Health Care One More Time

Republicans love to accuse government of waste and fraud while pointedly ignoring waste and fraud in the private sector. (I always think of that biblical phrase about ignoring the beam in one’s own eye...if you want to talk about fraud, Senator Scott….).

That disconnect is particularly obvious when it comes to America’s incredibly wasteful insistence on private sector health care. Several years ago, I was on a university research team looking at certain aspects of Indiana’s health care environment. I no longer recall the outlines of our investigation, but I do still remember my shock at learning that–at that time–seventy percent of all American health care costs were being paid by some level of government.

It wasn’t just Medicare and Medicaid, or the CDC, or the numerous federal programs aimed at specific diseases. State and city governments support local hospitals for the indigent, and other local programs; more significantly, the millions of people in the U.S. who work for a government entity–universities, police and firefighters, schoolteachers, etc. etc.–have health insurance paid for by tax dollars.

What really blew my mind was the realization that the money government was already spending would be enough to cover almost all of the costs of a national health care system if we simply reduced the enormous amounts spent–wasted– on duplicative paperwork and insurance company marketing and overhead.

What made me think about that long-ago epiphany was an article from The Fulcrum sharing “shocking statistics” about American healthcare.

The first was the number of people on Medicaid. (Not Medicare–Medicaid.) Most of us think of publicly funded healthcare as something offered by Canada and countries in Europe, not the adamantly “private” U.S.

The shocking truth is that most of the U.S. population will soon be on some form of government-sponsored health insurance. Right now, 158 million Americans (nearly half of the nation’s 330 million population) are covered by a combination of Medicare, Medicaid and subsidized enrollment in the state and federal exchanges. Experts predict that percentage will climb.

Within that population is an even-more shocking statistic: According to the Centers for Medicare & Medicaid Services (CMS), enrollment in Medicaid surpassed 90 million in 2022.

This program, traditionally linked to a small population of Americans in poverty, will serve more than 100 million people in fiscal year 2023 (or 1 in 3 insured Americans). Since 2020, Medicaid enrollment has jumped 30% thanks to expansion programs in several more states under the Affordable Care Act and Covid-19 public health emergency funding.

The article highlighted several problematic consequences of that staggering figure, especially the difficulty experienced by enrollees in finding primary care doctors.

The second statistic concerned individuals who aren’t on either Medicare or Medicaid.

Since 2000, medical costs have risen each year by 4.85%, significantly outpacing the 2.85% annual increase in GDP.

With healthcare premiums rising at a faster rate than revenue, businesses have made up the difference by transferring the financial burden to employees in the form of high-deductible health plans.

In 2022, despite below average healthcare inflation, U.S. employees paid a shocking 10.4% more in out-of-pocket healthcare expenses than the year before.

Already, medical costs are the No. 1 cause of bankruptcies in the United States. If a recession ensues as many economists predict, millions more workers and families will suffer economic hardships.

Number three? Forty-eight percent of those eligible for Medicare choose Medicare Advantage.

“Traditional” Medicare, enacted by Congress in 1965, continues to use a fee-for-service reimbursement model—one that pays doctors and hospitals based on the quantity (rather than quality) of medical services they provide.

In 1997, Congress created an alternative program called Medicare Advantage (MA). Unlike traditional Medicare, this option is “capitated.” That means the federal government pays healthcare providers an annual, up-front fee based on the age and health status of the enrollees.

Supporters of MA say that capitation incentivizes doctors to keep patients healthy without over-treating and over-testing them.

However, there are some downsides. Although seniors enrolled in MA enjoy more predictable annual costs and added benefits such as eyeglass coverage, they have fewer choices when selecting doctors and hospitals.

I found that last observation interesting, since most people who oppose national healthcare insist that Americans value choice more highly than cost. Apparently, we don’t.

The article concludes by reminding readers that healthcare inflation has exceeded GDP growth for half a century. The U.S. spends more than twice as much as the next most expensive nation for health care, and the last time I looked, American healthcare was ranked 37th. Meanwhile, employers and families are increasingly finding the costs out of reach.

