My life long (since 5 years old) and best friend lost her husband to throat cancer. He was a carpet layer and had no health insurance. He developed a throat problem (swallowing, irritation) and waited the year or so till he would turn 65 to go to a doctor. By that time it was stage 4 cancer and had spread and there was nothing the doctors could do. He died within a year. The doctors told him that if he had come to them sooner they could have saved him. This should never happen in this country.
I am a retired emergency physician who has worked all over the USA.
The medical system has so much money in it that it has been taken over by capitalist business. Most doctors now work for a private company and are paid for productivity and increased billing. They spend 1/3 of their time on computers documenting the high possible charges and defense against malpractice. (In most countries contingency fees are unethical and illegal).
Most Western countries have a system like universal Obama care, only with complete coverage, low overhead like Medicare, and no maximum care and billing.
The top medical students at Harvard go into Dermatology because it has the best life style and pay., instead of increasing the length and quality of life.. The average American medical student graduates $300,000 in debt, but in Europe most medical school is free.
Most welfare patients get their medical care from the ER and clinics because Medicaid pays doctors too little. All the drug abuse, violence, and poverty also increases medical costs. Most Republicans think medical care (and welfare) is a privilege and not a right.
I'm on Medicare and am not strapped financially. But preventive health care? Good luck. Unavailable at any price. My "healthcare provider" primary physician sees me for 15 minutes, recommends tests and just hopes some sign of disease shows up that she can recommend meds or surgery for. So far I am healthy, but I know sooner or later I'm going to need care. What then?
Get out of mainstream medicine, and do like Robert did- clean up your diet now, walk daily, take a few pounds off- you may stay healthy and never need high tech care
Whatever our health insurance system is (private or public) it must reimburse doctors for providing lifestyle medicine treatment, consultation, and education. We don’t just want an efficient system, we also want a healthcare system that focuses on promoting wellness. There are many organizations trying to promote lifestyle medicine but they need a radical change in the way doctors are paid. Checkout the American College of Lifestyle Medicine (ACLM) and Physician for Responsible Medicine. Checkout the Rochester Lifestyle Medicine Institute (RLMI) and sign up for the virtual Jumpstart course that will help get you on a Whole Food Plant-Based (WFPB) lifestyle to prevent and reverse cardiovascular disease, Type 2 diabetes, obesity, and debilitating inflammation. There’s so much we can do to be healthier and paying doctors for lifestyle medicine - no matter what our healthcare system is - is essential!
I love this positive approach! I'm curious about your background. Would you care to share? Are you by any chance a neurosurgeon somewhat paradoxically? No pressure to "blow your cover".
Thank you for this important essay and your willingness to further the cause of Medicare for All.
However, I think the greater problem is American capitalism and its relentless urge to privatize; profit at any cost; scam and lack of accountability for profiteers; especially against the non-wealthy in this country.
Just look at the scandal surrounding the approval by the FDA of the unproven and dangerous Altzheimers' drug, Aduhelm.
As a result of collusion between some FDA members and Biogen ( the maker of Aduhelm), and the outrageous price (originally over $58.000, now $28.000 after pushback), Medicare recipients will see the greatest cost increase in Medicare history, in anticipation of the drug's cost.
And while CMS has proposed limiting the availability of Aduhelm, Biogen has been flooding the CMS comments period lobbying for widespread use of this dangerous and unproven medication; this despite the fact that many medical institutions and doctors have stated that the'll refuse to prescibe the medication to their patients.
The scandal surrounding Aduhelm is just another reminder that Medicare for All is desperately needed in this country.
I definitely agree that the problem is profit at any cost and that the price of Aduhelm is absurd. Having followed the development of Aduhelm, I, like a number of medical professionals, disagree about its "danger." It's not more dangerous than Alzheimers. It's certainly a small, imperfect step in efforts to address an horrific, fatal disease. Big Pharma greed already destroys lives. It shouldn't also be allowed to halt even small first steps. If potential help exists, it should be up to doctors and patients whether to use it. Judgment shouldn't be made based on greed and price. To allow that is to enable Big Pharma greed. If the price of Aduhelm were $2/year, how many would complain about having a choice that could slow impending horror? Better to fight Big Pharma greed and a broken healthcare system than to punish patients by thwarting small steps and options.
