This week, we witnessed the former heavyweight champ return to the center of the ring to bathe in the celebration of one of his greatest moments. Former President Barack Obama returned to observe the anniversary and an ever-so-slight improvement of the Affordable Care Act.
And, given the nature of our politics today, we throw a party for installing a plan that was conceived in a conservative think tank, passed, barely, by a Democratic President and challenged by Republicans almost weekly. And frankly, while offering some insurance to folks who couldn't afford it before, still did virtually nothing about the cataclysmic rip-off that is the American healthcare system.
A bit of overstatement, you say? Au contraire, mon frere. Thought I'd toss in something from a country with an excellent healthcare system. My fellow beleaguered taxpayers, we are being monumentally screwed and it's getting worse. Let me offer some statistics, and I promise you will neither be bored or surprised. Ah, but I have a solution as well, and one we are already doing successfully.
As a country, we spend 19%, just under one fifth of our national wealth on medical care in 2020. That is just under $12,000 per man woman and child per year. And that jumped from 17% of the GDP just a year before. Some of that was due to covid, but then, every country had to deal with that.
OK, you say, those cheese-eating, tulip-growing, wooden shoe-wearing Europeans and others of their ilk must spend more with their socialized medicine, eh? Nope, in Sweden, it's $5,700 a year. In Canada and the UK, it's around $5300. In fact, the only country close to our overall spending was Britain, with 13% of their GDP going into the doctor's bag.
How about one of our big trading rivals? In Japan, they spend on average, $4,691 a year per person.
Alright, you're thinking at this point, but our care is a notch above the rest, right? Well, buckle up, grasshopper.
According to most national healthcare rankings, we are way down the list. But understand, those rankings include cost and availability. US doctors and facilities are first-rate, if you can get to one. And that is where we fall down and are ranked below every industrialized nation, and some not so.
The World Health Organization ranks us 68th in the world in cost, access and successful outcomes.
CEOWorld magazine ranks the land of the free 30th in the world list of healthcare systems.
And some things that other countries take for granted are a luxury here. An ambulance ride? In the US, 71% of ambulance companies don't take your insurance. Average cost for a ground trip, $450. If you are helicoptered to a hospital, it's $21,700 on average. By the way, in France, the ambulance will have an actual doctor on board, not an EMT.
An MRI in the states can run around $14-1500. In the UK, it's $450...in the Netherlands, $190.
I had a hip replacement a couple of years back, and thanks to my company plan, and Medicare, I only paid a fraction of the $40,000 cost. In Australia, it would have been $19,000...in the UK it's $15,000...and in Spain, $6,750.
I could list several procedures from cataract removal to a heart bypass, and the cost in the United States dwarfs that of other industrialized countries. So, why is that? It is simple. We have a for-profit system to deal with an aspect of our society that can literally mean life and death. I remember when the Buick was nicknamed the "doctors car." It was pricier than a Chevy, but only the banker drove a Cadillac. Well, the doctor's car is likely a Mercedes these days.
Do I begrudge them that? Of course not. They spent, or went into debt, for a bloody awful pile of college costs, which is another argument, by the way. They didn't invent this system, they just swim in the same ocean we all do. But that is all part of the unbearable burden we all bear anyway.
And because of that, the leading cause of bankruptcies in this country, 66% of them, is medical debt. Even the loss of a job or divorce pales in comparison. This, of course, leads us into the area of philosophy.
Is health care a right guaranteed by the nation to its citizens, like education, police and fire protection, etc? I would argue, yes. Life and death shouldn't depend on your income. You may disagree or propose some other solution than the one I will suggest, like increased competition. Go ahead, suggest it.
That supposes we buy health care the way we buy a car or a fridge. When was the last time you shopped prices on doctors or hospitals? If you are talking to a doctor and he says an x-ray catches 70% of the possible cancers out there, but an MRI is twice as good, do you settle for the cheaper scan? If it's your child's life at stake, do you look for the cheapest doctor? If we are car shopping, we stay in our price range usually. If you're in the Ford category, that's where you shop. If we bought cars the way we buy health care, we'd all be driving Bentleys. When it comes to the life of your loved one, good enough isn't good enough. Well, OK, I’d still like the Bentley
When I was on a reporting trip to Germany when east and west were about to reunify, it coincided with our national debate over the Clinton health care plan. I was talking with the interior minister for West Germany about healthcare and the differences between the conservatives and liberals, the Christian Democrats and Social Democrats. Did the conservatives want to go back to a for-profit system? Oh no, he demurred. They don't argue about the need for national health. They argue about who can run it the most efficiently.
So, what are they doing right that we aren't? Well, you already know, but what you may not have thought of is, we are doing it as well, just not completely.
There are different types of national health around the world. Some are true socialized medicine. The British National Health Service is an example, as the UK funds health care with tax revenue and also employs the country’s medical providers (people can opt out of the NHS and obtain medical care privately, but this is rare).
