hours a week sliding into the sewer of commercial insurance complexity. Imagine what the excess spending is when you take all U.S. doctors into account.
The same phenomenon occurs in every hospital. At Lyndon State College in 2011 Antonia Maioni from Montreal’s McGill University presented a talk about the Canadian health care system. I watched the event online and have never forgotten her comparison of the billing operation in a small U.S. hospital to the same operation in a much larger Canadian hospital. In the American hospital, billing took up an entire wing of the facility. In the Canadian hospital, billing was in a single room with a few desks.
There are indicators that our already terrible system will actually get worse. The medical journal JAMA reports that “private equity” firms are buying up increasing numbers of medical practices, hospitals, etc. If you know anything about private equity firms and how they run the businesses they buy, that should give you chills. When the owners of a medical facility are laser focused on driving up revenue and driving down costs in order to improve return on investment, what kind of care you can expect? Imagine going to a hospital owned by a private equity firm headed by Mitt Romney.
Monumentally high costs, a large portion of which go to administering the system, rather than providing health care. Mediocre results despite the monumentally high costs. You might wonder why we have stuck with this system for so long when so many are ill-served by it. Wonder no more: It’s because some very, very rich and powerful people are getting rich off the system and have no intention of losing that source of riches.
Recent talk of “Medicare for All,” and polls showing increasing public support for it, scared these people enough that they banded together to, according to Becker’s Hospital Review: “… influence Democrats during the midterms to stay more moderate on healthcare and focus on bolstering the ACA, rather than promoting single-payer plans … [and, further] to temper messaging and stunt the growing popularity of Medicare for All so that it doesn’t become part of the Democratic Party platform in 2020.” This coalition of people who get rich off our broken system calls itself the Partnership for America’s Health Care Future, and it includes, among others, America’s Health Insurance Plans (the association of health insurers), the Pharmaceutical Research and Manufacturers of America (the association of drug manufacturers), and the Blue Cross Blue Shield Association. Get ready for the slickly produced propaganda pieces trying to convince you — using the money you paid for insurance and drugs — that the health care systems that perform so much better than ours all over the developed world is “unrealistic” and “dangerous?”
Isn’t it finally time for us to wise up? What is unrealistic and dangerous is the system we have now.
