Health Care Reform

Introduction

While Obama Care health care reform did some good things for some Americans, it did nothing to address the biggest problem in health care-the profit motivation. Six years later, understanding who and why 20 million Americans are still uninsured is part of the larger problem of expensive underinsurance. In this corrupt system preventative care is hard to get, contributing to escalating illnesses which the industry makes billions of dollars a year treating. Single payer health care is the path to eradicate the crippling profit motivation and put this embarrassing failure in the past. 

Reform Still Needed

With 20 million Americans still uninsured, health care reform is still needed. The new question is who are those who are uninsured:

• 40% are Hispanic (up from 29% in 2013)

• Undocumented immigrants

• 41% are White (down from 50% in 2013)

• 12% are Black (down from 13% in 2013)

• 6% are Asian and other races (unchanged from 2013) 

• 50% of uninsured are young ages 19-34 

• 58% are men (Goodnough)

The majority of the uninsured are the very poor, living in Southern states that have not yet expanded Medicare. While most of the uninsured have jobs, they have jobs at small companies, “with fewer than 25 employees. Those companies are exempt from the health law’s requirement that employers offer health insurance to their full-time workers or pay a fine” (Goodnough). While President Obama’s health care reform did do some good things (close the gap in Medicare Part D, remove pre-existing conditions, etc.) it failed to do the most necessary thing to ensure equitable health care, and that is to remove the profit motivation. The profit motivation is the greatest single scourge of health care, and is why America pays so much more for health care than any other developed nation. Some of the other scourges of the profit motivation include:

• Over-specialization of doctors leading to a shortage of general practitioners.

• Too heavy an influence of the pharmaceutical industry (in education and practice of medicine)

• Hospital policies reflecting profit end game rather than needs of the patient lessening quality of care and increasing mistakes. 

• Lack of affordable preventative care

• Expensive end of life care.

• Pricing of goods and services inflated for insurance. 

• Exceptionally high administrative costs.

The profit motivation could benefit the health care industry if providers, insurers, and doctors made money off of keeping people well, but the profit motivation is skewed to benefit shareholders if people are sick. A single payer system:

The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care. (Physicians for a National Health Program)

While more people have health insurance now, the majority of Americans are underinsured with policies they cannot use rather than in the worst case scenario. This makes the most effective care, preventative care impossible, and without regular visits doctors are unlikely to catch diseases until symptoms make them much more difficult and costly to treat. 

(Figure 1 omitted for preview. Available via download).

Unfortunately, this may be part of the entire twisted system of profiteering which is inherent in the system. For the fact is the Pharmaceutical industry is one of the most profitable in the world, as the graph above shows.

One keen example of this intense profiteering that heightens the call for the essential need for health care reform is the cost of cancer treatment. Dr. Brian Druker, who is director of the Knight Cancer Institute and one of the signatories, has pointed out “If you are making $3bn a year on [cancer drug] Gleevec, could you get by with $2bn? When do you cross the line from essential profits to profiteering?” (Anderson). The cold truth is that there money to be made in treating cancer, not in preventing it, and this is the biggest reason the system needs to be reformed away from profit. 

While many have been advocating for single payer health care for some time, many believe it is unlikely to pass, however this change could begin to manifest by increasing competition in the marketplace through introducing a public plan to give the public options to private insurance. This would force the private industry to compete for clients, and drive down the unwieldly cost structures inherent in profiteering. President Obama tried to do this when he introduced his reform bill six years ago, but it was a stumbling block to passage. However, the intense public support recently for Bernie Sanders has put the public option back on the debating floor. Analysts emphasize, Social Security cuts aren't on anyone's table right now. It's been relegated back to a GOP pipe dream. A full-throated defense of it from Democrats united with the grassroots made that happen. That's how you make good stuff happen. That's what has to happen again for expanding health care to everyone. (McCarter)

The health insurance companies have too much of a say in who gets what type of treatment, and it is warping the entire system. Health insurance companies drive up costs and then lie about the process of providing for care. For instance, “Highmark defended its request by saying it was paying out more in claims than it was receiving in premiums” (McCarter). This is untrue, since all insurance companies invest in reinsurance-the process of insuring their insurance-and in the end they never lose money. Many health insurance companies have seen their stock inflate over 1000% since Obamacare forced 20 million Americans to receive healthcare (Potter). Under the lie that they are paying for more insured Americans insurance companies are planning on raising their premiums by up to 40% next year. This is pure greed, totally unrelated to the needs of anyone, and way profit motive must be reformed out of the system. 

