Health Care In America:
Why It is So Unfair and Unaffordable,
And How Americans Can Fix It
(This article last revised 8.20.2013)
In 1948 The United Nations adopted The Universal Declaration of Human Rights, and Article 25 states the following:
"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."
Canada and many countries in Europe have come a fairly long way in trying to ensure those human rights, but even though the United States was a key influence in writing and adopting that Declaration in 1948, in the last 30 years the United States has been going backward in that regard.
In fact, the U.S. is one of the biggest failures in the world in failing to secure those rights and ensure that everyone can enjoy a decent standard of living with income adequate for their health and well being.
America has failed so badly that it has one of the highest rates of child poverty in the industrialized world, to the extent that, as the latest UNICEF report on child poverty showed, 23.1 percent of American children live in poverty and suffer from malnutrition, giving the United States the second highest rate of child poverty out of 35 developed countries. Only Romania ranked higher in child poverty. And, in recent years, 20.5 million Americans were living on less than half of the federal poverty level (which is based on an outdated and inaccurate formula to calculate data).
This is disgraceful, since children in poverty become malnourished and prone to illnesses and diseases, and it's especially disgraceful since America has failed in spite of the fact that it has the knowledge, the technology and the means to be one of the most successful in serving in the interests of all the people.
The cry by Republicans, Libertarians and some fiscally conservative Democrats that "We cannot afford" the human services government now provides, let alone provide more, is simply misleading propaganda created and spread by rich people who don't want to pay their fair share of taxes.
The actual problem is that during the last 30 years the wealthiest few and their giant corporations and banks have been enabled to hoard 95 percent of the nation's wealth, and pay little or no taxes.
That's why America still has the most costly for profit system of health care in the world. Even its supposedly non-profit hospitals and insurance companies rake in huge profits and pay their top executives as much as huge profit-making corporations do -- which is millions of dollars per year.
Moreover, even though Americans pay more than anyone else in the world for their health care, the care they receive ranks relatively low in the world. And the care they receive is determined not by the doctors of patients who need care, but by profiteering insurance companies that are still allowed to control the system.
While the medical insurance companies would like us to believe they provide “managed care,” what they do is manage their costs. Insurance companies even hire and pay investigators to find any reason they can use to deny care, deny tests that patient’s doctors order, and deny treatment. Insurance companies also hire and pay their own doctors to decide if patients need further care, and they can overrule doctors who are actually treating the patients in question.
This is an absurd system that has been made legal by the U.S. Congress, even though and even after it has proven to be horribly detrimental to patients in many cases. So we must correct this, because the proper decision whether or not to do tests or continue hospitalization or care should be made by a patient and the patient’s doctor, not by someone hired by the insurance company.
Why has it become this bad?
Mainly it's for the same reason that America has such a huge income gap and income disparity between the wealthiest few and the working poor. The government and its political economic system is rigged to ensure that the wealthiest few keep getting wealthier; that incomes and profits are unlimited; that rich investors are very richly rewarded; and that the tax burden is shifted from the wealthy and placed on the middle class and working poor.
The problem is that while that is great for the wealthiest few, such unfairness and inequity is to the detriment and at the expense of the vast majority of the people, the environment, the infrastructure, and the whole country.
That has produced the horribly unfair and inequitable situation in America in which the wealthiest few are multi-millionaires and multi-billionaires while about 20 percent of Americans live in poverty and at least 40 percent of the people work full time for a living but are paid meager wages and salaries that are insufficient for them to afford all the basic necessities of life in America.
By the way, if you want fact and figures about that, the article on Poverty: America's Greatest Shame explains how and why such inequity, unfairness and injustice exists, and also explains the results and consequences. It explains how and why the U.S. is rapidly going backward in terms of protecting the rights of workers and providing help to those who really need it.
But, the basic reason the health care situation is so horribly expensive and bad is because the U.S. is the only industrialized nation in the world that does not have non-profit, publicly funded universal health care for all its citizens. America has simply not yet acknowledged that with universal health care we would spend far less because there would be no need to richly reward owners and investors with high profits, and the people would pay for just what they need through taxes according to their ability to pay.
Instead, the U.S. has a system driven by profit-making and getting the highest profits and the greatest return on investments --- a system in which prices and costs steadily escalate and rise as demand increases --- a system that richly rewards the rich at the expense of everyone else.
[The disgraceful 2017 Republican efforts to "replace Obamacare" is a grossly exaggerated version of that system, at it is a gross abuse of power. It would amount to the largest tax cut in American history for the wealthiest few, and the largest transfer of wealth from the middle class and working poor to the rich.]
