Health Policy Costs Us All

For more years than I can count, opponents of “socialized medicine” (i.e., single-payer, universal health insurance) justified that opposition by assuring us that we were “number One!” American healthcare was the best in the world, thanks to the innovation that was made possible by our refusal to extend that healthcare to everyone who needed it.

As the world got smaller, and more Americans traveled abroad, we began to realize that we really weren’t number one–that in fact, those global indices that ranked us somewhere around 37th or 39th were onto something.

More recently still, medical tourism became a thing (at least, pre-pandemic, when we weren’t shut out of healthier countries.) Americans are traveling to have procedures–and babies!–in places where the care is just as good or better, but much cheaper. 

There’s a reason so many reasonably well-educated, reasonably well-meaning middle-class Americans were so slow to recognize the gargantuan flaws in America’s patchwork approach to medical care–and for that matter, all social services. So long as we remain lucky and privileged, accessing health insurance through our employers, not getting a rare or terribly expensive disease, not having to navigate a system designed to say “not you,”  there’s simply no way we could imagine the experience of those who aren’t so lucky or privileged.

For years, I fell into that “lucky and privileged” category. But many years ago, when a diagnosis meant that my oldest son was unable to work, I encountered the Byzantine world of Social Security disability. At the time, it took two lawyers (me and my youngest son) and a friend who headed a social services agency to navigate the process.

When I asked my oldest’s then-doctor what happened to people without family lawyers and savvy friends, he said simply, “They die.” 

Just over a week ago, we got another lesson. My oldest grandson and his wife had a very premature baby. Born at just over 26 weeks, she is in the NICU, life-lined and hooked up to a tangle of machines and devices. My grandson and his wife take turns being with this much-desired little girl (and when I say “little,” she was one pound five ounces at birth, and about the size of my grandson’s hand.) The stress they are experiencing is etched on their faces.

In addition to the helplessness we feel watching this unfold, the whole family has worried about costs that their insurance won’t cover. If there is anything they don’t need,  especially right now, it’s thousands of dollars in out-of-pocket expenses. My granddaughter-in-law’s sister was so worried she set up a Go Fund Me page, something that wouldn’t be needed–or even comprehensible–in “socialized medicine” countries. (I have a son who lives in the Netherlands and an adult granddaughter who lives in England, and both sing the praises of their healthcare systems.)

We were relieved–and surprised– to learn that there are government programs that  provide at least some measure of secondary insurance in these situations. It’s just that no one in our (reasonably well-educated) family knew they existed until now. And I’d be willing to wager that, unless you are a social services or health insurance worker, those of you reading this haven’t heard of them either.

There is an important public policy lesson here–not to mention a lesson about equity.

This country spends far more than any other country in the world on medical care–twice as much per capita as the next most expensive country. (But hey–“We’re number 37!”)  That includes significant amounts on a patchwork of low-profile programs that help eligible people who manage to find out about them, and still more on the bureaucracy that serves as a “gateway” to those programs.

Think how much we could save if we replaced that haphazard patchwork of complicated and under-inclusive programs with some version of Medicare-for-All. Of course, a simple, single-payer health insurance system with a common and comprehensible “entry point” would serve all citizens, not just empowered ones–maybe that’s why we don’t have one.

There is some evidence that American voters are beginning to catch on.  In a recent column for the Washington Post, E.J. Dionne wrote:

No matter how hard they tried, Republican politicians and their allies could not stop Missouri’s voters from expanding access to Medicaid under the Affordable Care Act.
They tried to rig the timing of the referendum by forcing the vote during a relatively low-turnout primary on Tuesday rather than in November. That failed. They played on racial prejudice and nativism by falsely claiming a yes vote would mean “illegal immigrants flooding Missouri hospitals . . . while we pay for it!” That failed, too.
And so did Missouri this week become the sixth state since 2017 — five of them staunchly Republican — where voters took the decision on the expansion of health coverage out of the hands of recalcitrant conservative politicians.

You shouldn’t have to have a social work degree (or a friend with one) in order to access government insurance against calamity.

And Republicans should stop kidding themselves–calamities don’t just happen to “those people.”