These statistics just confirm that ideology can kill. (If you doubt that, look at the disproportionate number of Republicans who died of COVID because they refused to be vaccinated.)

Clinging to the belief that we aren’t already “socialized”–and very inefficiently– costs all of us a lot of money.


  1. As a resident of Florida for over 50 years, I can attest to the criminal aspects of Rick Scott, former governor and current senator of our state. His dishonesty has certainly been surpassed by two other Florida politicians – Ron DeSantis and Donald Trump, but his abhorrence of humanitarian considerations should be legendary.

  2. Years ago, “60 Minutes” aired a program on how high health care costs were in Indianapolis. Driving around I-465, it became apparent that one could not drive longer than 10 minutes without seeing another health care facility on our beltway.

    60 Minutes detailed how excess capacity health was costing us money. If a private office offering MRIs didn’t have enough customers to pay for their expensive machinery to do MRI tests, of coure they had to charge more to pay for that expensive and often unused machinery. They had other examples of excess capacity causing doctors clinics to order more tests and test patients in more expensive tests to justify machninery treatment. I saw that at work when my elderly mother’s own doctor ordered repeated, unnecesary x-rays to avoid diagnozing a problem which our family dr. easily found on the first ex-ray. The surgical screw in her hip replacement had come loose and was causing her pain – something the specalists either didn’t see (after three visits) or preferred not to reveal. I’m still convinced he was profiting from Medicare money off my mother’s misery. After that experience, I’ve become a big proponent of getting second opinions. Yes waste and fraud does exist.

  3. About 57% of Indiana’s citizens receive their health insurance coverage from their employers, according to a recent report ( And our hospital prices are among the highest in the nation (Rand 4.0), averaging over 3 times what Medicare would pay for the same services. This goes a long way toward explaining why Hoosier wages are so much lower than the national average. We have a problem right here in River City!

  4. My son Mark moved to Florida in the mid-1980s, self-employed as a brick mason he became well known for the quality of his work and his honesty, he kept himself and his small work crew working most of the time. He was rear-ended on the highway resulting in 7 fractured vertebrae; due to the injuries from a vehicle accident he had an attorney working for him but it took 2 1/2 years to qualify him for Medicaid. Medicaid doctors diagnosed him with terminal cancer. Fortunately his home was paid for, his truck repossessed; he rented his spare bedroom to a friend for $300 monthly and his sister, on disability, and I sent what money we could monthly. The attorney continued working to get him declared disabled; this took almost another 3 years. He received his first SS Disability check on a Monday, $1,495.00. On Friday he received the cancellation of his Medicaid due to his income being too high. I wrote to Michelle Obama whose staff forwarded my letter to Florida’s district Medicaid/Medicare office; they sent me the application forms and instructions which I sent to Mark. They agreed to reinstate some Medicaid assistance IF he provided documentation that he had spend $1,210.00 monthly for his medical care, with that they would pay a small percentage of his medical care. He again had no medical care and the 2 year wait on Disability to qualify for Medicare. His sister and I continued sending money.

    Living in Indiana when I applied for Social Security Disability in 1994 I answered truthfully when asked if I had a savings account; I had $3,100.00 which took me 11 years to save. I was qualified for Disability but due to the savings I was without health care and the $3,100.00 disqualified me for any public assistance. Because I was forced to retire due to disability, when I qualified for Social Security Disability, that allowed me to begin receiving my PERF retirement before the SS retirement age of 65. That disqualified me for public assistance and I was without medical care for the 2 year wait.

    Medicare Parts A and B do NOT pay for eye exams for prescription glasses. Medicare Advantage (Part C) qualifies payment for eye exam and partial payment for eyeglasses (or contacts) once yearly only IF you have had cataract surgery AND intraocular lens implants. I qualify for this assistance.

