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'Medicare for all' proponents state their case

By Doug Hanneman
Litchfield (Minn.) Independent Review, Dec. 5, 2017

Nov. 1 was a day of relief for Gene Chrast. It was his 65th birthday, the first day he was entitled to Medicare benefits.

Retiring in 2009 after 38 years at 3M, Chrast, who lives in Meeker County, had been frustrated by his health insurance for too long. A couple years earlier, in an effort to shrug the tax impact of buying health coverage through MNsure, he turned to a broker, who found the only plan available to him on the open market. The down side: His doctor and the three nearest hospitals were out of network.

“I couldn't come to Hutchinson, I couldn't go to Glencoe, I couldn't go to Litchfield,” Chrast told an audience attending a health care presentation Sunday at the Hutchinson Event Center.

“I could go to a clinic in Litchfield, and the doctor there told me, 'Well, just call your insurance company and we'll have your work done at the hospital there.' He didn't know they wouldn't accept that.”

Chrast's experience was familiar to the presentation's hosts, Dr. Ken Engelhart and his wife, Carol, a registered nurse.

“People are happier and relieved when they get on Medicare,” Engelhart said. In all his years of practicing medicine, he noted, he never heard a patient wish to return to a private, employer-provided health plan.

The Engelharts, who have worked in rural and urban medical settings for more than 35 years, are part of Physicians for a National Health Program, which is pushing for single-payer national health insurance.

Under such a system, a tax would cover all or most health care expenses, every citizen would be covered, and delivery of care would largely remain in private hands. It would be similar to Medicare, but without the need for supplemental insurance. The approach is commonly called “Medicare for all.”

SINGLE-PAYER'S BENEFITS TOUTED

Under a single-payer system, Engelhart explained, “You aren't restricted by networks where you can go. That's the free market. What we have now is not the free market.”

The current situation — created by insurance companies and reinforced by Washington lobbyists and a reluctant Congress — are among the reasons Americans have the most expensive health care in the world, Engelhart said.

He offered numbers from various sources to back up the claim:

  • United States per capita health care spending, $9,024, is more than twice the average, $3,620, of other developed countries, according to the Organization for Economic Cooperation and Development.
  • National health expenditures consumed 17.8 percent of our nation's gross domestic product in 2015, more than twice the rate in most other industrialized nations, according to the Centers Medicare and Medicaid Services.
  • At approximately $3 trillion a year, health care costs account for one-sixth of the American economy, a rate that's expected to rise to one-fifth of the economy in the next seven years.
  • About 31 percent of that amount is spent on insurance administration, advertising, CEO/management salaries, profit making and other non-direct care costs that Engelhart described as “waste.” “That's more money than we spend in this country on K-12 education,” he said.

Despite that high spending, Americans don't realize the best health outcomes. Far from it, according to Engelhart:

  • Under the best circumstances, about 23 million Americans will remain uninsured in 2019, according to the Congressional Budget Office.
  • The U.S. life expectancy of 78 is ranked 30th highest in the world, right behind Costa Rica and ahead of Cuba.
  • A rate of 6.1 deaths per 1,000 infants gives the U.S. the world's 26th lowest infant mortality rate.
  • Higher cost care doesn't necessarily translate into more care. Americans, on average, see a doctor 4.2 times a year, while in Japan, where life expectancy is 83, patients see their doctor 13 times a year.
  • In terms of overall health care quality, France ranks No. 1, Australia ranks No. 2 and the U.S. trails at No. 19.

With lagging outcomes and high costs, more American businesses are wising up to the situation, according to a video the Engelharts showed to the 14 people in attendance. In the video, American business leaders, a retired insurance executive, physicians and others criticized the American system for its heavy rationing based on ability to pay, the plight of patients who defer needed care, and inefficiencies.

Businesses would fare better, according to the video's speakers, if they could shift the burden of health care insurance to a single payer. They argue that through Medicare, Medicaid, the VA, public employees' private health insurance coverage and other programs, government is already paying for 64 percent of all health care.

Under a single-payer system, according to the video, patients could see any doctor, visit any hospital, all costs would be covered, and nobody would be left out.

A handout distributed by the Engelharts estimated that if a single-payer program existed in Minnesota, an average business in 2014 would have saved $1,214 per employee annually. An average household would have saved $1,362 annually.

WHAT OPPONENTS SAY

Nobody attending the presentation spoke against the single-payer system. But opposition remains strong. Common arguments against it include long waiting times for specialized surgeries and other procedures, limitations in coverage for benefits such as mental care and prescription drugs, and public policies that ignore growth and innovation. Opponents also argue single-payers systems run the risk of fostering fraud, and because the government controls payments to providers, fewer people will want to become doctors, especially specialists.

Despite those objections, nationwide support appears to be growing. Kaiser Family Foundation Polls show 53 percent of poll respondents in June 2017 favored a single-payer program, while 43 percent opposed it. That contrasts with 40 percent support and 53 percent opposition in 2000.

“We're gaining momentum now that people are seeing it's wrecking our economy,” Engelhart said.

Chrast is among those who support it. Between dropping his first retirement insurance plan and enrolling in Medicare, he couldn't afford to see his longtime doctor in Hutchinson.

“He was telling me, 'Why aren't you coming in? With your high blood pressure, you're really due for a checkup.' I said, “I'm sorry, you're out of network.' … I was willing to die before putting my family in jeopardy and losing everything I worked for all my life. I wouldn't go to the doctor. I know people that have cancer who won't go to the doctor until they hit the Medicare age.”

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