  1. Copied and pasted from a Salon article; “…Believe it or not, the downfall of the American health insurance system falls squarely on the shoulders of former President Richard M. Nixon.
    In 1973, Nixon did a personal favor for his friend and campaign financier, Edgar Kaiser, then president and chairman of Kaiser-Permanente. Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be. And which insurance company got the first taste of federal subsidies to implement HMOA73 … *gasp* … why, it was Kaiser-Permanente! What are the odds?”

    In 1973 the world was concentrating on Nixon and Watergate; the perfect time to slip through his Health Maintenance Organization Act to overfull Edgar Kaiser’s coffers to ensure Kaiser’s continuing reelection donations, which brought us to where we are today. Forty-Seven years later we are trying to undo this horrendous Act overnight without first finding a way to undo the billionaire corporate health care control sucking this nation dry. Of course, most people do not know about those government agencies to go to for help; they are buried under tons of other government issues in obscure bills and laws passed during the past forty-seven years. No statistics on the number of people without family lawyers and savvy friends who have suffered and died but the majority are the uneducated in civic and civil rights, low-income and minorities.

    Are those organization still in place today? Are they available for those who cannot get tested let alone treated if they were diagnosed with Covid-19 today? WHERE ARE THEY? How do those suffering with other major illnesses, or those pesky “pre-existing” conditions, find their/our way to them for help? Medicare-for-all or single-payer health care is a thing of the distant future; millions need help now, NOT promises that better times are a-comin’ if you vote right.

    One of the highest costs of this current “health care” system is the cost of funerals today.

  2. Shelia, Happy to celebrate the newborn, sorry to hear of her premature birth. Hoping she pulls through.

  3. While it’s wonderful that Missouri passed their Medicaid bill, it should be noted that almost all rural counties rejected it. If it weren’t for the educated urban areas, this would not have passed. The deep rooted Republican ideology is still alive and well in much of America, especially the south (of which I live).

  4. Bernie, et al, have promoted single payer. Didn’t Harry Truman of Missouri and without a college degree, I think, propose it? How did meanness infect the DNA of Republicans and conservative Democrats? How are they blind to a better plan that is cheaper? I often think of Burl Ive’s character in “Cat on a Hot Tin Roof” spitting out “mendacity, mendacity.”

  5. Due to campaign donations from Big Pharma and Insurance, neither party will serve the people in this country. Look at who Eli Lilly donates money to — both parties equally.

    Neither the DNC nor GOP supports single-payer health insurance because they receive monie$ to avoid the conversation. It’s also why the first COVID-19 rescue bill tossed billions toward Big Pharma after their lobbyists wrote the bill allowing them unlimited profits from tests and vaccines.

    It’s just another capitalist racket.

    The politician’s idea of cost-control is cutting out programs as opposed to single-payer, where the government is the only purchaser of goods and services and can set prices.

    And guess who else supports our for-profit healthcare system of inequality?

    The mass media giants or other profit whores. Big Pharma spends a fortune on ads in print and on TV. And, as I’ve mentioned before, Big Media profits from campaign spending, so they support Citizens United.

    Our economic system should be called a “trickle-up” Ponzi scheme; money moves from consumers/citizens flowing into the upper layers of the Oligarchic hierarchy. Imagine a giant vacuum over local communities throughout the U.S.

    It also makes one wonder if lawyers don’t approve of such social inequalities or injustices because they also profit from the sick, perverted system. I am sure bankruptcy attorneys will see plenty of business during and post-pandemic if there is such a thing.

    You have to love a country where all the “institutions” support profiting off the sick, weak, and ignorant.

  6. I anticipate the coming of stories in the news about the high cost of time spent in ICUs for recovery from Covid, and the outrage of insurance coverage shortfalls, price-gouging and unexpected billing from hospitals, services that are billed as “out of coverage”, etc. Maybe this time Americans will finally see that health care services are not appropriate for a for-profit model.

  7. I believe we will see single payer in this country within the next decade. Hope the baby is okay.

  8. Yeah Sheila, me too! To see a baby hooked up to machines looking like a bank of the videogame consoles, not only does it make you reflect, it causes great angst and grief. The same happened with my granddaughter 11 years ago, it does make one feel very helpless. But, she’s a big beautiful young lady now and an artist who is extremely talented, and because of this coronavirus she gets to spend a lot of time practicing, SMH!

    But hey, we have to get our priorities straight! While We whine about healthcare, our president wants to get his likeness chiseled into Mount Rushmore! Priorities priorities priorities.

