The Importance of Fingers and Toes
Today, Health and Human Services Secretary Tom Price and the President unveiled the first phase of their proposed health insurance plan to eventually replace “Obamacare.” Ironically, In his New York Times editorial, Paul Krugman recently complained that for the past several years, Republicans have been substituting slogans and hollow one liners for concrete solutions to our national problems. Price promises that his healthcare “system” has to be ”affordable to folks, accessible and of the highest quality.” Meanwhile, Mike Mulvaney of the Office of Management and Budget asserted that “people have to be in charge of their own coverage.” These are the same type of buzzwords that we hear from Betsy DeVos, newly appointed Secretary of Education with regard to her heretofore unsuccessful voucher and charter philosophy of childhood education. The question before the Trump administration is obviously whether or not the Republican caucus can turn their slogans into successful “systems” without completely adulterating federal programs as important as healthcare and education.
Apparently, the new proposal scraps the ACA individual mandate as well as many federal subsidies while rolling back Medicaid expansion. When questioned further, supporters of the new healthcare initiative promised that eventually they would introduce portability of health insurance across state lines, currently forbidden, something which they promise will allow for “intense” competition between insurance companies and substantially lower premiums. Clearly, this is something that President Obama eventually realized was necessary for the ACA, but could not pass due to paid obstruction, apparently, in both parties as well as the then corrupt Congressional Budget Office. At the time, the Democratic controlled CBO rather drastically underestimated the impact of portability while Republicans painted it as the economic “holy grail” of healthcare salvation.
Unfortunately, as has been shown so many times, what both Republican and Obamacare “supporters” both choose to ignore is the actual status of the private medical insurance industry. By mandating that companies spend some 80% of premiums on patient care, “Obamacare” shockingly revealed the bitter truth: In a free market with the absence of pre-existing condition clauses and without limits on coverage, with today’s excessive cost of patient care, there is no possible way for the private medical insurance industry to survive. If one, however reluctantly, looks at the simple arithmetic of universal medical coverage, the entire concept of private medical insurance is clearly on life support with conservatives trying desperately to save it! Many, like Dr. Price and Mr. Ryan, may actually believe that the concept can be rescued, but the math just does not lie.
I have practiced medicine for over 35 years, managing standard fee for service as well as HMO practices and I know what medical and medically related charges are and I know what the real costs are. In the HMO setting we had to pay for the phony itemized “outpatient” bills and the drugs that cost more than twice as much as they do in Canada. We found out what the actual retail prices were for durable goods, oxygen and lab work, an astoundingly small fraction of what Medicare paid for the same services. These represent bipartisan graft. There is no other word for it and as of March 23, 2010, with the inception of the Affordable Care Act, the heretofore fraudulent insurance industry actually became victims of even more fraudulent lobbies! Even the very largest insurers, with a maximum of a few million members per state to use as leverage, could not legitimately survive on the percentage of premiums allocated to them by Obamacare. Premiums “soared,” but for the most part, no higher than they would have without the ACA.
Meanwhile, as Krugman accurately pointed out, slogans and talking points cannot take the place of any real, well researched plan for universal healthcare. Vouchers, tax credits, withholding medical health insurance support for the soon to be ex well to do (after buying insurance or going bankrupt) borders on the mathematically absurd! Wake up already, folks!. In a private/ free market system, almost half of my middle aged patients’ insurance premiums would have to be at least 20,000 to 30,000 dollars a year due to preexisting medical conditions. If Medicare is privatized, we’re talking about well over 60% of patients. While rich retirees could hardly afford decent coverage, the less wealthy and the young could only afford “disaster” coverage. Fewer businesses could afford to furnish health insurance to employees and an industry without a sufficient number of customers cannot survive. As well meaning as the Affordable Care Act was, it is clear as day that it only temporarily saved the private insurance companies from bankruptcy. The fact is that the companies simply cannot handle the financial responsibility of universal coverage without massive government subsidies. To put it kindly, It is my contention that anyone who denies this either failed arithmetic in grade school, didn’t do his homework or is flat out lying.
I further contend that virtually any student of medical care understands that the only way to provide universal healthcare is through some sort of single payer system. Meanwhile, the only way to legally mandate that everyone must purchase medical insurance is through real taxes, not virtual taxes. Anyone who complained about the hokey Supreme Court decision that the Obamacare mandates represented a virtual tax can hardly deny that mandating a 30% surcharge for lapses in coverage is also a virtual tax. What’s more, there is no other way to control current medical costs than to employ a single payer system with universal competitive bidding, universal formularies and punishment for illegal bribes and graft on the part of various medically related lobbies.
Currently, the official agents of these lobbies have been repeatedly legitimized by a Supreme Court virtually owned, at the time, by the Koch brothers. The shocking Citizens United decision, provided supposed “First Amendment” protection for unlimited political campaign donations, while mysteriously denying the same First Amendment protection for the right to vote. The bizarre decision was met worldwide with shock and disbelief, making the Roberts Supreme Court the laughing stock of the entire free world! Many observers believe that the embarrassed Justice Roberts voted to support the ACA’s mandate to somehow make up for possibly the most perverse decision in the Court’s history. The upshot of the decision simply reinforces the obvious: As long as congressmen, senators, judges and so many federal elected officials are involved in currently legalized “pay for play,” they can in no way be trusted to manage Medicare, Medicaid, or any government sponsored or socialized healthcare program in any form!
If Medicare could be decontaminated by the employment of professional competitive bidding formulas and lobbying activity reduced to legitimate arbitration at all levels, a number of single payer alternatives could be developed. Some models would involve management by federal bureaucracy, some by regulated private insurance (managers, not owners) and some examples would have state bureaucracies manage their own single payer systems. In all cases, however, a federal system would have at least shared involvement in bidding contracts, taxation and funding to states in order to obtain the most reasonable contracts and guarantee the most economical services to the patient.. If each state is left completely on its own, the costs would remain prohibitive. From this physician’s point of view, our so called current medical “system” is at best a patchwork quilt of many non matching pieces and at its worst a foul mixture of blind ideology and bipartisan corruption run by a group of grown men and women who can only count using their fingers and toes.
Allen Finkelstein, D.O., M.Ed 3/7/17