There are no longer any sideshows at the circus or at Coney Island. We are too refined, too evolved for such. But we watch freak shows nightly. They are inescapable. Every single channel shows them.
Whatever do I mean? Shriner's Hospital and St. Judes Hospital run long prosy, promotional ads showcasing their young patients, with photogenic disfigurations--poor dentition, withered limbs, missing limbs. Oh the things they can do! Bike, paint, do gymnastics, walk! Don't you want to support them? Always young, always cute, always soprano. Mostly Caucasian, with only a sprinkle of Asian and maybe half a glimpse of an African-American. Once they go basso, they’re no longer box office boffo. Poor Alex from Shriner's now gets to introduce the new mutants, as cuteness quotient dropped with the deepening of his voice.
Alternatively, for those with non-picturial diseases or who have attained their majority, there’s GoFundMe. In the internet market, they can beg like schnorrers in the natives of Calcutta, sacrificing dignity for treatment.
Imagine a world where these poor souls could have a little dignity, instead of having to shill for their treatment. Once upon a time, these armless painters and legless bikers at least could earn a good living enticing rubes into paying for circus admission. They were celebrities. Now they are forced to cede medical confidentiality to fund raise. One wonders if they worry that refusal equals denial of further treatment.
And yet an alternative world exists. In almost every country of Europe, such souls do not pay a dime for their treatment. If they need cabfare, they are reimbursed for it. And not only those anomalies and curiosities of medicine. All those with medical problems. You must have seen the commercial where the woman has to walk her children to the doctor, because she cannot afford groceries and pay car insurance as well. Where is the outrage in living in a country where medical health has to be compromised for basic necessities?
And that is why for the past five years I have been a fervid advocate for single-payer insurance, sometimes known as Medicare for all. Over 33% of all Americans cannot access needed medical care due to money. In fact, the United States is the only country in the world where citizens declare bankruptcy due to costs of medical treatments. And over ¾ of those had health insurance. Currently, health care administration constitutes 31% of health care costs in the United States, versus 16.7% in Canada. The private insurance overhead is 11.7% vs government insurance of 6.8%. Administrative tasks constitute 13.5 % of US physicians time vs. 8.4 in Canada. Under single-payer, Federal funds currently utilized for Medicare, Medicaid, Family Health Plus, and Child Health Plus would be combined with the state revenue in a health trust. Local share of Medicaid funding would be terminated. New York would receive a federal waiver so that the new single payer option—New York Health, would be enveloped within Medicare, Medicaid, Family Health Plus, Child Health Plus, ACA benefits, and any other federally funded program. Medicare for all gives teeth to Black Lives matter.
Worse, mental health care receives decreased funding. Although mental health has parity, the reality is insurance will cover less than 13 sessions. Additional sessions may cost $200 each. THRIVE helps New Yorkers recognize an individual in need of mental health services. It doesn’t provide these services. Emergency rooms and urgent care are not mental health services and in fact may be mental health exacerbaters (and exasperators).
What are the consequences of lack of mental health coverage: mental health deterioration, decreased economic status, decreased social status, increased social isolation. Psychotherapy works: 80% of those receiving psychotherapy improve. Those with little access to psychotherapy show higher rates of mental distress. Medicare for all is an issue for Black Lives matter so that they too can thrive.
In our present system, the more mental distress, the more sadistic restrictions. Insurance agents contact patients in hospital, informing them they don’t merit such restrictive environments. They contact users in rehab, informing them similarly. They deny coverage of physician prescribed medications. They deny access to specialists who may better meet patients’ needs. Patients receive threats to confidentiality, delays in receiving care due to prior authorization. And finally—lack of access for children and minorities. Medicare for all would g enhance the economic health and social status of minorities(especially males) in New York. Medicare for all is a Black Lives matter issue.
All countries, regardless of whether they offer health insurance, have similar prevalence of mental health disorders. However, the US has the lowest rates of treatment. Least likely to receive treatment: the young, the poor, the lesser educated, and males. Furthermore, while most industrialized nations have increased spending on mental health services in the past decade, the US has decreased such. In other countries insurance is a social service. In the US, it is a source of shareholder, stockholder, and CEO profit. As such, over 50% of dollars support overhead or profits. Administrative overhead of private insurance in the US is five times higher than that of the single-payer program in Canada. The waste cost in US health care was over $910billion in 2011. The biggest waste: administrative complexity. And results in increased rates of the mentally ill incarcerated or homeless. Medicare for All is a Black Lives matter issue.
