Just over a year ago, I wrote
The Attack on Medicare: An Attack on National Health Care? in which I outlined the Bush administration’s gutting/fleecing of the public insurance program that serves over 40 million elderly and disabled Americans. I believed then and believe now that Republicans intended to make federally administered health insurance onerous to Americans, in order to install in this country a fear of universal single payer health care like that found in most western countries.
http://www.dailykos.com/story/2007/8/12/12568/1643/766/370457Medicare was created by an act of Congress during the LBJ administration. You can read about its difficult passage here:
http://www.larrydewitt.net/Essays/MedicareDaddy.htmIn recently released White House tapes, LBJ
makes clear to Moyers that he does not see programs like Social Security and Medicare as being about economics.
Johnson: My reason though is not because of the economy. . . . my reason would be the same as I agreed to go $400 million on health. I've never seen an anti-trust suit lie against an old-age pensioner for monopoly or concentration of power or closely-held wealth. I've never seen it apply it to the average worker. And I've never seen one have too much health benefits. So when they come in to me and say we've got to have $400 million more so we can take care of some doctors bills, I'm for it on health. I'm pretty much for it on education. I'm for it anywhere it's practicable. . . . My inclination would be . . . that it ought to retroactive as far back as you can get . . . because none of them ever get enough. That they are entitled to it. That's an obligation of ours. It's just like your mother writing you and saying she wants $20, and I'd always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that's a much better reason and a much better cause and I think it can be defended on a hell of a better basis. . . . We do know that it affects the economy. . . . it helps us in that respect. But that's not the basis to go to the Hill, or the justification. We've just got to say that by God you can't treat grandma this way. She's entitled to it and we promised it to her."
Appealing to public sentiment----the horror of seeing elderly dying of neglect---worked when FDR tried to pass Social Security and it worked when LBJ tried to pass Medicare. Sentimentality is the reason for the success of SCHIPs---who wants to see innocent children suffer from treatable disease? If—no,
when we get universal health care it will be by appealing to the hearts rather than the minds of Americans and its elected representatives.
However, some common sense is needed to fix some of the problems with Medicare.
I. Medicare (Dis) Advantage By now, I think that everyone---except the private insurance companies that get paid an extra 17-19% per member to deny health care to super-healthy Medicare enrollees---agrees that Medicare Advantage plans are a scam. Authorized by the Balanced Budget Act of 1997 as a way to reduce Medicare costs, all they have managed to do is soak up tax payer money.
http://seniorjournal.com/NEWS/Medicare/2007/7-05-24-CongressAMA.htm Wilson said, "Eliminating the overpayments to the insurance companies will save Medicare $65 billion over five years, according to the government's own estimate," adding, "Congress has to make a choice -- preserve access to care for all seniors by stopping next year's Medicare cut to doctors or continue to help insurance companies line investors' pockets"
The latest twist in the Medicare Advantage racket----the plans share a cut of their ill gotten gains with state and local governments. In exchange, retirees are forced onto the Advantage plans, which now routinely deny care for medically necessary treatment or have prohibitive copays or other barriers to care.
http://www.healthbeatblog.org/2008/07/the-trouble-wit.htmlAll insurance companies know that the best people to insure are people who are not looking for insurance. If they sign themselves up, it means they have health care on their minds.
A recent survey showed that over 40% of people enrolled in these plans had faced denials of care (something that rarely happens on traditional Medicare) and 80% did not understand their plans.
http://seniorjournal.com/NEWS/Medicare/2007/7-05-24-CongressAMA.htmThe first fix under Obama and the new Congress should be leveling the playing field. Private insurers who agree to cover Medicare patients should get 100% of their anticipated medical costs plus the same 3% overhead that Medicare spends. If they can not make a profit with that, let them go into some other business. II. Medicare Part D: “D” Stands for Drugs Recall that the 2003 Congressional Act creating Medicare Part D, the prescription drug benefit
prohibited Medicare from using its bulk purchasing power to negotiated reduced pricing from pharmaceutical companies. What kind of capitalist society keeps a buyer from bargaining for a good price? A crypto-fascist one that exists to serve the needs of the corporations. (Fascist governments serve corporations, socialist governments serve the workers) We all know what happened when Medicare agreed to pay whatever the drug companies wanted to charge for drugs.
The drug companies all got together and raised their prices. Any fool could have predicted that.
http://seniorjournal.com/NEWS/MedicareDrugCards/6-06-21-MedicarePartDDrugPrices.htm June 21, 2006 - Over the past five months, virtually all Medicare (Part D) plans raised their prices for the top drugs prescribed to senior citizens, according to a report issued yesterday by the health consumer organization Families USA. The report, based on pricing data submitted by the plans to the federal government, contradicts the Bush Administration's assertions that the new Medicare drug program is effectively moderating rising drug costs, according to Families USA.
