I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.
I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.
I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. Click on this link to do so.
The Issue is Access to Care, Not the Number Who Buy Insurance
As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.
The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.
Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.
In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.”
The Insurance Scam
As Kevin Zeese and I wrote last fall, the ACA is one of the biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.
And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme.
And it is a scheme, because there are no guarantees that people who have insurance will be protected from financial ruin if they have a serious health problem. It is essential to remember that nothing about the basic business model of insurance companies has changed. They exist to make a profit and they are very good at it. While they complain about the ACA, because its regulations require more work on their end to find ways around them, it has been very lucrative for them. Health insurance stock values have doubled since the law passed in 2010.
One of their major work-arounds is the use of narrow and ultra-narrow provider networks to discourage patients with pre-existing conditions from buying their plans and leave patients footing more of the bill. Narrow networks exclude at least 30% of local hospitals and ultra-narrow networks exclude at least 70%. This means that if the local cancer center isn’t included in a plan, then people with cancer are unlikely to buy that plan. To make it worse, it’s difficult for patients to determine what providers are included in different plans because the information on the insurance exchange websites has been found to be wrong half the time.
The reason for the narrow networks is that when patients don’t go to an approved health provider, they bear most or all of the costs. The limit on how much money people can be required to spend in addition to premiums doesn’t apply when patients go out of network (and the limit was removed for 2014 anyway). In practice, if someone develops a serious health condition and the hospital or health professional that treats the condition is not in their network, they will have to go without care or find a way to pay for it. And if a person has a serious accident and is taken to a hospital that is out of network, the patient will again bear the total cost. Buying insurance is a health care crap shoot.
The Race to the Bottom in Health Care Benefits
Medical bankruptcy and self-rationing, foregoing necessary care due to cost, are two products of our market-based health system and we can expect them to continue under the ACA, even as more people become insured. Supporters of the ACA often quote the slowed rise of health care spending that has been happening since the financial crash in 2008. They claim it is a sign of the law’s positive effect; however, the slowing is actually due to fewer people using health services. In 2012, 80 million people went without necessary care because of cost.
Self-rationing will continue because there has not been an economic recovery for most of us. More than 80% of people are buying lower tier health plans that require high up-front payments for care at a time when most families are living paycheck to paycheck. The number of people who are considered poor or low income is rising. And, as Paul Bucheit writes, if we updated our standards for measuring poverty to reflect the current economic realities (the costs of food, housing, health care, education, etc), the poverty threshold would be over three times higher than it is now. He adds that half of the US population owns zero wealth because of debt. It is a sad irony that people are being forced to pay monthly premiums for health insurance that will leave them without money for actual care.
And now that lower coverage plans are legal, they are accelerating the race to the bottom in employer health benefits. Employers are shifting more of the cost of health care onto employees, reducing coverage for dependents, moving employees into private insurance exchanges (which do not qualify for subsidies) and penalizing employees for poor health habits, which places the blame for health problems on the individual without acknowledging that many drivers of poor health are out of the individual’s control. While tying health care to employment is not ideal, in the US at least the employer-based plans used to provide better benefits than those on the individual market.
The Practical Solution
The solution to the ongoing health care crisis is obvious. We need to reverse direction completely and move to a national publicly-funded health insurance for everyone. Some call this a single payer or ‘Medicare for all’ plan. We are already spending enough on health care in the US to provide high quality care to everyone. It is just wrong from a standpoint of what works to continue shifting more of our health care dollars to bureaucracy instead of to care and to the private insurance industry which is designed to keep as much for itself as it can get away with. It is immoral to protect insurance company profits instead of protecting the health and wellbeing of our people.
Putting our money into the insurance industry is a step in the wrong direction. The Expanded and Improved Medicare for All Act, HR 676, in Congress, would eliminate the insurance industry and create lifelong comprehensive coverage for everyone. No matter what you choose to do about insurance, tell your Congress member to support HR 676. And if you are one of the millions who do not plan to buy insurance, join me in telling Obama why. Click here to write President Obama.