    “Supporters of MA say that capitation incentivizes doctors to keep patients healthy without over-treating and over-testing them.” Contrary to their opinion, while this does provide medical care it can be a pain in the ass, which is not covered, and can be stressful. I won’t bore you with the long tale about my repeated testing for a necrotic ulcer on my big toe which cost the system over $22,000.00 and resulted in referral to a podiatrist. Or my in-patient hospitalization with viral flu, severe dehydration and bladder infection which the Methodist ER doctor diagnosed as heart disease and 3 days of testing which found no heart problem. One of his interns, a woman who could see how stressed I was, visited me without the crew and told me my true diagnosis. The Chief Cardiac Surgeon visited me daily to tell me my test were normal. He finally overrode the ER doctor, canceled the next day’s scheduled tests and released me.

    I won’t apologize for the length of this because the stress of being qualified for medical care too often results in doctors prescribing expensive medications and/or unneeded testing adding to actual medical conditions. I appreciate the assistance I do receive but have had to fight the over-prescribing and over-testing and having to refuse additional prescriptions for anxiety or depression which cause me ugly side effects. All medical care has become a Catch 22 situation.

  5. My experience with Medicare Advantage is that the premiums are low but the different levels of copays and the networks of doctors make it confusing and full of unexpected costs.

    My husband and I went back to traditional Medicare with a supplement after one year. The supplement costs almost $600 a month, but we both had serious hospitalizations during the last two years and had every cost covered with no hassle.

  6. Anita said it all, with respect to our distinguished Senator (Scott). I read that he is the wealthiest one in the Senate. That doesn’t surprise me because before he ran for Governor, he was the head of a hospital system that was “leaned on” by the Federal Government for various kinds of fraud. He bailed out, with a golden parachute, before the corporation was sued by the government and fined a few billion dollars. Apparently, that was not enough to prevent people from voting for him. Clearly, people don’t think when they vote.

  7. I remember reading an article which said the overwhelming majority of our health care costs are in the last year of our lives. That certainly was true for my Mother with her heart condition and bypass surgeries. Yes two bypass surgeries as the first one resulted in one bypass blowing apart shortly after she was transferred into cardiac ICU. She was at the Cleveland Clinic known as the best heart clinic in the world and one that takes the worst cases.

    In my own case I am covered by VA medical care as I’m currently 80% disabled and have retained a law firm that specializes in VA and Social Security disability. Just had a telemedicine appointment with a psychiatrist who believes I qualify for 100% due to my PTSD. Thank you everyone here who pays Federal income tax as you are paying for my health care.

  8. There is one other aspect of capitation that I would like to point to. The insurance companies offering part C, are incentivized to deny coverage for what you and your doctor might think of as necessary treatment and they routinely do just that.

  9. While we are here, the US is one of only two countries in the entire world that allows advertising for prescription drugs. And, no, this has nothing to do with the 1st Amendment….We have “capitalized” medicine.

  10. Yes, Anita! Legendary should be the word for that….!
    He reportedly even screwed over his own party’s Senatorial Campaign fund in
    the run-up to the ’22 election, as I have read.
    America’s national mythology is like an unseen albatross around its neck, keeping
    us from dealing with many aspects of reality. it’s a bit of a surprise that there is no
    Paul Bunyon party out there claiming that he, and his blue ox, could somehow solve
    the environmental problems we face.
    Our system seems to not mind waste, as long as the oligarchs can make money
    out of it…surprise!

  11. Along the subject…primary care. Recent stats for Massachusetts:

    – Primary care spending represents less than 8 percent of overall medical spending and declined across all insurance categories from 2019 to 2020.

    – In 2020, 33.7 percent of primary care physicians in Massachusetts were age 60 or older

    Follow the money to…”specialty” care.

  12. ** Regarding Medicare Advantage plans – the government does NOT pay the healthcare providers/doctors. The government pays Insurance Companies an annual fee to cover enrollees in their Medicare Advantage plans. The biggest problem with Medicare Advantage plans is that they are guilty of scamming the government/taxpayers out of billions of dollars by claiming that their enrollees have health problems that they don’t actually have. The government pays Advantage plan insurers for each enrollee based upon their individual health issues. The government pays insurance companies a much higher annual amount for enrollees with more serious health issues.