But no question, the U.S. Healthcare system is terrible. No doubt the money spent on drug ads alone could save many lives. Greedy drug companies market drugs as if they're candy, leaving doctors to waste time "unselling" patients on drugs that aren't right for them. The capitalism of greed doesn't belong in healthcare.
I'm replying to the original post. A common theme for me is that "the" fundamental problem may be lack of will by our voting majorities for solutions which often benefit us better as individuals as well as collectively. This begs the question of what is the root of that problem.
Good idea. Take a look across the “Pond” to Australia. Medicare for all, plus the option of purchasing private health insurance. Also, if your income is very high you are hit with an extra tax….the Medicare Levy if you do not have the add on insurance. This way everybody gets a “fair go”
Let's get real. Specialists are not the problem. Corporate medical care especially hospitals and specialty group practices SUPPORTED BY PRICE GOUGING CORPORATE INSURANCE companies are. For those of us on Medicare--RR?--read your periodic statements. See what the system charges, and how small a portion Medicare pays! Read the documents.
With the unusual advice of a university human resources officer and our excellent certified socially responsible financial advisor, we kept our BlueCross/BlueShield of TX insurance even as I moved to a much better academic position in another state. Few have this advantage,
But the US needs to learn, and be shamed by international comparisons. As in most social issues, we are a tragic outlier. Death rates--far more than ankles--underscore this. All "developed" nations and many "undeveloped" nations have forms of universal health care. Not US. American exceptionalism. DR (haha) Rand Paul certainly wouldn't know this :) But his "friend" Tony Fauci does!
When my future wife and I moved to Canada in 1970 for graduate school (and for her to complete her BA and BEd) and take preemptive measures in face of the draft for the Vietnam invasion, we became "landed immigrants" not "resident aliens". And we immediately received free health care in Ontario, passed by the Progressive Conservative Party. We didn't spend a penny on health care, other than prescriptions for five years.
Then we returned to the US in 1975. As they say (both not in this blog), "the rest is history." It's now 2022 ....
Hi Harvey. I'm about to comment on the original post. It is useful but of course limited to conceptualize "The Problem" but here's my attempt: With physician being one of my many hats ", I see THE fundamental problem as our society having excessive trouble achieving "the greatest good for the greatest number" in far too many aspects of our life with healthcare being only one of the most notable ones. We as a society cannot seem to wrap ourselves in thought and action including voting around the idea that giving up some options, including some which we consider as "rights", such as specific health care services is often worthwhile in order to gain better ones overall such as better healthcare, for ourselves as individuals and society. More above. I always enjoy your thoughts.
Universal health care was studied by the OMB as well as conservative groups like Forbes and even Koch- associated. All three huge deep dives into policy concluded over the first decade covering us all with a Single Payer Plan would save billions. All the other studies regarding lack of coverage effects show huge benefits and lives saved if we were all covered from birth. A simple way to see why Medicare for All would save so much money while making us all better off is:
As Reich and others point out, there is so much administrative cost (overhead, marketing, profit, determining who is covered for what and tests authorized at every point in the patient-system encounter, roughly 33% or more, when Medicare has on overhead of about 2%---Canada and other developed countries have overhead of about 12%. Now 20% difference between US and Canada overhead of 4 trillion dollars is a huge saving. With that we could cover everyone and have plenty to transition insurance industry workers into healthcare workers, dental, mental health, and so much more. Just by allowing a Single Payer system to negotiate a volume discount like the VA and Canada do would save billions. (Congress, assaulted by more lobbyists than Congressmen, outlawed volume discounts).
So just by providing a nonprofit system and slashing the nearly trillion dollars in administrative waste, we could cover everyone at birth with a "Cadillac" comprehensive plan far better than any of us have now and save money in the process.
First we may need to agree as a nation that healthcare for All is a right.
Medicare for All won't save anybody any money and will make health care worse if it were implemented like the stealth "pilot Program" being implemented by the Innovation Center at CMS. The Direct Contracting Entity program is Medicare Advantage plans fraud on steroids and needs to be stopped immediately. You must emphasize that you are talking about Single Payer traditional Medicare, and no for profit middle men managing billing and payments as the pilot program is doing. Be sure to mention that in your presentation.
For those among us who are incapable of resolving ambiguous acronyms from memory, "CMS" refers to a U.S. government agency named "Centers for Medicare & Medicaid Services". Or at least that seemed to be the best match from the hundreds of possibilities.