In the meantime the benefits of Obama care have provided a foundation of reform to build upon. Some of these positive changes entail:

• allows the FDA to approve more generic drugs in order to drive competition up and prices down.

• increases rebates on drugs through Medicare for Seniors.

• Health Insurance companies can’t drop your coverage when you are sick.

• Children under the age of 26 can stay on their parents insurance.

• The law imposes a 10% tax on tanning booths.

• The 80/20 rule is implemented. Insurance companies now have to tell their customers how their money is being spent. If they don’t spend at least 80% of the money on health care they have to give customers a rebate for the difference.

• payment increases to physicians, mostly in rural areas. (Obamacarefacts)

Thanks to the passion and outspoken nature of Bernie Sanders, more and more American doctors are expressing their desire for reform. Recently, “A group of more than 2,000 physicians is calling for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care” (Lagasse). This represents a fundamental shift, since for the past few decades calling for single payer would have people being called socialists. However, due to the outrageous profiteering of the insurance/pharmaceutical companies crippling the ability to provide quality care more people are raising their voices in protest. Now, over half of Americans support single payer, whereas in the 1990s that number was closer to 15% (Lagasse). This reform would:

• save about $500 billion annually by eliminating the high overhead and profits of insurance firms, and the "massive paperwork" they inflict on hospitals and doctors.

• patients could choose to go to any doctor or hospital of their preference.

• Most hospitals and clinics would remain privately owned and operated, receiving a budget from the program to cover all operating costs.

• Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics. (Lagasse)

Conclusion

On the current profiteering schema, the current health care system has the potential to bankrupt America in the next fifty years. Whether by choice or necessity, it is only a matter of time until a single payer system emerges to put health care in its rightful perspective. Until then Americans would do well to practice preventative care on their own.

Notes

1: Chart retrieved from: http://www.bbc.com/news/business-28212223

Works Cited

Anderson, Richard. “Pharmaceutical industry gets high on fat profits.” BBC, 6 Nov. 2014.  Retrieved from: http://www.bbc.com/news/business-28212223

Goodnough, Abby. “Six Years Into Obama’s Health Care Law, Who are the Uninsured?” The New York Times, 18 Aug. 2016. Retrieved from: http://www.nytimes.com/2016/08/18/us/six-years-into-obamas-health-care-law-who-are-the-uninsured.html?rref=collection%2Ftimestopic%2FHealth%20Care%20Reform&_r=0

Lagasse, Jeff. “More than 2,000 doctors call for single-payer health system.” Health Care Finance News, 2016. Retrieved from: http://www.healthcarefinancenews.com/news/more-2000-doctors-call-single-payer-health-systems

McCarter, Joan. “Democrats, don't shoot yourselves in the foot on healthcare reform.” Daily Kos, 18 Aug. 2016. Retrieved from: http://www.dailykos.com/story/2016/8/18/1561507/-Democrats-don-t-shoot-yourselves-in-the-foot-on-healthcare-reform

Obamacarefacts. “Health Care Reform Timeline.” Obamacarefacts.com, 2016. Retrieved from: http://obamacarefacts.com/health-care-reform-timeline/

Physicians for a National Health Program. “What is Single Payer?” pnhp.org, 2016. Retrieved from: http://www.pnhp.org/facts/what-is-single-payer

Potter, Wendell. “No. Obamacare isn’t killing the insurance industry.” Healthinsurance.org, 1 Mar. 2016. Retrieved from: https://www.healthinsurance.org/blog/2016/03/01/no-obamacare-isnt-killing-the-insurance-industry/