    When you can keep people fighting for healthcare, when you can paralyze individuals from making rational decisions because of fear of losing at all, when you can control how much a person can eat, whether a person can actually attend a school that is funded let alone has an adequate curriculum, and the aforementioned healthcare, affordable housing, access to life-saving medications and simple checkups, those folks are so busy trying to just live, they very rarely take part in political issues. So, the plan works to perfection, the majority tends to be disenfranchised because of trying to live, they tend to hope that the more fortunate have enough compassion and empathy to consider them when they’re casting their ballot. That usually doesn’t happen.

    The Gulf’s wider between the haves and the have-nots, but as society or rock from the head, more of the privileged start to slide into that underprivileged category. Kind of forced to walk in someone else’s shoes. You tend to realize how little life is worth in this country, especially compared to a lot of the Nordic countries, it makes no sense and it’s shameful.

    When folks have to worry about being gunned down in the streets to even walk to the store let alone cast a ballot, you have already lost morally, when so many have no hope, there can be no social cohesion! Case in point, here in Chicago, because of the police shooting a man with a gun, the night was full of rioting and looting. And, where is BLM? The downtown is shut down with all of the bridges in the up position. Large swaths gutted by the organized looters. I think POTUS needs to have his image placed on a milk carton rather than Mount Rushmore, he is missing in action!

    This pandemic issue is driving complete insanity on all sides, can you imagine if Barack Obama was president during this time? They’d be looking for a rope.

  9. JoAnn,
    The Salon article has some glaring inaccuracies. I have no love of Nixon; his name was on my draft notice (along with a cheering “greetings”) but he is not responsible for the for-profit nature of the health insurance industry. Kaiser-Permanente was and is a not-for-profit organization. The Kaiser organization did not make money from it. All of the initial HMOs were not-for-profit. They did not begin to convert to for-profit status until the 1980s, long after Nixon had moved on.

  10. I would only suggest that it’s a “crony-capitalist” racket and that there is still room for capitalism in the health-care supply-chain. Markets work best when there are many sellers and many buyers and the latter have access to and understand all relevant information to make reasoned purchases. So a procurement specialist in a hospital purchasing Equipment & supplies can still work.

    But in most cases the patient and their loved ones do not have that information so the primary market cannot function – this being one central argument for single-payor. The other being that the overall health of our communities is a public good that depends on everyone having access to it regardless of their ability to pay (or if they’re working).

    A truly socialized healthcare system goes another step further where a government agency is the employer of all health care workers. I don’t see the real benefits of going that far – too many decisions for any bureaucracy to keep up with and in an environment that will constantly change. But on the single-payor side, the number of decisions a bureaucracy makes must be dramatically reduced. It cannot decide how much a hospital should be reimbursed for cotton swabs. It should decide how much health-care providers should be reimburse for providing a years with of general health care services, and then lump sums for treatment programs to deal with treatment programs for chronic illnesses or traumatic injuries.

    Prayers for the teeny one’s continue progress towards a healthy rich life on Earth.

  11. We don’t have health care; we have a for-profit medical industry. We need to call it what it is and stop saying “health care.” It’s all about maximizing profits and making sure we all pay for it, whether via insurance premiums or taxes – either way the corporations vacuum up the money. Until we shift everything to real Health as our central value, instead of ” wealth” (meaning monetary profit not real wealth), everything will keep getting worse. Sweden has done this: Health is now at the center of ALL policy decisions.

  12. Biden WANTS to expand the FOR PROFIT health care system of the ACA, i.e.e “fix it.” How in the hell does one “fix” a for-profit machine? That’s a joke. No thanks. Another example of Obama who turned his back on people suffering and not able to afford outrageous premiums, out of pocket, and let the for-profit Health Insurance folk and their lawyers write the bill!!! (smh)

    Capitalism is a FOR PROFIT SYSTEM. Period. I think it was Halderman and Nixon who came up with the brilliant idea of privatizing health care so as to make them (theoretically) compete and be cheaper for the customer! Yup. Good old supply and demand. Puke!!!

