By George Bohmfalk, M.D.
The Aspen (Colo.) Times, September 13, 2018
(Part 2 of 6. Read parts 1, 3, 4, 5 and 6.)
In this series of weekly articles, I will describe the current status of health care in America and how we might improve it. Inasmuch as most people younger than 65 have no great need to understand what Medicare is, and as Medicare may be a good model on which to build a universal system, I’ll briefly explain a bit about it.
Medicare began over 50 years ago, in response to poor medical care and high poverty rates among our seniors. It has succeeded in alleviating both of these crises and continues to be a very popular and efficient health insurance program. Medicare is a universal, single-payer system, meaning that it covers everyone in the designated group, and that payments for medical care are all made via a single source — the federal government. Funding comes from both taxes and premiums. In striking contrast to some European-style socialized systems, medical care under Medicare is privately delivered, at private hospitals by doctors in private practice. Every Traditional Medicare enrollee has free choice of doctors and hospitals.
Notwithstanding its many successes, Medicare is not a perfect system. Its most glaring deficiency is that it pays only 80 percent of charges, leaving the enrollee to pay the remainder, either out-of-pocket or through Medigap plans sold by for-profit private insurers. While seemingly small, this 20 percent difference, along with deductibles and copayments, can become an insurmountable financial burden in complex cases. Seniors are filing bankruptcy because of medical debt.
Another major deficiency when Medicare began was that it did not cover prescription drugs. As medicines became unaffordable to many seniors, Congress attempted to remedy this in 2003 by adding Medicare Part D, the prescription drug program, available for an added premium. Unfortunately, the pharmaceutical lobby arranged for a provision to be included in the law that forbids Medicare from negotiating drug prices. As a result, we in the world’s largest pharmaceutical market pay the world’s highest prescription drug prices. Productive young people are dying because they can’t afford insulin, once one of the least expensive and most life-saving prescription drugs.
Traditional Medicare still does not cover dental, hearing or vision care, aspects which can have large impacts on our overall health. I once operated on a man whose tooth infection spread to his brain. Dental problems contribute to arterial disease, and poor hearing and eyesight lead to higher injury rates and accelerated mental deterioration. These and other deficiencies can be readily corrected in a national Improved Medicare for All program.
Where do we stand now overall? Unfortunately, we don’t have the best health care system in the world. We do have many great doctors and hospitals, but we pay about twice per person what most other industrialized countries pay for their excellent health care. Yet nearly 30 million of us remain uninsured and 40 million underinsured. You may know someone, or find yourself, among the underinsured. These are folks who believe they have good insurance, often through their employer, but when a health issue arises, the high deductibles and copayments are daunting. If you’re underinsured, you may be forced to choose among wiping out your life savings to pay for care, filing for bankruptcy when the bills come in, or delaying or declining needed care, if that’s possible.
Even people with good insurance are often surprised by its deficiencies and disruptions. In order to maximize their profits, insurers seek discounts from doctors and hospitals and form provider networks of those low-bid participants. These narrow networks become very inconvenient when you are covered only at a remote hospital or forced to change doctors. There are dozens of stories of people being stuck with $25,000 to $60,000 bills from air ambulance companies that were not in their insurance networks. How were they to know that beforehand? Health insurance isn’t what it used to be, and it’s getting worse.
You might think that paying such high prices gets us good results, but it doesn’t. Reports by the OECD (Organisation for Economic Co-operation and Development) show that we rank below most industrialized nations in many health outcomes, including life expectancy. Our maternal and infant mortality rates are among the highest. We pay the most, and get the least for it.
In subsequent articles, we’ll see where all our money is going and how it might be redirected to improve our nation’s health. The short answer is by expanding Medicare to cover everyone, and improving it to remove the deficiencies described above.
Spoiler alert: In the end, we’ll spend less overall. It’s a mind-boggling thing.
Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.