By contrast, publicly funded Universal Health Care is a sane publicly owned system in which the actual costs of staff, medicine, equipment, research and development and overhead are not raised by a manipulated profit margin. They are provided at cost. Patients pay nothing out of pocket, and the system is funded through tax revenue, the amount of which is, and in America would be, a much smaller amount than Americans now pay through insurance premiums, co-pays, costs for medicine, etc.
In other words, as an increasing number of physicians and economists have been saying, Universal Health Care would not only be beneficial to all, but it would be far less expensive than the for-profit system American has now.
For example, Physicians for a National Health Program published an article (click here), which begins as follows:
“Upgrading the nation’s Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses."
“That’s the chief finding of a new fiscal study by Gerald Friedman, a professor of economics at the University of Massachusetts, Amherst. There would even be money left over to help pay down the national debt, he said.”
America does not have that yet because Americans have been sold the misleading idea that what they have is a fair and natural system born out of "free enterprise and free market entrepreneurship."
Using those words, and especially the word "free," makes it sound good. But it's free only in the sense that those individuals who rule the system are free to be profiteers raking in multi-millions of dollars per year at our expense. And those who sold the misleading idea that it's just "free enterprise and free market entrepreneurship" have not only fought against non-profit universal health care. They have even fought against reasonable reforms of the profit-making corporate health care system, and they have made it even more profitable for the wealthiest few who control it.
But their system is not “natural.” It is calculated for profitability at our expense. Even hospitals and health insurance companies that are supposedly non-profit (and receive big tax breaks because of it) are actually raking in huge profits. And the claim that it is fair is merely rationalization by the profiteers and their propagandists and lobbyists and politicians they've bribed to try to justify it.
For example, CBS News has reported that University of Pittsburgh Medical Center (UPMC), supposedly a non-profit hospital, is reaping huge profits and driving up health care costs. It made about a billion dollars in profit in the last two years. It gets a state and federal tax break of about $200 Million. It pays its CEO $6 Million per year and its 12 top administrators a million dollars a year. Yet it spends only about 2 percent to help charity patients, and while it has grown, opening new branches in affluent communities, it has closed branches in low income communities.
This is not an isolated case either. All over the country hospitals that are claiming non-profit status are doing the same thing, reaping huge profits and driving up health care costs. And The Affordable Care Act has had an unintended consequence of helping these hospitals do that, as they charge more and more for procedures and services. And health insurance companies that claim to be non-profit are charging more and more for premiums, copays, etc.
This shameful situation has caused tens of millions of Americans to suffer financial hardship, at the very least, because of the ever-rising high costs of health insurance, copays, medicines, and other health care costs.
Hospitals, whether blatantly for profit or supposedly non-profit, are also profiteering at alarming rates. For example, The New York Times published an article in August 2013, titled How to Charge $546 for Six Liters of Saltwater. It points out that the average manufacturer’s price for a bag of saline solution, according to government data, has fluctuated in recent years from 44 cents to one dollar. It is one of the most common components of emergency medicine, and it is used to replace lost or insufficient fluids in the body.
However, the charges on some of the patients’ bills in many hospitals are commonly marked up 100 to 200 times the manufacturer’s price, not counting separate charges for “IV administration.” And on other bills, they article states that “a bundled charge for ‘IV therapy’ was almost 1,000 times the official cost of the solution.”
Anyone familiar with the skyrocketing costs of medical care in hospitals is familiar with the outrageous price gouging. And as the article reports: “At every step from manufacturer to patient, there are confidential deals among the major players, including drug companies, purchasing organizations and distributors, and insurers. These deals so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost. And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it.”
The U.S. Health Care "Reform"
Many Americans are thankful for the 2010 Health Care Reform Act, also called the Patient Protection and Affordable Care Act (now also known as the so-called "Obama Care"), because at least it did provide some needed reforms and improvements. For instance, it stopped insurance companies from callously denying coverage to patients with pre-existing conditions. However, the Affordable Care Act was and is an insufficient, weak and misguided effort at health care reform.
Another example of why the Affordable Health Care Act is inadequate and harmful is the fact that it is causing employers to cut workers hours so they don’t qualify as “full time employees” so the employer doesn’t have to pay anything toward their health insurance.
For example, it allows private insurance companies to keep taking a huge percentage of every dollar spent on health care, and continue to raise premiums, copays, and other out of pocket costs for patients. And because of that, our health care costs are as high and higher than they were before.