Jane, I was so angry when I read that CMS was going to force Medicare recipients into HMOs in ~ 10 metro areas. Are they doing this? I can't find out for sure. They can take their Disadvantage plans and shove them.
Time to start writing letters. Unfortunately the last time I wrote to Biden I got a response that was so content-free I couldn’t even tell what the issue was. I was extremely disappointed. We have to stop this.
I suspect Medicare for All is a shortcut way of explaining what they’re promoting, not necessarily a description of exactly how it will work. I get the impression that people have a negative view of the term “single payer,” or they don’t understand it. Just a guess.
A conversation with a student from Germany years ago that still lingers makes me wonder what role our current healthcare system is playing in preventing us from being our most fit and health-conscious. This student said that BECAUSE of the national health care system in Germany, people have the attitude that it is the citizen's responsibility to remain as fit and healthy as possible - for the good of all.
Neither of my twins could afford insurance under the 'Affordable' care act. The deductibles were so high, it just did not make sense. They were uninsured until my daughter's husband joined the Navy and my son got a job paying $30/hour, which included health insurance for himself and his wife that cost $300/month.
We keep having example after example of the failure of the American state capitalist system to effectuate any of these reforms because the battle between laissez-faire capitalism and state capitalism is increasingly one in which the latter triumphs. Corporations have consolidated their control over Congress and the regulatory apparatus and the courts. Soon the state will be deprived of any right to tell private enterprise what to do about preserving the health of the population if it interferes with commerce, not that institutions like the CDC will do so. It might take a few more years before they do away with Medicare via the HMO route but they will.
So when I see all of those members of the progressive caucus, you know the ones who voted to delink infrastructure and BBB bills, I wonder what planet they are on. Is it Planet Fantasy where they sing “would in it be wonderful” from My Fair Lady?
Wasn't the infrastructure bill originally broken out from the BBB bill in the Senate? And then sent back to the House? I thought the progressives were against breaking out the infrastructure bill, and then once it was broken out and sent back to the House, against delinking them.
No what happened was that the House progressive caucus held out from signing off on the infrastructure bill until the Senate passed the BBB bill so that one couldn’t be approved without the other. They demanded this because delinking meant BBB would flounder. They were persuaded by Biden to abandon their opposition on his promises that he could get BBB through the Senate. the infrastructure bill was then passed by the House. Once this lever was lost Manchin did his thing and BBB floundered in the Senate. So this has been a problem with the progressive caucus lacking political nerve and strategy and depending upon the President’s leadership to no avail. It is why Biden’s poll numbers are so low and why the Democrats are about to commit political suicide this Fall and put the Trumpers in control of Congress.
As Michael Moore pointed out, Medicare for All was a huge giveaway to the insurance industry, and the name 'Affordable Care Act' is a misnomer; it is neither affordable nor is it 'caring'.
@Laurie. I am so glad you brought this up - in this country nothing gets through Congress without a big paycheck attached for one or the other interest group. The "cost of doing business" to get Medicare for All past our nominal representatives and particularly past the so-called deliberative body is to have a bill that preserves at least some of the "rents" that go to the medical insurance companies. This insurance industry employs thousands of people too, so if they were suddenly cut off completely there would result job losses and a certain amount of economic dislocation. I'm not trying to put words in anybody's mouth, but it seems that support for the current legislative efforts is the pragmatic approach, to not let perfection be the enemy of progress.
Every time they privatize something they build up a huge infrastructure and then when people propose doing away with that Republicans cry “job losses.” It’s happened over and over and it’s intentional. Of course doing away with government jobs doesn’t bother them one bit. We can’t let this manipulation derail us.
There is nothing in the American health care system that can be considered progress on any level. We are an outlier, this system is awful, lowest mortality rates, Americans are the sickest among rich nations, it is a wholly owned subsidiary of the corporate elite. No other comparable nation lives like this. Oh, and those jobs? People won't lose jobs they'll be plugged into the new system that also will require administrative work, etc.
@Claire. I hope nothing in what I wrote can be construed as a defense of the current situation? I was talking about the role of money, lobbyists and industry influence in what happens to legislation in our Congress.
Unfortunately, "the cost of doing business" is what keeps us from getting anything meaningful or worthwhile ever done or done right, which is then always followed by our representatives telling us how wonderful it is, but people know it's BS and just despair of Congress ever getting anything right. Why do we keep doing stupid and stupider? When do we ever learn? Because government doesn't work for the majority, as most of us here would probably agree. And those who support the other guy, they just want to do away with all of government for probably many of the same reasons.
