Keep your government hands off my Medicare!
Sunday, September 6th, 2009In July, an angry constituent confronted Rep. Bob Inglis (R-SC) at a town hall meeting. “Keep your government hands off my Medicare!” the man demanded. Inglis tried as he could to explain that Medicare was and had been from the beginning a government program, but the voter would have none of it.
That episode illustrates the level of confusion surrounding health care reform in particular and our health insurance system in general. For the record, Medicare is a single-payer system, though in recent years private insurance has made huge inroads in altering the system, aided and abetted by Congress. Since it is not purely single-payer in the broadest sense of “everybody in, nobody out,” it does not achieve the economies of scale a nation-wide all-inclusive single-payer system would. And of course, you have to be 65 to be eligible for Medicare.
Our very own socialized medicine
The Veterans Administration (VA), on the other hand, is an example of socialized medicine, since the providers of the healthcare are government employees and the hospitals are all government facilities. So we do indeed have socialized medicine in this country. It is just (ironically) that it exists where most people least expect it—within and on the periphery of the military.
Neither system is inherently bad, though generally Medicare seems to get higher marks from its constituency. The problem with both systems, contrary to what most people believe, is that they are the poor boys of the healthcare system. Because they cater to two groups that have relatively little power compared, say, to the insurance industry—namely, the elderly and veterans—Medicare and the VA system get relatively little attention from Congress.
… and our single-payer system under attack
Let’s be clear that what makes Medicare single-payer is the formula of a government-sponsored payment plan for privately administered healthcare. To the degree that this model is adhered to, Medicare is popular among those it covers. Most of the problems with the Medicare system stem from its concessions to the prevailing external system of private insurance companies. The best example of this single-payer model gone astray is Medicare Part D, which covers reimbursement for prescription drugs.
This system is so complex even pharmacy professionals were totally confused by it for the first year or so it was in effect. It illustrates the downside of having a health care system dominated by the insurance and pharmaceutical industries.
For one thing, when Medicare Part D was passed in 2003 to become effective January 1, 2006, it required seniors to purchase insurance to cover prescription drugs. In a good single-payer system, pharmaceuticals would be covered the same as laboratory tests or doctor visits. Depending on the system, there might or might not be a small copay. But all these issues should be transparent to the patient.
Part D is completely different. There is none of the beauty and economy (for the consumer) of universal coverage. Instead, we have an enigmatic system that has both reduced coverage and increased costs at the same time—precisely what happens when private insurance gets the upper hand.
What’s more, once Part D went into effect, enrollees had to sign up for these benefits within a short period of time or be penalized. (All this from a group of patients whose predominant source of income was presumably Social Security!) As one of our senior readers pointed out in a private correspondence,
Obama says [he wants to cut spending on] Medicare, but that delivered benefits to patients will not be cut. Apparently, he wants to get back some of the money the insurance companies have been stealing. (For example, when Medicare-D was introduced by the Bush League, the insurance companies slashed benefits, increased premiums, raised copayments, and just kept all the extra money the government was giving them.)
Belatedly, the Democrats figured out what was happening. But Obama doesn’t say how he intends to stop the insurance companies from stealing the money. The insurance oligopoly just does whatever it wants unless there is a single-payer system or at least a government-run competing option. But unless Obama can straighten out Medicare, I have no confidence he will straighten out the larger system. It is about time for him to stop talking bipartisanship and to start exposing all the whores and thieves. Here is a perfect opportunity to show why we need a single-payer system—to prevent the sort of larceny that occurred with Medicare-D.
Indeed, an essential part of that larceny was a provision passed by Congress that forbids Medicare from negotiating drug prices with the pharmaceutical companies. Medicare has to pay whatever price the drug companies ask. Yet, given its large constituency, the Medicare system is in an enviable position to exact savings on the part of the seniors it represents. (The VA, in fact, does do this for veterans.) But for Medicare, that practice is strictly forbidden by law, costing taxpayers billions annually.
Given these shortcomings in our existing single-payer system, it is easy to see why so many citizens throw up their hands and shy away from health care reform altogether, even if they have managed to figure the whole system out. But Medicare could be made much better by keeping it to the pure single-payer model rather than saddling it with all the trappings of our private insurance system.
Private delivery of publicly paid care
What’s good about Medicare is that it leaves the healthcare delivery side of the equation alone. You can go to your existing doctor or find another one if you like. (Not all doctors accept Medicare, but then they aren’t all in the same “networks” of existing private PPOs, either. So for those who think they’ve just found a major shortcoming in the single-payer system, nice try—but it’s a wash.)
Walking away from healthcare reform just leaves the thieves and liars to run the show. Far better to exclude them altogether. A pure single-payer system is the only option that makes total sense, because it stands to save the public $4 trillion over the next 10 years, while simultaneously extending coverage to the 47 million or so Americans who are currently uninsured.
That’s why it becomes the least expensive way to cover everyone. By absorbing the money now taken by the insurance industry for overhead and profits and putting that money towards health care, we can add the uninsured to our rolls without increasing overall costs. Suddenly, you don’t have to worry about losing your insurance should you lose your job or about becoming uninsurable because of a prior illness. The current private healthcare system makes it a practice to remove people from its rolls once they begin to need its services.
Choices aren’t always what they’re cracked up to be
Adding a vague “public option” into the mix of private plans providing meaningless choices such as HMO vs. PPO, deductibles vs. copays, should be considered only as a fall-back position in the event that all else fails. We envision a single-payer system in which you get care from your hospital or doctor and the government pays the bill—a healthcare system that is privately administered but publicly funded.