Congressional workhorse, Henry Waxman has calculated how much money we are flushing down the toilet due to the no-negotiating-prices clause of the prescription drug bill.
http://oversight.house.gov/documents/20080724101850.pdfOver the next ten year, taxpayers would save $156 billion if Medicare could bargain the way that Medicaid can. And people would save an additional $27 billion out of their own pockets. That is close to $20 billion a year that Big Drug is getting because of an anti-free market clause in a piece of legislation that earned its authors lucrative jobs with the drug industry. For the record, no major health insurer that buys medication in bulk for a large number of clients pays top dollar---except Medicare.
So, Congress needs to amend the Medicare Pharmacy legislation to allow the insurance program to bargain with pharmaceutical companies---just as if it was a real health insurer and not a trough from which private business can feed. III. Wanted: An Ounce of Prevention A huge problem for the U.S. health care system is our lack of focus on disease prevention. Though we spend around $5000/per person per year on health care, almost twice as much as most Western European countries like France and Great Britain and Canada, our health indicators like life expectancy, infant and child mortality, death from preventable illness are poor. That is because those countries have cradle to grave universal health care which emphasizes disease prevention, so that people reach the age of 65 in the best possible health. In the United States, our business community encourages people to eat to excess, drink to excess, smoke, forgo healthy exercise and ignore their health until they hit Medicare age, at which point the medical community suddenly offers them an all you can eat buffet of very expensive remedies for a lifetime of medical neglect. This makes the
Medical Industrial Complex very, very happy---it consumes 15% of the GNP---though it does little to add to the quality of life of America’s seniors, since dialysis will never compare to a good set of kidneys---which could have been saved through early life diabetes management.
http://www.amsa.org/business/Medicare%20Report.pdfThis report shows where the money goes---check out the inpatient spending.
http://www.newamerica.net/blog/new-health-dialogue/2008/cost-end-life-spending-can-boost-bills-without-extending-life-3181This article discusses the high cost of end of life spending---and how it can vary from facility to facility. In patient care eats up a lot of that budget. For the last ten to twenty years or so, the medical establishment has been stuck in a groove when it comes to dealing with the rising cost of treating the rising number of Medicare beneficiaries. Even though everyone understands that it is their
chronic illnesses that keep costs high, the solution is always sought in cost containment strategies---like the Medical Advantage plans that were supposed to save money not cost taxpayers more.
Few have dared to consider the possibility that
chronic illness is not inevitable.
Here is an ABC report that compares health status and health costs for Europeans and Americans:
http://abcnews.go.com/Health/Diet/Story?id=3683683&page=1Turns out that Europeans smoke less and have less obesity, less hypertension, diabetes, arthritis, heart disease, cancer, asthma, emphysema and a host of other illnesses than Americans.
This added burden of disease has led to higher health costs overall. If the United States could improve its population's health to have the same levels of chronic illness as Europeans do, Americans would save between $1,200 and $1,750 per year each on medical bills, the researchers found.
All told, the higher rates of disease are costing Americans between $100 billion and $150 billion per year, or 13 percent to 19 percent of total health care spending for those age 50 and over.
With this is mind, the new Congress and the new president need to
get medieval on tobacco the number one cause of preventable disease in this country.
Environmental cleanup needs to be a priority, too (though first we need to admit that environmental pollution contributes to disease, something that government funded public health has been reluctant to do for fear of cutting the tax base). Too many children and adults can no longer go outdoors in major cities, because of the toxic air. Fish is not safe to eat. Soil is contaminated. Cancer is at epidemic levels in some parts of the country.
Income disparity needs to be addressed since this creates medical problems including suicide, increased infant mortality from multiple factors including prematurity, decreased life expectancy from chronic disease, depression, alcohol and drug dependence, domestic violence, gun violence.
Nutrition should be addressed, especially food industry efforts to get people addicted to high fat, high salt, high sugar foods at a young age.
Occupational safety issues can lead to later chronic diseases.
Family planning needs to be available to every adolescent to prevent teenage pregnancy and STDs.
Cities need to be planned to encourage mass transit and discourage private cars which will increase the amount of walking that people do and decrease the amount of urban pollution---just like in Europe.
Greater educational opportunity and improved literacy rates should also help with improved health.
These are just some measures which should cut down the rate of chronic disease and improve the sense of health and wellbeing of people over 65. Republicans won’t like them, but right now, no one likes the Republicans.
The three measures above add up to around $30 billion a year immediately and $150-180 billion a year eventually in savings to Medicare----and should make all of us much healthier in the process. That kind of money can easily fund a few public health projects, which are generally dirt cheap since they involve targeted educational programs and some legislation.
Democrats were swept into office on a mandate to supply universal access to health care. We need to make sure that everyone is covered, because it is the right thing to do, and we need to make sure that we can keep the promise we make today no matter what happens tomorrow.
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