Such things are probably unintended consequences, but they are just more reasons why the “reform” was not really the reform we need, and why we actually need Universal Health Care.
Some say the Act was originally concocted by the right-wing Heritage Foundation, and was first enacted in 2006 in Massachusetts by then-Governor Mitt Romney. Then it was enacted as federal law after being written into legislation mainly by corporate attorneys and lobbyists.
It has enough provisions in it so it sounded good to some people -- especially patients with preexisting conditions that had been denied coverage. But, it provides about $447 Billion in subsidies for the pharmaceutical and insurance industries. It penalizes the working poor who are unable to afford the high costs of medical insurance, rather than provide them with the help they need. Furthermore, it failed to provided the most needed reforms, it not only enabled the private profit-making health insurance industries to charge us even more, it also enabled hospitals to grow and charge even higher and continually escalating costs for procedures and services.
Physicians for a National Health Plan (PNHP) have reported that the Act leaves at least 23 million people without insurance, costs will continue to escalate because the Act does not set any limits on premiums or copays, including for patients with pre-existing conditions, and senior citizens can be charged much more than young people.
The Act enables the profiteering corporate health care system to be so unfair and costly that about 62 percent of personal bankruptcies are caused by high medical bills, and nearly 80 percent of the people who were forced to declare bankruptcy did so to because of the high medical costs and insurance costs that they simply could not afford.
And it’s no wonder, because twice as much is spent per capita (for each individual) on health care in America than is spent in other industrialized nations. The average is $8,160. And some elderly couples have to pay about $1,400.00 per month on insurance alone, beside escalating high costs for medicines and copays.
The Huge Need for Universal Health Care
Why should anyone be able to profit from other people's misfortune and suffering?
Granted, well educated professional health care providers and administrators of a health care funding system should be paid well in accordance with their education, skills, and the services they provide. But that would be the case in a truly non-profit, universal health care system.
Therefore, why should we have a profit-making system? Why can't we have a non-profit universal health care system that operates at cost, rather than allow profiteers to constantly raise prices arbitrarily to gain higher profits so they can get richer while we grow worse off?
There is no valid excuse for charging patients far and above what’s needed to operate the system just so that rich investors can profit and top executives of health care facilities and health insurance companies can be paid millions, tens of millions and even hundreds of millions of dollars per year. What makes them think they are entitled to that?
Well, there's an explanation of why they think they are entitled. The article on Ronald Reagan’s Real Legacy points out that much of this corruption and inequity and economic crises is the consequence of Reaganite propaganda and rhetoric that combines corporate propaganda along with a “Gospel of Prosperity” which was conveniently provided by the leaders of the “religious right."
While they masquerade as Christians, they actually turn Christianity up-side-down to serve the interests of the wealthy who are driven by greed and self-interest. And they do that by claiming that great wealth is a reward from God, and that the poor deserve to be poor because they are merely lazy, not "self-reliant," and don't have enough faith in God.
How convenient. How cunning. And how wrong.
The Reaganite "Gospel of Prosperity" was and still is a cunning scheme that appeals to arrogant, self-righteous and "holier than thou" people, but is actually deceptive, misleading, and heartless.
Why was it adopted by America? Well, part of the “Conservative” Reaganite agenda is to destroy the legacy of the great American President Franklin D. Roosevelt and his New Deal, which included proper and needed regulation of banks, financial institutions, corporations and companies. And it also included safeguards and safety nets for the people, like Social Security (and then Medicare, which was established in 1965 in amendments to existing Social Security legislation).
Roosevelt's New Deal was truly Christian, but Reaganism claims otherwise. The Reaganite hidden agenda is not only to fool the American people with misleading corporate propaganda, but also to indoctrinate the American people with a shameful and ironic distortion of a Christian principle. For while Jesus of Nazareth did say we reap what we sow, he also rebuked the rich who reap unjust profits at other people's expense. Moreover, Jesus said that we should treat the poor and the least of our brethren as we would treat the Lord.
Now, because right-wing extremists are fighting so hard to maintain the status quo which favors and benefits the wealthiest few and their private banks, lending institutions, corporations and insurance companies, and have extended their fight not only against universal health care but even against reform and regulation of the profit-making private health care insurance industry, we need to examine the reality of the situation, realize the real problems, and solve them.
Why Does It Stay So Unfair?
Unfortunately, very wealthy right-wing extremists have fought against reform, even stooping to the absurd and extremely deceptive tactic of labeling those who advocated reform as “Socialists” who wanted a “Government Takeover” of the health care system. And they even tried to get the U.S. Supreme Court to strike down the reform act.
