The OLD Philosopher – John M. Miller
Because of our unique and relatively short history, Americans tend to perceive life differently from most other nationalities. That is especially true for other developed and wealthy nations.
For example, Americans are more likely to believe that personal success is determined by themselves, that we are quite able control our own destiny. A Pew global attitudes survey suggested that 57% of Americans believe they determine their own success, whereas, by comparison, only 31% of Germans believe that.
Our usual attitude affects numerous factors in American life. One area where it is now being fiercely debated in Congress is health care. For as long as there has been a United States of America, Americans have concluded it is up to us individually to provide for our own health care. Thus we have had private health insurance for many decades. This distinctively American type of insurance is intended to control the destiny of our health.
It does not. Either we are healthy or we aren’t, but having health insurance does not and cannot guarantee us good health. Only health care providers can do that, if even they can do it.
The Affordable Care Act, also known as ACA or Obamacare, was passed early in the first term of President Barack Obama. It was originally intended to provide nearly universal health care for all nearly Americans. That was an excellent idea. But it failed to do so, and for two reasons: first, because of political opposition, it did not cover everyone, and second, it continued to rely on the failed American notion of private health insurance. It guaranteed everyone insurance coverage without higher premiums due to pre-existing conditions, but its proposed success was still based on private insurance.
That has always been the fatal flaw of American health care. Good health care for all citizens cannot be based on private health care or on private insurance to guarantee good health care. Since the end of World War II, every other advanced nation has clearly realized that the only way to provide universal health care to all citizens at a reasonable cost is to have a government-sponsored single-payer national health service of some kind.
Excellent private health care for everyone is an oxymoron, a contradiction in terms. The profit motive is antithetical to good universal health care. But because Americans are the world’s uber-capitalists, we have not yet figured that out. The USA has a higher percentage of citizens without guaranteed health care than any other developed country in the world. And the health care bill currently being debated in Congress will guarantee a much larger percentage of Americans with no means of attaining adequate health care in the future. This is not a mere statistical possibility; it is a certainty.
Private insurance companies abhor accepting people into their health plans who have pre-existing conditions, unless it is agreed that their premiums will be much higher. Every GOP proposal regarding a new health care bill either allows the insurance companies to charge higher premiums or it shifts the burden to the states to work out the details, rather than the federal government. But that is simply an exercise of moving the deck chairs on the Titanic. The problem is private health care; it is not which level of government provides the health care.
Tax Breaks vs. Health Care
An equally disruptive feature of the Republican proposals in both houses of Congress is that a major feature behind its passage is a major tax reduction for wealthy Americans. It allows them to reduce their taxes by deducting more for their personal health care, since they can pay for better care and better insurance. It also gives a major deduction to business owners who pray for medical insurance for their employees. Lower income Americans do not have either of those options.
The GOP health bill lowers federal costs for health care because it cuts health care for millions of Americans. Further, it relies much more heavily on private insurance. To express that reality in a different way, in the long run it intentionally cuts expenditures for both Medicare and Medicaid.
Not many people who are likely to read this essay receive Medicaid, but a majority of readers, I suspect, are on Medicare. Medicare and Medicaid are both single-payer national health systems. In otherf words, they are socialized medicine. Let us examine specifically just how successful Medicare is, to which you Medicare folks will give strong affirmation.
Whenever a Medicare patient receives any medical treatment, that treatment is funded from three sources: Medicare, secondary supplemental private health insurance, and the patient’s pocket. If patients have very good coverage from their secondary health insurance policy, they may not have to pay anything, and the contents of their pockets remain intact.
Now let us follow a hypothetical Medicare citizen who enters the hospital via the emergency room to be treated for a suddenly obstructed bowel. (Medicare people are more likely to have bowel problems than younger people. Indeed, they are more likely to have more medical problems of almost every variety than most younger people.)
Let us further assume that the plugged-up innard is repaired without serious future ramifications. Because the treatment occurred in an American hospital (whether private or not-for-profit), the bills have to be paid by at least three payers: Medicare, secondary insurance, and the patient.