    A sibling of mine went bankrupt 30 years ago over in-payable hospital bills. 30 years ago! This whole exploitive system of health care has been ravaging people and families for decades. I saw that up close as a hospital chaplain. Obscene. Bankruptcy, because of health care cost, was (and I think still is) the #1 reason citizens have to file for bankruptcy in America, land of the free, home of the brave. Ha. Capitalism has a way of freeing a person from their labor wages and make them brave the cold-hearted profit-monsters of this country. Enough is enough!!!

  13. I am very glad I am now retired from health care. I graduated from nursing school in 1974 when insurance companies still paid for treatment. When I became a substance use counselor, I spent too much time trying to get extensions on coverage. It was obvious there was system stigma against people with mental health and addictions disorders.

    I wonder how much money is spent on marketing by health care systems in other countries.

    It is also obvious to me that the free markets in health care have lead to large hospitals buying out the small rural hospitals. Health care in rural America is increasingly scarce.

    The other thing that is evident to me is that our public health infrastructure has been markedly weakened over time. We need programs that motivate people to stay healthy. We need better “health” education. As they say, an ounce of prevention is worth a pound of cure. People living in poverty, on food stamps are not able to afford healthier food which leads to obesity and diabetes.

    When it comes to OB care in the US, the stats compared to other first world nations are disturbing. Other nations use midwives much more than we do with better success.

    I hope your great grand daughter is soon out of NICU and on her way home. Please keep us informed on her progress, Shiela.

  14. Our preemie grandson (now a healthy six year old) was a quarter of a million dollar baby before he was a year old. How glad I am for a) modern medicine and b) to know that the Affordable Care Act gives him a reprieve from life-time caps on medical care.

    Several summers ago, our neighbors traveled to Spain for a wedding. One of their young adult sons suffered an injury to his arm that required an emergency room visit on a Saturday night, x-rays, stitches, a splint and some antibiotics. Since they were not residents, they were advised they would need to pay for his care by cash or credit card. At the risk of being nosy, I asked if they would be willing to share how much they had to pay. I had a pretty good idea of what that would cost in the U.S. They obliged. It was around $200. You couldn’t have walked in to an ER in the U.S. for that. Your deductible alone would have been at least that – and probably more.

  15. I am glad that the discussion has included comments on the health care industry. As a recent patient for two (minor) surgeries, one in-patient and one outpatient, I have been lifted out of my bubble and allowed to see how big hospitals have become and how rampant the poor communication and lack of focus on the patient have become. From laying on a gurney in the ICU for hours waiting for a room, to having the surgeon not show up for my surgery because of a mixup in scheduling, to waiting two hours for even the simplest of requests (please unhook me from my IV so that I can use the bathroom)–I discovered first-hand how health care has become so very hyper-organized and dysfunctional. While I am grateful that my condition was treated and admiring of some of the professionals who treated me, I am convinced that our whole system needs drastic reform. And now, seeing the “explanation of benefits” notices from my insurer and realizing that people without insurance are paying outrageous amounts while my insurer pays a very small percentage and I pay only a pittance, I understand even more how dire this situation is and how we must remedy it, at the root of the way we organize healthcare and along the branches with how we pay for it and make it available to all.

  16. I will echo Carol Johnston’s statement.

    We do not have a health care system. We have a Health Care Industry.

    I worked for 25 years for a local hospital and my wife worked 40 years at the same hospital, in the IT department on billing. We know many of the ins and outs of this industry.

    I was lucky enough to retire early but the one big downside is having to pay for my own heath insurance to the tune of $800 a month for crappy coverage. If I travel in the US, outside of about a 4 state region I have to pay extra for a Travel Health Insurance policy.

    I am now self pay for dental. I am not sure why the US does not understand having bad teeth might effect you health. At some point people might wake up to the fact that having health insurance tied to your job does not always work. The alternative means financial ruin and maybe even death.

    Patrick Wiltshire, I will say that “competition” in the health care market does not work. About 5 blocks from house, The major hospital chain has just announced they are building a new $1.2 billion hospital on 44 acres of newly acquired land. This “not-for-profit” hospital will no longer pay property taxes on this newly acquired land. A benefit they received because they were supposed to provided charity care in the community. I doubt the amount of charity care adds up to 1/2% of their annual revenue, which is in the billions of dollars. They are building this new hospital across the street from the 600 bed hospital that was built in the mid 90’s, so the old building is less than 25 years old. I suspect that the old buildings they are replacing will not be torn down and the land will not be sold. So my whole point is that we are overbuilding hospitals because of “competition”.