@Jim. This can be a very valuable conversation! For example, is it really a majority of Americans that get nothing (or too little) from government? Or is it really the media circus pushing misinformation that makes a lot of people think that a lot of other people are unhappy? I think Reich has shown in this column that there is a gap between way people say about themselves (doing ok, feeling pretty good) versus what people in the same poll say about the state of the country (going to hell, people very unhappy). As you can easily see the "majority unhappy" is a perception, a big lie and a piece of leverage to influence votes. In our country a clear majority vote Democratic; it is the operation of the Electoral College, the design of only 2 senators per state regardless of population, the role of money in Congressional influence and the malicious, cynical manipulation of the media by corporations, the super rich and international oligarchs that reduces the Democratic majority enough to keep Republicans in government.
The only way to efficiently, cost effectively and reduce worsening of death rates and chronic illness is the Medicare for All Act. The continued move to privatize (DCE) Medicare and for profit middle men will only continue to raise the costs, while making a few for profit entities richer. Decisions need to be between the provider and patient period. The Medicare for all Act is the best solution as far as I can see
The fundamental problem is not that there are a lot of specialists and not enough generalists. That is somewhat symptomatic. The fundamental problem is that almost all of the medical profession adheres to the mistaken ideology of allopathic medicine....that only man made chemicals can cure disease. It is a cult belief (with no scientific basis) which has prematurely killed millions, injured millions more and rarely cures anything. But it does massively enriches drug companies, insurers, hospitals, government gatekeeper "regulators", practitioners, their instructors and a whole plethora of associated professions. The belief in our allopathic medical practices sustains the pill illusion because pills may "cure" some bacterial diseases, and some inoculations may prevent some fatal childhood scourges. They have no curative effect on the vast majority of chronic diseases that plague modern life (heart disease, cancer, diabetes etc.) The patient is grateful for the symptom relief of "modern medical practice". The symptoms have been suppressed but the disease is still raging and will likely prematurely kill them. In short, not only is modern U.S. medical practice outrageous expensive, the practice is a fraudulent unscientific deception.
@Kendrick. The science is clear on the other side - homeopathic attempts at treatment are ineffective across the board. This is proven fact. Also, many formulations are toxic and/or dangerous by enticing people to avoid modern medical treatments. So far as I have been able to find, there are no exceptions. Meaning there are no homeopathic, traditional or shamanic treatments that are better than modern medical practices.
Thank you Robert for going to Congress. Health care in this country is one of the most deplorable aspects of American life. It is patently a cruel system. In many cases the quality of health care (not if you have money*), access to physicians and pharmaceuticals, ugh.
*The money, I know people who cannot get a general practitioner unless they'r willing to pay for "concierge medical service." The strictures, if you will, are tightening between rich people's access to health care and everyone else. The system, as it is now, is only getting worse.
Yes! It’s almost impossible to find general practitioners who are taking new patients. Even the concierge doctors have waiting lists. The only alternative seems to be Kaiser, which both my husband and my mother like but I feel like it’s a factory and don’t want to use it, especially as it’s far away. Things never used to be like this.
My life long (since 5 years old) and best friend lost her husband to throat cancer. He was a carpet layer and had no health insurance. He developed a throat problem (swallowing, irritation) and waited the year or so till he would turn 65 to go to a doctor. By that time it was stage 4 cancer and had spread and there was nothing the doctors could do. He died within a year. The doctors told him that if he had come to them sooner they could have saved him. This should never happen in this country.
I am a retired emergency physician who has worked all over the USA.
The medical system has so much money in it that it has been taken over by capitalist business. Most doctors now work for a private company and are paid for productivity and increased billing. They spend 1/3 of their time on computers documenting the high possible charges and defense against malpractice. (In most countries contingency fees are unethical and illegal).
Most Western countries have a system like universal Obama care, only with complete coverage, low overhead like Medicare, and no maximum care and billing.
The top medical students at Harvard go into Dermatology because it has the best life style and pay., instead of increasing the length and quality of life.. The average American medical student graduates $300,000 in debt, but in Europe most medical school is free.
Most welfare patients get their medical care from the ER and clinics because Medicaid pays doctors too little. All the drug abuse, violence, and poverty also increases medical costs. Most Republicans think medical care (and welfare) is a privilege and not a right.