    The big insurance companies chose to commit fraud by claiming their enrollees have health issues they don’t have. This allows the insurance companies to charge a higher fee for those enrollees. United Health Insurance and Indiana based Anthem Insurance are two of the largest violators. They’ve both been caught committing fraud and have had to pay fines. Those fines are a drop in the bucket compared to what they get away with stealing, so they just keep stealing and will pay another fine the next time they are sued by the government.

    Anthem recently changed their name to Elevance – I believe to help escape the bad reputation they gained over many years of cheating both the government and the people they cover. They continue to expand their Medicare Advantage plan coverage into new markets in other states because Medicare Advantage plans have become one of the most lucrative money makers for insurance companies. They lobby Congress to keep the federal governments watchdogs understaffed so that there isn’t enough manpower to review their Medicare Advantage plan bills to ensure they aren’t up-billing for diseases that people don’t have. It is sickening what they manage to get away with. The federal government, and we taxpayers, would be money ahead by subsidizing Part B premiums for everyone and ending the Medicare Advantage program.

  13. An argument can be made that Nixon’s greatest sin was not the plumber goof but his 1973 O.K. to his friends at Kaiser Health back in California to initiate private health insurance coverage for the masses. Look at where we are now with the “privatized” costs of health insurance often in excess of that paid for food with our admixture of socialized and privatized health plans, a “system” as measured by myriad complaints that isn’t working and should be discarded.

    Someone (preferably a senator) should come up with a plan similar to that of the 1935 Social Security Act to bring us compulsory and universal health coverage. Socialized medicine paid for by taxes? Yes, an addition to the admixture. How to fund it? Reduce the military (read Boeing, Raytheon et al) budget along with hundreds of billions per annum (per IRS estimates) we will enjoy with increased IRS auditing of the rich and corporate class to offset the initial shock of the program – and go from there.

    Other results? Those who could neither get coverage nor afford it and everyone else are covered without reference to small print insurance coverage escapes, larger deductibles and the like. The program is taxpayer friendly since it would also be good not only for the nation’s health and productivity but the large monthly premiums of $600 and up per month would remain in the pockets of all Americans and add greatly to demand in the marketplace and thus economic growth as envisioned by Keynes, all to the delight and enrichment of merchants and others in the marketplace.

    FDR and those in the Congress who proposed the Social Security Act of 1935 (in the middle of the Great Depression) were maligned by Republicans of that day as communists, socialists, and other bad guys, predicting our imminent downfall as a result, but it turns out that that act is the greatest piece of anti-poverty social legislation the Congress has ever passed. Nonetheless, I fully expect my roughly described proposal offered here today to attract similar putdowns by those who are profiting from the status quo, as then, so bring it on.

  14. Gerald; I live in the shadow of the Indianapolis Raytheon facility in a small housing development. Seven or eight years ago they began constructing numerous small wooden buildings which now cover a large area behind their main building. My friends live with their back yard abutting the Raytheon fence; during the summer they frequently see emergency vehicles with flashing lights speeding around the buildings, no sirens to scare the entire neighborhood. A few years ago, under Republican Mayor Ballard, there were military “games” carried out at Raytheon; 5 or 6 huge helicopters suddenly flew over our houses. The noise was deafening and houses and the ground were shaking; People were running out of homes looking at the helicopters in fright, no idea Ballard had given permission to carry out the games for three days. The local news reported that evening what was going on and warned us that there would be bombing on Friday; Friday came with severe thunderstorms and tornado warnings in our area. We had no idea if the explosions, shaking houses and ground were the games with bombs, tornadoes or what was going on. I later went through my stack of earlier Indianapolis Star newspapers and finally found from about 2 weeks earlier a brief 2 paragraph notice from Ballard about the event, buried on an inside page of the newspaper.