    Competition does not work when it comes to MRI’s either or other large equipment like that. If you are going to get $600 for an MRI, every Tom Dick and Harry radiologist group runs out and buys a machine hoping to suck some of that money away from the established players and in most cases they succeed because they are strip mall operations where as an overweight American with health problems, god forbid, you have to walk more than 50 feet from your car to get service. The machines in the hospitals then go under utilized and they have to subsidize the cost by over charging for something else, or they don’t upgraded. That vicious cycle is just fodder for the competition is good argument.

    Because part of our health care industry is paid for by the government (Medicare and Medicaid), people realized there need to be some regulation, but again, with some many big companies lobbying in Washington for their slice of the pie, and our inability to agree on a solution, we have this huge complicated mess, that we are finding out leaves too many people on the outside looking in.

    Fear of losing your health insurance is a powerful influence and every politician is going to try their hardest to push that button if it means they stay in power.

  17. RN here–I have worked in Cardio-thoracic step down units, the health dept for a stint, an autism and child and adolescent psychiatry outpt clinic, when I moved to Nashville and could not get a job I got a job with Blue Cross’s Medicaid contract group (did that for 8 months and sooooo glad I got out) and now at Vanderbilt working in a geriatric psychiatry clinic and their dementia/Alzheimer outpatient clinic.

    Our healthcare system is horrific. It is all about insurance and insurance dictates care and not the MD. I have only worked at nonprofit, academic medicine clinics and often times it is research that keeps us afloat.

    What drives me nuts is that a MRI can cost $1000, but if you have insurance insurance will negotiate it down to where you may pay $200 out of pocket and they pay $200 and so that $1000 procedure is now $400. If you have no insurance, you are expected to pay the $1000.

    I asked when I worked at a clinic with a 1.5 year wait list why were we going to accept co-payments from Anthem that were less than what medicaid was going to pay for a doctors appt and the response was…well, if you join an insurance group they send all their people to you. I am like…we have a 1.5 year wait list and the only gig in the state. I think we have negotiating power.

    I fought two Indiana contracted medicaid companies who lost their contracts from my interventions (I know this because the CFO of one of them contacted me and gave me their personal cell number and begged I did not contact the state.)because of what I saw were intentional roadblocks to care, like taking up to 2 weeks to approve a medication for a child and their rationale for denying the medication was on faulty research and crap medicine. Then I worked for Blue Cross and their constant focus was on profit. I am convinced that insurance is intentionally cumbersome in the hopes people just accept what they(insurance) is telling them, that you do not fight like tooth and nail thus paying for things that more than likely you do not owe.

    There is no such thing as an informed consumer because you will not be able to get a straight answer on costs because nobody can really give you that as it is all based on what type of insurance you have and where do you work and, etc…etc…

    We have to get rid of this for-profit system. It is literally killing us. My PCP up north said she could not afford to hire nurses to give the best care to the patients, instead she had to hire more utilization review folks to chase down the dollars that insurance owed her–they lose papers consistently, state they never got forms returned, or the code was not right or…..they create pitfalls to keep from paying. There is a reason some MD’s are leaving big hospitals and associated doctor groups because many will not deal with insurance companies they expect the patient to do it so that they can focus on patient care.

    I can go on and on but I have prior authorizations for Medicare to reject.

  18. Debt collectors buy unpaid hospital bills then go after the debtors with a vengeance. I can’t imagine coming out of hospital after serious condition & then be subjected to the ruthless harassment of the collectors. Also funding to nursing homes is just enough to give elderly/invalids just adequate basic care with enough trained staff. Business people taking that funding for personal/other business expenses is beyond egregious. The deleterious effect on the lives of those vulnerable people & their caretakers is miserable. I can’t believe that these practices are allowed in US!

  19. Free markets have only the potential to serve all stakeholders like consumers, workers, supply chain partners, investors, communities, and future humans in terms of the environment that we leave them. Several other conditions must be in place to realize any benefit. Among them are, first and foremost, competition which is not possible in the healthcare industry. Can you imagine getting bids for NICU care from competing hospitals or selecting the cheapest surgeon for cardiac surgery? Another is regulation even if, as it is for most regulation, after some corporation has invented a new way to screw some of their stakeholders to the benefit of others. Still another is progressive taxes in order to redistribute back some of the wealth that capitalism only distributes up.

