I had emergency surgery awhile back, and the results were so positive that when I went for my follow-up visit there was little to say. So I asked the surgeon how he would untangle the grievous mess that is the U.S. health care system.
“Take the profit motive out of medicine,” was the response. He’s right, but it’s easier said than done; still, we must try.
A frisson went through those who control the giant profit-making health care companies when a patient with a murderous grudge gunned down United Healthcare CEO Brian Thompson in Midtown Manhattan on Dec. 4 – especially after many in the notorious national chat room suggested he might have had it coming.
Murder is never justified, but how did we end up in this dark place, where despite all the billions of dollars poured into the system daily, we’re more frustrated than ever?
The statistics are almost too familiar, but bear repeating: The U.S. has by far the world’s most expensive system, yet has dismal rankings for overall health – and life expectancy in many areas has actually fallen.
One explanation is how two national systems developed in the U.S. and Canada, its nearest and most familiar neighbor.
In both nations, a program called Medicare started in the mid-1960s, but quickly diverged.
In Canada, the system covers everyone. No patient gets a bill; costs are negotiated and allocated among providers, with government playing a leading regulatory role.
As in any system, there are complaints – especially the waits for elective surgery that Americans probably wouldn’t tolerate. But satisfaction among Canadians is far, far higher than ours, and costs are much lower.
In the U.S., Medicare covers only those 65 and up. It’s “single payer,” meaning the federal government pays the bills and raises tax revenue to support it.
Yet since the early 2000s, Medicare has been invaded by private interests – both through the “Advantage plans” government subsidizes even though it could offer the same benefits directly, and Part D prescription drug coverage, which – at Republican insistence – allows manufacturers to charge the taxpayer whatever they want.
Only with President Biden’s foot-in-the-door bill requiring price negotiations on a few high-price drugs have we seen any relief, but drug costs will remain a major problem.
Then there’s the enormous bulking-up of provider networks, with larger and larger companies buying up more and more hospitals and physician practices.
Even in Maine, where non-profit “charitable” organization remains the model, just two companies – Maine Health in Portland and Northern Light in Bangor – control the vast majority of care.
We should recall that these hospital consortiums are private entities whose decisions are opaque to the public. What maternity wards remain open, what staffing levels are maintained, what new services are offered is largely private and unaccountable, not reviewed by any public agency.
In the end, we have huge providers and drug companies trying to maximize revenues, opposed by insurers who try to contain costs largely by denying claims.
It’s no secret who’s being squeezed – patients and their doctors.
Everywhere, doctors say they can no longer select the most effective treatment; instead, they prescribe what insurers will pay for, a constantly changing target.
The Affordable Care Act of 2009, the most significant change in the system since Medicare began in 1965, and President Obama’s signature achievement, did tackle the biggest problem of the day – the uninsured. But it did so by vastly increasing those on private insurance, perhaps accelerating the consolidation that elevates the “profit motive” ever higher.
We’ll never fundamentally change the system until we recognize that we need a national system under public control, just like every other advanced country.
Calling it “single-payer” is perhaps the worst euphemism ever coined, meaningless to the average person. We can call it “national” or “universal” or even “government directed” but it’s the only way to reclaim our rights.
Such changes are a remote possibility with the incoming administration, since Donald Trump rarely mentions health care, and has no plan beyond the vestigial Republican impulse to “repeal Obamacare,” which is never going to happen.
Except for recanting her earlier support for “single payer,” Kamala Harris had little to offer, either.
Proponents of national health care should get busy developing a real plan, showing how Medicare can be purged of profit-seeking, private insurance contained, drug prices regulated and state-run Medicaid programs, which vary widely, made subject to federal standards.
Then we’d have something closer to “Medicare for All” – no longer just a slogan – and finally achieve something for all Americans closer to Canada’s efficient delivery system.
It may seem impossible, but we’ve confronted and solved difficult problems before. Let’s face it: Nothing changes until we demand change.
Douglas Rooks has been a Maine editor, columnist and reporter for 40 years. He is the author of four books, most recently a biography of U.S. Chief Justice Melville Fuller, and welcomes comment at drooks@tds.net
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