Medicare for all is a capitalistic solution. It is based on a single-payer system set within capitalism, such as the Canadians already have. At present, the difference between Canadian capitalism and the American is merely over who the payer is: the government, as opposed to a combination of patients and their insurers. With the latter, payments are pawns to a false philosophy: patients are wiser utilizers of medical services when they have “skin in the game” (i.e. a copay). Skin in the game restricts access, as many refuse to see physicians for minor ailments, and only make appointments when minor problems become major. Skin in the game enhances distrust between patients and physician when patients wonder whether physicians only recommend treatments based what their insurer will pay, or, patients reject recommended praxis due to fiscal concerns. Furthermore, access is further restricted when insurers decide to review records using clerical personnel and decide to reduce physician payments based on their assessment of what best praxis should cost. Throw in a lack of true parity for mental health, vision, and dental care and one can only wonder why a latter-day Samuel Adams (himself an American with disabilities) has not thrown all health insurers into some harbor. These practices only serve to ration care, not rationalize it. A single payer system would restore trust, increase access, and reduce health care costs by paying hospitals and doctors a lump sum monthly. These health care professionals would retain private status, and would not be government employees.
New York is a progressive state. Under the Affordable Care Act, states are encouraged to innovate their health care systems. Hence, a new prod to renovate into a single-payer system. The proposed New York Health Assembly Bill (Senate bill S3525) currently under consideration in the New York Legislator is our chance to lead the way. It has been passed by the lower house and will eventually be voted on by the Senate. Under this bill, every New York resident would be covered, regardless of their age, their income, their savings, their employment, or their legal status. Residents desirous of medical care would simply flash their eligibility card in front of the receptionist to receive services. There are no co-pays or deductibles. Single payer is not socialized payer. Doctors would bill the Health Department for services. Tests and prescriptions are all covered. True parity would be offered: not only medical, but mental health, dental and vision care. Since every resident is covered, treatment is available to all who wish. It is not socialized as doctors and hospitals remain privatized—they negotiate patient care with the patient—not with a third party. New York Health would just pay the bills. No doctor would have to face patients ripping out their IV tubes and signing themselves out against medical advice because their insurer does not cover that physician or that hospital. No medical bankruptcies. No loss of employer coverage when sickness trumps employability.
The money is there, via the state payroll tax (paid 80% by employers,20% by employees and 100% by the self-employed). Non-payroll income, such as capital gains, dividends, and interest would also be used to fund New York Health. Medicare for all would be funded via progressive revenue: 6% surtax on household income over $225,000, 6% tax on property income, 6% payroll tax on the top 60%, 3% payroll tax on the bottom 40%. Costs for the individual would decrease—no more premiums, deductibles, co-pays, and out-of-network minimums. The average cost of an employer-provided family plan in New York today is over $17,500 with an average family deductible of over $2200. The average individual spends over $6,000 a year for health care premiums. Overall health care costs will decrease as the profit that insurance companies must have (up to 30% of the health care dollar) will disappear. Doctors’ administrative costs will decrease, as there will be no need to have billing specialists whose sole job is to negotiate with various insurance companies: no more insurance companies operating within New York State
The ACA (Obamacare) has failed to ensure universal coverage. It was based on the notion that Federal aid would enable citizens to buy insurance via subsidies—it did not predict that insurance companies would then raise their premiums to ensure their profits would never be used to pay for health care costs, a perpetual game of keep away. Keep away does not bring down health care costs, as insurers are a for-profit venture with no incentives to make costs transparent. The growth in the net cost of health insurance is due to administrative waste and executive profits. ACA further assumed that states would expand Medicaid coverage—and approximately half did not. One third of Americans report they are now unable to access needed medical care due to cost. Medication costs are 50% higher in the US than in Canada. Pharmaceutical companies spend less than 13% of their revenue on research. They spend 31% on marketing, 20% for profit. Who really has skin in game? The insurance CEO’s. Private insurers kept $47billion of the $401 billion collected in premiums. In the past few years, 32 executives of for profit insurance received $548 million through cash and stock.
Trump’s presidency has insured that the Affordable Health Care will die the death of a thousand cuts. Individual subsidies have been eviscerated and more middle class individuals have to drop their health care insurance, echoing the woman in the advertisements—they can’t afford health care insurance and groceries.
New York Health would reduce health care spending by 15% due to decreased billing expenses, administrative waste, and fraud. New York would only be a more desirable place for employers, as it would cost less to hire workers. Doctors would be free to offer care for their patients. Patients would be free to consider all the empirically sustainable medical options. The VA already offers single-payer for some. What about the rest of us? We already have public schools for all, police protection for all, fire protection for all. We have free public libraries which are open to all. Why not the rest!