    Capitalist health care has only been made to appear beneficial by the invention of capitalist health care insurance paid for by capitalist employers.

    No, free market health care and health care insurance has been a scam right from the very inception and never stood even a chance of benefiting consumers, patients, we the people.

    The only solution is socialized medicine like our VA provides only for veterans. Not even socialized health care insurance like Medicare and Medicaid and TriCare can save us from the economic ravages of pretend competition.

  20. Shelia – Good luck to you and yours and their premature girl. Good things can happen.
    The guy who gave us the EPA and who intoned that “We are all Keyenesians now” also gave us Watergate and his (allegedly) non-profit Kaiser buddies a government approved health profit system. This was a mistake that has cost us billions if not trillions, and for what? An overpriced system that is eating up our disposable income and that isn’t working and can’t work. When I was in Sweden in 1975 this act was only two years old and we hadn’t had time to see just how bad it was going to be, but we certainly know now, and yet we keep this profit machine in place. Why? See Todd’s piece.
    I once engaged in an argument with an MD in Grand Rapids, Michigan, about single payer and he said he had no objection to it except for all the office help it would put out of work. He was referring to his clerks who daily navigate through the insurance company labyrinth of fine print (and whose salaries we pay as medical costs, salaries we wouldn’t have to pay with single payer). I have three nephews who are MDs, two of whom are for single payer. All complain of clerical costs and insurance companies except one, and perhaps understandably, since he is vice president of his state’s Blue Cross. See Todd.

    It is not just the bad ol’ insurance companies that are keeping us from installing single payer healthcare coverage; also implicated are the politicians who for one reason or another (usually campaign contributions) keep the damper on its adoption. The industry has framed single payer as “socialized medicine.” I for one don’t care if it is communized medicine; I’m not into adjectives. My only criterion is Does it work? and we have seen that it does, not only in terms of quantity but quality as well, and at far less cost. Right now is a good time to actively agitate for its adoption with millions of the formerly comfortable who depend upon employer insurance unemployed, uninsured, and one cancer away from losing their homes etc., so let’s get on President Biden’s case from the get-go.

  21. Rick Scott, a Florida Senator whose net worth exceeds $150 million, acquired his wealth as a CEO of health care companies that defrauded medicare and medicaid. His contribution to medical care was to manage people who shuffled paperwork and in the process, denied coverage as much as possible. It’s miraculous to me that anyone would believe he or his ilk had anything to do with making American healthcare better.

    Forgetting the commonality of greed, graft and corruption, how could anyone buy into the notion that allowing a sizable portion of America’s medical care budget to go into profits for corporate executives leads to better or more affordable care? Even a poorly run single-payer bureaucracy would do better.

    As a nation, we are so pathetically naive that we invite greedy people to fleece us and reward them handsomely for their efforts. Next thing you know, we might even start denying science.

    American exceptionalism describes our almost unique willingness to surrender our hard-earned wages to snake oil salesmen in an astonishing number of critical areas of our lives as consumers.

  22. Emergency insurance offered by the state of Indiana; easy to say!

    Several years ago, I was insured under a company plan…until the Insurance company dropped the company. Then I found that I and my son were no longer insurable. Why. Because we were blackballed as part of a larger black ball levied against that company AND, by association, all their employees.

    No problem: The nice state of Indiana has a plan for just such circumstances. Did they ever! “Sure, Mr. Kaiser, and here’s the good news: it only costs $2000-a-month.” That was in 1979 when my yearly income was about $8000. Six years later, I found a private insurer who would insure me at a reasonable price. I doubt if things are much better for Hoosiers now.

  23. Robin Riebsomer and Elaine, the two medical professionals who have posted, my mom is on Medicare and says 90% of her lifetime medical expenses have occurred since she’s been 65+. Only 10% of her medical costs occurred during her 0-65 lifetime.

    In your experience, is that a typical ratio of lifetime medical costs — 90% occurring after age 65 and on Medicare?

    If that is true, then adding the age group 0-65 (i.e. Medicare for all — MFA) to Medicare coverage will add only 11% (10% divided by 90%) to the present cost of Medicare. If, in the transition to MFA, Medicare is allowed to subject drug manufacturers to competition, similar to that allowed by the VA, the drug cost saving could exceed 11%, thus enabling the switch to MFA at no net increase in Medicare cost.