  15. It seems that advantage plans reset the doctor patient relationship. The insurance company is the doctor’s boss, the one who pays them. They are incentivized to keep care at a minimum. What a quandary for doctors. Also, insurance clerks deny tx’s. the doctors prescribe. That third hand (supplemental) in the healthcare relationship has too much power. Medicare recipients’ contract for 20% supplemental and that agency takes over the other 80% and looks for and finds way to get the most profit out of the deal. It seems the main aim in healthcare now is profit and not healthy outcomes.
    Also, healthcare providers are overwhelmed with work, it’s unbelievably normal times add pandemic stress to that load and it almost reaches unbearable. Try working in protective garb, it’s hot and cumbersome and has to be changed between each pt. When trump was Potus nurses had to wear plastic trash bags for protection due to interference in the supply chain!
    Businesspeople often operate in aggressive mode, whereas healthcare workers are required and do work in therapeutic mode. Keeping pts. in parasympathetic mode (calm) is part of the healing process. This is an aspect that is taken advantage of.
    When business interests interfere with the health outcomes of pts. something needs to done!

  16. How much actual medical care do we receive from our primary physician? They rarely even take our vital signs themselves and bill out insurance coverage hundreds of dollars. Just guessing ages of commenters here; didn’t you all grow up when doctors actually treated you for illnesses and injuries, they stitched our wounds, delivered our babies, examined us when we were hospitalized, lanced our boils, took temperatures, gave us vaccinations, took blood samples, most handed out sample medications and came to our homes when needed. Today they listen to our complaints, ask and answer questions, write prescriptions, refer us to specialists to actually treat us for whatever ails us and refers us elsewhere for tests.

    Progress does not always mean improvement. And this is a primary source to FOLLOW THE MONEY.

  17. Much of this has been covered by Peggy and Nancy, but as another tack, look at Part C advertising
    “You are missing FREE benefits – you are being cheated by regular Medicare”

    Now the dental and eyeglass coverage is poor to so-so, and specialists must be pre-approved, leading to delays at best and denial at worst. Meanwhile, as Nancy points out, many insurance companies game the system. Insurance companies, even the better ones, prefer Part C because they make more money and push patients to the “in network” practitioners.

    Consumer Reports suggested Part C for relatively healthy people who don’t see specialist. For the rest, due to co-pays, caps, etc. they recommended to avoid it.

    The ACO (Affordable Care Organizations) is another approach where “capitalism” (incentives in the form of shared savings), were supposed to work. Truthfully, home visits to ensure that patients take their medication may prevent many hospitalizations. The problems with the ACOs is the extreme bureaucracy, with no feedback from the government for six months at a time. It is hard for those organizations to gauge their progress. The government has also altered the sharing formula, to the detriment of the organizations. This tends to drive out the smaller local attempts to improve medical care and favor the large corporations that can better handle the uncertainty.

    Medicare for all, or some variant thereof, along with some price negotiation on pharmaceuticals makes a lot more sense than what we have now.

  18. I have heard the horror stories about MA plans, and I object to the plans on principle; however, when my late husband became eligible for Medicare, he opted for an Advantage plan. Through numerous hospitalizations, surgeries, and two unrelated
    stage IV cancers–the first was successfully treated, the second took him from me– we incurred very little out-of-pocket expense. The insurance company never questioned any of his prescribed treatments or tests, and the costs, even at the insurance company’s negotiated reduced rate, were astronomical.

    Based on our experience with Medicare Advantage, I also opted for one when I became eligible for Medicare. I have also encountered serious health problems, including a stent, replacement of my aortic valve, implant of a pacemaker, and am now facing lumpectomy surgery for breast cancer. My insurance does not require referrals for specialists or for most tests. The meds I take have either no co-pay or under $10 for a three-month supply. I am able to order them online, free shipping, so no trip to the pharmacy. My annual ophthalmology exam, including prescription for my glasses and contact lenses, is covered.

    I am fortunate to live in a city with world class medical centers. All of my doctors are affiliated with NYU Langone, which also has worked with me when my charges are more than I can pay, and do so in a matter of fact way, allowing me to keep my dignity. My only income is Social Security and a very small pension, so that assistance is important.

    I know how fortunate I am. The experiences of so many have been very different from mine. I fully support a national health insurance plan, but until that happens, I will stay with my Medicare Advantage plan.

Comments are closed.