Why would right-wing extremists do that sort of thing? Because they are fighting to maintain Reaganism, which enabled the wealthiest few to rule completely. And they feel "righteous" because they have been influenced and misled by right-wing ideologues and demagogues who have misconstrued, distorted and twisted not only the U.S. Constitution and the intent of the Founding Fathers, but also misconstrued, distorted and twisted the core universal teachings of Jesus of Nazareth that are based on the Golden Rule.
Ironically, many of them claim to be Christians, but they listen to the wrong people -- to demagogues who appealed to the ego, pride, prejudices, greed and self-interest of the American people, causing them to forget that the Founding Fathers intended for government to promote the general welfare and ensure domestic tranquility and justice for all.
More recently, though, right-wing extremists have been claiming one of the Founding Fathers, James Madison, as their champion. But, they misinterpret Madison and the Constitution, and they attempt to rewrite history.
They ignore the fact that Madison was a leading advocate of the Commerce Clause, which gave the federal government broad powers to regulate interstate commerce. And they ignore or deny that such programs as diverse as Franklin Roosevelt's New Deal, Dwight Eisenhower's federal highway system and Barack Obama's health-care reform are in line with Madison’s thinking.
President Franklin D. Roosevelt was definitely in tune with the thinking behind Thomas Jefferson’s and James Madison’s Democratic Republican Party, with which they tried to establish a Democratic Republic. But, in spite of that, for the last 30 years right-wing partisan politicians have been trying to destroy or repeal Roosevelt’s New Deal programs and regulations, and they’ve had some significant success in doing that.
Now they are after the Health Care Reform Act or Affordable Care Act, labeling it pejoratively as “Obama Care” and calling Obama a “Socialist.” Therefore, as so many conscientious people have been saying, it is time for reason, sanity, and truth to prevail.
The truth is that the health care system in America is still terribly unfair and insufficient. Even with the health care reform enacted by the Democrats and the Obama Administration, health insurance premiums keep going up higher and higher, with higher copays and higher costs for procedures and medications. Many Americans are paying close to half their total household income on medical costs and the costs of medicine, and for some the problem is even more dire than that.
Of course, the Affordable Care Act will improve somewhat in 2014 by law, because it will expand Medicare coverage. And since three states already did that voluntarily, a Harvard study reported in the New England Journal of Medicine that there was a greater than six percent decline in death rate in those three states that expanded Medicaid coverage. The study looked at those three states (Arizona, New York and Maine) that in 2001, 2002 chose to voluntarily expand Medicaid eligibility to low income adults who did not have any children at home and didn't have disability, and who wouldn’t have health care coverage available to them in most states in the U.S.
The researchers felt the study was important because this is somewhat similar to what the Affordable Care Act will do in 2014; expanding Medicaid to all adults up to 138 percent of the federal poverty level. And basically they looked at those three states and compared to them to four neighboring states that did not expand their Medicaid programs and looked at the impact on several different outcomes – insurance coverage, access to care, health, and life expectancy or survival. And one of the most significant findings was that in the states that expanded their Medicaid program there were nearly 2800 deaths prevented by expanded Medicaid.
However, the study raises a big question. How many people died in the three states in the study that did not expand Medicaid? That’s a question being considered in many other states. For example, the difference in mortality rates, if applied to Florida, would yield about 5,680 fewer deaths per year among under-65 adults, Health News Florida calculated last week in an article titled Medicaid: Life and Death Politics.
We CAN Fix It
We can not only ensure that the most wealthy people pay their fair share of taxes according to their ability to pay, we can also ensure that they cannot collect Social Security and Medicare benefits if their net financial worth and/or income is high enough that they clearly don’t need the safety net that Social Security and Medicare should provide to those who actually need it.
Such benefits should be provided only to those who actually need them. It should be based on an assets and means test, such as the U.S. Veteran's Administration (VA) requires of veterans who apply for health care benefits. If and when Veterans have good incomes and have private health insurance they are required to pay certain amounts or copays to the VA for services and medicines. And such an assets and means test should also determine Social Security and Medicare insurance benefits.
Only those who really need Social Security and Medicare benefits should receive them. If that were the case, and if we with required the wealthy to pay their fair share of taxes, it would make the whole human services and health care system solvent and strong.