    Robin Riebsomer and Elaine, does that argument sound reasonable?

  24. With thoughtful concern regarding you great-granddaughter. I hope your great grand daughter gains weight and strength and is soon out of the NICU and on her way home.

    The health care situation here in the U.S. is particularly abysmal for those with little or no insurance. One can’t help but notice, especially since the pandemic lockdown situation, that the folks here in the U.S. are getting more like folks in Mexico, who often have an aversion to going to a hospital for care. From discussions with my Canadian relatives, and some personal experience, the costs and availability are better there. It amazes me to see the higher amount charged for a medical service to someone without insurance coverage, as shown on insurance explanations of benefits. While no system is ever perfect, we must do better. Healthcare for outrageous profit is obscene. We’ve got to loose our attitude that the U.S. healthcare system is the best in the world. It can be the best; it just isn’t. We need to be in a country where one doesn’t fear getting medical care because of the cost. Some doctors and hospitals turn away patients without insurance coverage. I recall a personal situation in the past having to hunt down a doctor that would take a self-paying patient, even flashing cash couldn’t get a doctor’s office appointment without it. The medical professions mantra of ‘do no harm’, does not mean do nothing, turn away, or do less based on an individual’s ability to pay. Bankrupting a family to pay medical bills only adds another tear in the fabric of this country. We should want better than this.

  25. When my oldest son was in high school, a fellow student got pregnant. Nine months later, she, with her new husband, aged 18, had a difficult delivery of a sick and deformed child. The child was hospitalized for months. By the time, the two teen parents took their child home, they were in debt over a million dollars, locked into a lifelong a economic calamity that would be impossible in single payer countries.

    We’re Number One alright.

  26. Inexcusable in the land of the free etc..Retired Canadian physician! Treated everybody thatcame through the door!

  27. I understand the bitter resistance of the Right Wing Republican Party. It is the Democrats who oppose Single Payer or Universal Health Care that is mind numbing. Joe Donnelly was a great example of a Corporate Democrat. There was campaign ad Donnelly ran reads as follows:

    When the ad’s narrator said “socialists want to turn health care over to the government,” Donnelly responded, “Over my dead body.” The nearly 30-second spot also criticized “extremes on the left and right” for advocating for cuts to defense spending.

    Well Joe we have a lot of dead bodies now and as others have noted those medical bills have to paid.

    It is surprising in a way more companies are not demanding Single Payer or Universal Health Care, they would lose all the expense of looking for a health care insurance company. Trying to keep costs down results in high deductibles for the employees.

    I doubt the McMega-Media will report on the astronomical costs people hospitalized with Corona will have. As others here have noted the McMega-Media makes a ton of money airing ads for drugs. The corporate answer will be another bailout this time to the health care vultures.

  28. Pete, you’re right about the VA medical care system being an excellent model on which to base an American single pay medical care system.

    I’ve used the VA hospital in Indy and in Florida for about 30 years. Every time I have an appointment or a procedure, I am amazed…about several things, not just the care.

    No paperwork. No pinning me down on data they might need to make a debt collector’s job easy. No wait time. Always no wait, never more than ten minutes. Effeciency. Dedication. Not one employee is in the business to become a millionaire. Meds arrive by mail, never late, unless I was late making the order. Teamwork among staff and doctors. Absense of expensive frills. Absense of staff kissing my ass to make sure I use their service again instead of just doing their job. Accountability: staff has bosses whose effeciency reports depend on results instead of profits, reminds me of my officer days in the army. No unneeded procedures, because VA people get no kickbacks from referrals. Respect for patients and equality of treatment is much greater in the VA.

    On effeciency: visit a local large private for profit hospital and make note of how few people are traversing the halls and entering and leaving. Then visit the Indianapolis VA hospital and note the same thing; it’s busy; like going to the Indiana State Fair, a thousand people in the halls. The VA hospital in Indy likely treats (on time every time) twenty times the number of patients in a day as do for profit hospitals. And I predict at a much lower per-patient cost. The VA is also really proactive in regard to preventative health. They can afford to think longterm.

    I would not go to war for any other American entity; not for its school system; not for its consumer economy, not for its social adhesion, not for its religions, not for its natural resources; but I would fight for its VA healthcare system.