Within the U.S., yes, right here at home, the Veterans Health Administration is an example of socialized medicine, although it only covers a small fraction of Americans.
Most though opt for what is known as single-payer healthcare. It is far simpler and easier to administer. No matter what the guy on Facebook says, it isn't socialized medicine. The same people own the hospitals, and the same doctors work for themselves.
What it actually is, is socialized insurance. All doctors and other practitioners operate under the same fee schedule, one that is arrived at in negotiations with the government. The doctor doesn't have to have several staffers dealing with all the different insurance companies out there, just one. He knows what he'll make, and we know what we'll pay. Will private health insurance disappear? Not necessarily, if you have the means and want to go above and beyond in some area.
The arguments against? Many say it will lead to rationing. Yeah, well, the current system does that quite nicely, thank you. With narrow provider networks, cost-sharing and a list of treatments and drugs they just won't cover, we are rationed. Not to mention cost. And the insurance company has an overriding incentive to deny care. The less they spend, the more they make. Ever wonder why insurance companies, of all types, delay so long? The longer the money they know they owe you stays invested, the more they make. That is until they can’t ignore your final angry phone call.
Some say it would stifle innovation. Again, our drug costs are far above other nations, and most of the truly pioneering work is initially funded by the National Institutes for Health. Yes, public money pays for most of the research. While Pfizer spends time and money extending the patent on Viagra, Uncle Sam funded covid research.
Add to the mix, we already have one of the largest single-payer systems in the world already in operation. It's called Medicare.
There are about 65-million people on Medicare, which is single-payer, twice the population of Canada and close to the populations of France and the UK. The overhead costs to run Medicare are 1.4% of its budget. For Aetna, Blue Cross or United, the overhead is around 17%. 17 cents of every premium dollar you spend goes to running the company, with a profit. I would think my conservative friends would be overjoyed to reduce paperwork and overhead costs.
The satisfaction rate among Medicare recipients is high, just ask your folks. And the horror stories about Canada? Is Sergeant Preston laid up for months waiting for his broken leg to be set? Canadians do not have to wait for any life-threatening condition according to the Canadian Medical Association Journal. In fact, its editor-in-chief, David Woods, who once advocated a market system, now says single-payer is essential to controlling costs.
And the healthcare outcomes are better. We are at the bottom of the list of industrialized nations in life expectancy, infant mortality, percentage of people over 65 with 2 or more chronic conditions and obesity rate. At the bottom among 13 other advanced economies.
So how do we pay for expanding Medicare to everyone? Well, how do we pay for health care now? The money that goes from your check to one of the big insurers, would go to Medicare. And it would be less, since as we pointed out, it's a lot cheaper to run. And the pool of Medicare recipients, unlike now with simply the elderly, would have lots of healthy people who pay premiums, but rarely need medical services. That’s how private insurance works. Those who are poor, would be handled by Medicaid as they are now, and there would be more money available for that. But the beauty of it is, everyone gets it, no matter what their problems.
It would even do wonders for American competitiveness. What is the one thing Toyota doesn't have to worry about that GM does? The cost of company health insurance. I did PR for General Motors for a couple of years early in this century, and the head of Human Resources once told me the difference in cost for, let's say, a pregnancy in Houston versus New York or California. They have to account for that for all their employees. He said, "If we tried to sell cars that way, we'd be laughed out of the market." Take that insurance monkey off corporate America's back, and you'd be able to hear the massive exhale of relief from coast to coast.
At this point, some of my conservative friends are typing furiously about the tax burden in some of these countries. Well, yes, Denmark’s income tax rate is around 50% and ours is around 35%. But for that, they get healthcare AND free college. The last survey of world happiness, they came out on top, so mom and dad aren’t pulling their hair out because the kid switched majors to art at U of Copenhagen. Besides, add in your insurance premium, Social Security and Medicare, and my guess is the difference will shrink considerably.
OK, it makes sense, would cover everyone, saves money, is good for business and isn't communism. So will it happen? In a word, no. In two words, hell no. And you can explain it in two other words. Campaign finance.
The rules for campaign contributions are determined by the very people who get said contributions. Ask Ted Cruz if he's willing to kill the golden campaign goose to help all Americans get health care. Oh, he might read some children's book to you, complete with blow-up charts, but after that, the answer would be laughter. And frankly, no one wants to hear Ted laugh.
And that is simply the rub that no amount of Ben Gay can assuage. As long as hospital corporations have marble-lined lobbies to build, doctors have Ferrari payments and insurance companies and big pharma can keep you on hold with Kenny G, and more importantly back up a truck full of cash to the Capitol, you'll never see it happen.
And that's a shame, in ways both trivial and important. All I can say is walk and take your vitamins. You'll need them.