The halfway measure of adding a government-sponsored insurance alternative to the current bewildering array of private plans is not only unnecessarily complex and inefficient, it will simply cost more compared to straightening out Medicare and extending it to all U.S. citizens.
We suggest you write your Congressman and tell him that.
While writing this editorial, we have noticed a few interesting things happening in the media. One is an exchange between CNBC’s Maria Bartiromo and Rep. Anthony Weiner (D-NY) captured on MSNBC.
We had always respected Bartiromo as a business journalist, though we haven’t watched CNBC in years. So we were surprised when she began spouting shop-worn platitudes in the course of this discussion. The notion, for example, that the availability of Erbitux is the barometer by which we judge a healthcare system is totally bonkers. And how many people in this country have access to it via private insurance anyway? We would like to know. (If you have been given Erbitux and had it paid for by your private insurer, please use our comment form below to let us know about it.)
We thought the best commentary on the Bartiromo incident came from Rolling Stone political commentator Matt Taibbi, who wrote about it on his blog post, Maria Bartiromo shows us how media has helped sandbag health care reform:
I was a guest on MSNBC’s “Morning Joe” to talk about health care and Bartiromo, who used to work closely with a relative of mine at CNN, was friendly before the segment started. So I was surprised when the show started and Bartiromo went on the attack, asking me how I could say America didn’t have the best health care in the world. Everyone, she said, would choose to be treated in America if they could.
I was staggered for a moment, I admit it, because I thought she was kidding at first. We were probably a full minute into the debate before I realized it wasn’t a joke. And here’s the really funny part: toward the end of my appearance, I said something about how health care in America is great, if you’re an executive at Goldman, Sachs. Then I left the set and… guess who they brought right afterward on to rip me and praise the American health care system? Bartiromo’s colleague at CNBC, Erin Burnett, a former Goldman, Sachs executive.
Bartiromo, both with me and in this spot with Weiner, has been hammering home the same point, that the proof that a public option won’t work can be found in the fact that the public health care system in England will not pay for the colorectal cancer drug Erbitux. I guess she is trying to say that there is rationing of health care in a single-payer system — that the fact that the government will not pay for the most expensive non-generic cancer drug on the market is proof that we shouldn’t have a public option in the U.S.
It drives me crazy when people make this argument. [A] fancy boutique drug like Erbitux[!] I have a very expensive private plan and I can’t even go to a doctor, not even to ask a simple question, unless it’s an emergency. I can’t get a routine checkup, can’t find out what that weird lump in my left foot is, can’t have the pleasure of a routine proctological exam unless I want to pay cash for it, and, well, forget about getting a filling replaced or seeing a therapist to deal with my incipient nervous collapse/burgeoning mid-life crisis.
Hell, forget about paying for Erbitux, if I wanted to get a colonoscopy to find out if I needed Erbitux, I wouldn’t be able to — I’d probably have to wait until I was a fully symptomatic cancer patient before I could even have that conversation on my insurer’s dime. And I’m one of the lucky ones, I actually have money to pay for care out of pocket, if I had to. No country in the world rations care more than the U.S. There are whole generations of Americans (20-40 year-olds in particular) who don’t know what it is to be able to go to a doctor for preventive care or routine checkups. Erbitux, for Christ’s sake! Give me a break.
To watch this short interview and see what your take on the whole thing is, click here. Don’t forget, then, to tell us all what you think about it by clicking on the red text, “leave a comment” in the grey box that marks the end of this posting. That will open up the comment box (if it isn’t already visible) below the posting itself.
Franken, the senator
Another video that hit the wires recently was of Al Franken calming down constituents at the Minnesota State Fair. This impromptu discussion is well worth watching, because Franken gives a generally good primer on health care reform issues.
We admit we had our doubts about Franken as a serious lawmaker before, but he shows here that he has the “people skills” it takes to show and earn respect in politics. So far as we’re concerned, that and the level of sensitivity and intelligence he demonstrates here is all he needs. We predict good things to come from this senator and wish him well. The exchange is here.
And to show just how ugly things can get (without even going into the incident in which a man had part of his finger bitten off) here’s a tape from the Star Ledger in New Jersey showing the shoddy treatment given a disabled woman in a wheelchair who tried to speak up about her situation in a New Jersey town hall meeting. There’s much more to it than that, but we’ll let you see for yourself here. Excellent work by the Ledger reporter, Brian Donohue.
There’s one misconception in this video that you should be aware of: Medicare is not socialized medicine, though the VA system is. Medicare, as we said before, is primarily a single-payer system, though private insurance, through its agents in Congress, is making inroads into corrupting that system. And while the narrator is certainly entitled to believe in tort reform, in reality that is a side issue completely unrelated to health care reform. As a pseudo issue, it’s been cleverly planted, we believe, by the opponents of health care reform. We agree with him about the importance of disease prevention and health maintenance in general, but again—those issues are not directly related to health care reform, if by that we understand the matter of reforming health care insurance, or in other words, the ways that we pay for and distribute health care.
Maria Bartiromo and Rep. Anthony Weiner (D-NY) mix it up on MSNBC.
Al Franken (D-Minn.) shows his stuff in calming down a potential angry mob.
You might also like:
- Obama brings back public option
- The Republican health care reform plan
- Stop the insurance industry bailout
- Of vaccines, mercury, autism and Julie Gerberding
- What does single-payer mean?
The Big Picture (beyond our site):