  29. I agree with Pete, and Larry Kaiser, “… VA medical care system being an excellent model on which to base an American single pay medical care system.”

  30. Calamity! My child had a brain tumor. Thank goodness for California Children’s Service which absorbs the brunt of Catastrophic Pediatric Illness costs. Nevertheless, twice I was forced to take his insurance to court in order to have lifesaving medications covered. Not an easy process for a mom with no legal training. Two victories say more about the disdain Big Insurance has for their clients than my self-training in law – they sent a lowly clerk to handle both cases. The primary job of everyone in the insurance industry is to find a way to deny coverage. I’m frankly surprised we rank in the top 100 countries for medical care.

  31. Oh…. Did I mention that the entire US Health Care Industry uses FAX machines??? A 1980’s technology!

  32. Gordon–I think it sounds reasonable. I have a few Medicare pts where we have had to tell them to use the GoodRx program (I want to know who or how this program works and who is paying for it) as some of their medicines cost $600 per month with Medicare but using GoodRX it will cost around $80 per month.

    I may have to answer at least 30 questions on a Medicare form–I was so ticked off with one last year as a pt had been on this medicine for 20 years and she is 91 and I was having to do a prior authorization and insurance denied it. Denying meds is fairly common and so often appeals has to be done–I submitted an appeals and it still got denied and so I called–I asked what medicine would you like us to start on a 91 year old woman?!! I asked what part of being on this medicine and doing well for 20 years do you not understand and since in my opinion you are dictating care what medicine would you like her to be on? They approved her medicine but I know there are not alot of people who will fight on this matter just because there is no time because in healthcare there is a shortage and there is a shortage in nurses at all levels.

    We need to negotiate medicine costs but not until we get money out of politics.

  33. How does the country with the “best health care in the world” have the most COVID-19 cases and deaths?

  34. I have a couple comments to make…

    First, I listened to an interview with a book author a couple of years ago about his book on the US medical system. He related a story where he interviewed one southern white man suffering from cancer. The man could not afford health insurance. The author asked at one point why the man wasn’t in favor of universal health care. The answer was that he didn’t want minorities and immigrants to get health care. By the time the book was published a year later, the man had died from his cancer. So, answer = racism. As usual.

    Second, I am Canadian. Our health care system is a hybrid. It offers basic coverage for most things, and extended health packages (insurance packages but highly regulated such that the insurance companies can only charge so much for the pieces) cover things like glasses, dental, etc. Shortly after birth, every person gets their “care card” which is an ID representing them in the system. When we go to the doctor or hospital, we just present the card, and get care. We never even see a bill. I have no idea what things cost, and I don’t care to know. Our system can certainly be improved, but I wouldn’t trade it for the US system for anything. I worry about my family becoming ill, but not about them receiving care. (Examples: My wife is now 12 years free of cancer, after lots of diagnostics, specialists, radiation, chemo, multiple surgeries, etc. My kids have all had their share of maladies and broken bones and normal kid stuff, too. I’ve had broken bones, and stomach and heart issues, and a tumour removed, etc. If something feels wrong or causes us concern, we go in and have it looked at. We’re proactive. And, again, we’ve never seen a bill for any of this.)

    We’ve had experiences with my son as a toddler in other countries. In the UK, he swallowed a 20-pence piece and it lodged in his throat and he began choking and frothing up bile. We needed an ambulance, emergency visit, x-rays, and a surgical team. Because he was put under and taken up to the operating room, he was assigned a room. Even though we weren’t UK citizens, the only thing we had to pay for was the room. All the rest was covered by the UK system. We owed $700 CDN.

    In Hawaii, he developed a high fever on the second day there. It spiked up to 104 a couple different times (in the middle of the night, of course), and each time we took him in to emergency. In one ER visit, they did an x-ray. In the other, they did a blood test. They didn’t figure out what was wrong, but told us it was likely an infection and we should see a local doctor during the day. (The local doctor was excellent, by the way.) The two useless ER visits cost $4500 CDN.

    Happily, we didn’t have to pay for either of them because they were covered by our Canadian system. (In the UK, actually, the hospital phoned to Canada and got the payment worked out right away. That didn’t happen in Hawaii, of course. We had to get reimbursed later.)

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