Regarding non-government health care programs and facilities, we can ensure that we have a new non-profit universal health care system, in which all citizens receive health care and prescription drugs without paying out-of-pocket costs. After all, as it is now, Americans pay more overall, and especially out of pocket costs, than any other people on earth for health care
According to those knowledgeable about it, including the Common Wealth Fund, despite having the most costly health system in the world, the U.S. consistently underperforms on most dimensions of performance, relative to other countries. Data that incorporates patients' and physicians' survey results on care experiences and ratings on dimensions of care show that compared with six other nations — Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom — the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.
The U.S. is the only industrialized country in the world that lacks universal public health care. This has left about forty-two million Americans seriously at risk. Most of them have either lost or cannot afford private for-profit health insurance, or were denied it by their cost-cutting employers in order to increase their profit margin. Others are forced to pay for very expensive health insurance from private profit-making insurance companies, and, even though Americans over age 65 have Medicare, it is still lacking in very significant ways, and seniors need supplemental private insurance to get adequate coverage for adequate health care and medications.
Besides that, many privatized, for-profit hospitals and other medical facilities have been down-sized and they've reduced their nursing staffs to less than a bare minimum to cut expenses and increase profits. Health insurance premiums keep skyrocketing to absurdly unaffordable rates, and it's the same with copays and other out-of-pocket costs that are in addition to costly premiums.
The consequence is that the U.S. health care system is absurdly and unnecessarily expensive, and it leaves many people uninsured or under-insured. Due to cost-cutting it has become increasingly understaffed and plagued with accidents made by overworked hospital staff. It has many serious faults and shortcomings, all of which would be remedied by a far less expensive, universal, public non-profit health care system.
Why Total Health Care Reform Is Needed
Americans need to realize that the profit-making American health care system is simply corrupt. Back in June 2009, the House Commerce Subcommittee held a hearing regarding “Termination of Individual Health Insurance Policies,” and while its findings were alarming, the commercial news media refused to tell the American people about it.
It was found that the total compensation for one insurance company CEO was $1.2 Billion yearly; that nullifications and cancellations of health insurance policies had netted insurance companies savings (unfair profits) of $300 Million; that the performance of insurance investigators is rated according to the amount of money they saved the company by nullifying and cancelling policies.
Furthermore, it was found that insurance company investigative policies focus on the claimant’s medical history for the sole purpose of finding any justification for denying claims and canceling the entire policy, even back to the original date of issue. That left the patient with no health insurance coverage, and to add salt to the wound, the patients were required to reimburse the company for any and all claims the company may have paid under the policy.
In July 2010 the Consumers Union revealed even more facts about how the premiums of many insured people were being raised between 20 and 25 percent in 2009 and by close to that much again in 2010 (even after the Health Care Reform Act was enacted in March 2010). Some copays were raised 150 percent. Deductible amounts were still being raised, and coverage decreased. And all that happened while the income of the CEOs of the insurance companies were in the millions per year. Of course, the companies claim they raise premiums simply for a “safety net,” even though regulators say that not a valid excuse.
All those facts are clear indicators of how corrupt the insurance company culture has become, right along with the cultures of many other industries, corporations, and government agencies.
Unfortunately, misguided and corrupt people, and those who benefit from the system as it is, just don’t get it. They fought hard against health care reform initiated by the Obama Administration, and since a weak version of it became law they have been fighting to repeal it. But their rhetoric is deceptive and misleading, all concocted by the health insurance companies.
A good book on the subject is Wendell Potter’s “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.” It reveals exactly how and why the forces of greed and self-interest are deceiving Americans, with the help of Reaganite Republicans, Libertarians, Federalists, and “Tea Party” members.
Granted, the health insurance industry is not completely to blame for skyrocketing costs. The medical health care industry itself is almost as culpable, charging as much as they can get away with for tests, procedures, hospitalization, staff services, etc. They probably rationalize their high costs, thinking that patients are not actually paying for it if they are insured, but we all pay for it, and patients pay far more than they should.
It is a self-defeating system, inevitably and continually raising health care costs. That’s why the top executives of both the insurance and health care industries are profiting immensely, while the rest of us are paying way too much and some of us are facing catastrophic financial disaster.
In spite of all the facts, right-wing “conservatives” don’t want universal health care, and they still want the status quo which is very rewarding to the wealthy few, exorbitantly costly to the majority, and often disastrous and sometimes even lethal for the working poor and others who are victimized by the system.
Now, the American people should just say no to the accusers and deceivers who want things to stay the way they are.
The American people need to stand up for what is truly right, and demand universal health care for all the people according to The United Nations Universal Declaration of Human Rights.