Hypothetically, here are the charges for the required three-day hospitalization: The hospital itself, including the charges for the hospitalists (the attending physicians who are employed by the hospital) - $12,127.36; Dr. A.L. Brown, gastroenterologist - $1,549.00; Dr. R.C. Chang, radiologist - $941.00; Dr. Siddhartha Gupta, proctologist - $516.00; A whole slew of tests and “lab work” – $2,384.27; Miscellaneous - $1982.17.
Here is the amount that was paid on the total charges of $19,499.80: $6,123.42. “How,” you ask yourself with understandable incredulity, “can that be?”
Here’s how. The patient, who in this hypothetical illustration, is in the Top 1%. He therfefore has excellent secondary health insurance, for which he pays almost $12,000 a year. He thus paid nothing at all for his three-day sojourn in American private health care. Well, nothing after his $12,000 annual insurance premium and the several hundred dollars deducted for Medicare from his monthly Social Security check. His insurance company paid $1792.43 to all of the various health care providers, after doing battle with each of them for a total of fifteen months. Medicare paid $4330.99, and it did so quite expeditiously.
In other words, under the “double-payer” plan of this hypothetical example (Medicare, plus private insurance), the total paid out on $19,499.80 in charges was $6,123.42. Most nations with a national health system do not require citizens to acquire additional private health insurance. In those situations, the actual payment would be $4,330.99, the amount actually paid by Medicare.
The United States of America had long had a socialized national health care system for millions of its citizens. It is called Medicare. It has another such plan for other millions of citizens, called Medicaid. But the private side of American health care drives up the costs of health care for everyone, which is why America pays more than twice as much for its health care as nearly every other developed nation on our planet.
In addition, American politicians from both parties like to give tax breaks to wealthy constituents through all the expenses they pay for medical care. After all, the affluent can afford to pay more for health care, and they are willing to pay for it. Thus health care becomes the largest political football on the congressional field of play.
The Health Care Deck Chair
Anything that has ever been described as “health care reform” in the history of the American republic does not promote health, nor is it ever truly reform. If a congressional bill passes in the next few weeks (which is unlikely), it will do nothing to move toward a resolution of the high costs, inequities, injustices, and philosophical foolishness of the method by which Americans have chosen to address their health needs. We are only moving the most detrimental deck chair on the Titanic every time we talk about health care reform while refusing to talk about a single-payer nationally-funded health system.
There are three irresolvable problems with every iteration proposed in any current GOP health care reform bill. 1) As written, it is fundamentally a tax bill, not a health care bill. 2) It refuses to address the primary deficiency of American health care for the past three-quarters of a century, namely, that it is essentially privately funded by millions of individuals, organizations, and insurance corporations. 3) It gives the states, rather than the federal government, additional authority and responsibility in health care, which further exacerbates the problem. Health care must become more centralized rather than intentionally decentralized.
To repeat: Private health care is an economic, philosophical, and medical contradiction in terms. Relying on private medical care is like relying on an all-mercenary military, directed and paid for by a private corporation. It is like turning NASA over to Elon Musk and other interested private individuals. It is like turning all our streets and roads into private toll roads. It is akin to deliberately making every public utility a private utility.
Albert Einstein described insanity as perpetually trying to find an alternative to an irrefutable law of nature and expecting to come up with a different result. For three-quarters of a century, long after everyone else has concluded that a national health care system is the only system that works well, efficiently, and at the lowest reasonable cost, America continues to entrust private enterprise to provide the best health care possible. It is political insanity by any other definition.
In most economic matters, the private sector is preferable to the public sector for making enterprises efficient and effective. But there are some activities which can reasonably be accomplished only by the public sector. Health care is one of them.
Since the end of the Second World War, most nations of the world, except the USA, have come to understand that health care must be a public, universal, and socialized enterprise. Until Americans also accept that undeniable reality, we shall continue to force millions of our fellow citizens to endure illnesses and conditions that are easily and cheaply avoided. And we shall waste billions of dollars in the process. Millions of the rest of us will be forced to pay for health care which otherwise would be far more effective at a far lower cost. It is American lunacy at its historic worst.
-July 16, 2017
John Miller is a writer, author, lecturer, and preacher-for-over-fifty-years who is pastor of The Chapel Without Walls on Hilton Head Island, SC.