I'm on Medicare and am not strapped financially. But preventive health care? Good luck. Unavailable at any price. My "healthcare provider" primary physician sees me for 15 minutes, recommends tests and just hopes some sign of disease shows up that she can recommend meds or surgery for. So far I am healthy, but I know sooner or later I'm going to need care. What then?
Get out of mainstream medicine, and do like Robert did- clean up your diet now, walk daily, take a few pounds off- you may stay healthy and never need high tech care
Whatever our health insurance system is (private or public) it must reimburse doctors for providing lifestyle medicine treatment, consultation, and education. We don’t just want an efficient system, we also want a healthcare system that focuses on promoting wellness. There are many organizations trying to promote lifestyle medicine but they need a radical change in the way doctors are paid. Checkout the American College of Lifestyle Medicine (ACLM) and Physician for Responsible Medicine. Checkout the Rochester Lifestyle Medicine Institute (RLMI) and sign up for the virtual Jumpstart course that will help get you on a Whole Food Plant-Based (WFPB) lifestyle to prevent and reverse cardiovascular disease, Type 2 diabetes, obesity, and debilitating inflammation. There’s so much we can do to be healthier and paying doctors for lifestyle medicine - no matter what our healthcare system is - is essential!
I love this positive approach! I'm curious about your background. Would you care to share? Are you by any chance a neurosurgeon somewhat paradoxically? No pressure to "blow your cover".
Thank you for this important essay and your willingness to further the cause of Medicare for All.
However, I think the greater problem is American capitalism and its relentless urge to privatize; profit at any cost; scam and lack of accountability for profiteers; especially against the non-wealthy in this country.
Just look at the scandal surrounding the approval by the FDA of the unproven and dangerous Altzheimers' drug, Aduhelm.
As a result of collusion between some FDA members and Biogen ( the maker of Aduhelm), and the outrageous price (originally over $58.000, now $28.000 after pushback), Medicare recipients will see the greatest cost increase in Medicare history, in anticipation of the drug's cost.
And while CMS has proposed limiting the availability of Aduhelm, Biogen has been flooding the CMS comments period lobbying for widespread use of this dangerous and unproven medication; this despite the fact that many medical institutions and doctors have stated that the'll refuse to prescibe the medication to their patients.
The scandal surrounding Aduhelm is just another reminder that Medicare for All is desperately needed in this country.
I definitely agree that the problem is profit at any cost and that the price of Aduhelm is absurd. Having followed the development of Aduhelm, I, like a number of medical professionals, disagree about its "danger." It's not more dangerous than Alzheimers. It's certainly a small, imperfect step in efforts to address an horrific, fatal disease. Big Pharma greed already destroys lives. It shouldn't also be allowed to halt even small first steps. If potential help exists, it should be up to doctors and patients whether to use it. Judgment shouldn't be made based on greed and price. To allow that is to enable Big Pharma greed. If the price of Aduhelm were $2/year, how many would complain about having a choice that could slow impending horror? Better to fight Big Pharma greed and a broken healthcare system than to punish patients by thwarting small steps and options.
But no question, the U.S. Healthcare system is terrible. No doubt the money spent on drug ads alone could save many lives. Greedy drug companies market drugs as if they're candy, leaving doctors to waste time "unselling" patients on drugs that aren't right for them. The capitalism of greed doesn't belong in healthcare.
I'm replying to the original post. A common theme for me is that "the" fundamental problem may be lack of will by our voting majorities for solutions which often benefit us better as individuals as well as collectively. This begs the question of what is the root of that problem.
Good idea. Take a look across the “Pond” to Australia. Medicare for all, plus the option of purchasing private health insurance. Also, if your income is very high you are hit with an extra tax….the Medicare Levy if you do not have the add on insurance. This way everybody gets a “fair go”
Let's get real. Specialists are not the problem. Corporate medical care especially hospitals and specialty group practices SUPPORTED BY PRICE GOUGING CORPORATE INSURANCE companies are. For those of us on Medicare--RR?--read your periodic statements. See what the system charges, and how small a portion Medicare pays! Read the documents.
With the unusual advice of a university human resources officer and our excellent certified socially responsible financial advisor, we kept our BlueCross/BlueShield of TX insurance even as I moved to a much better academic position in another state. Few have this advantage,
But the US needs to learn, and be shamed by international comparisons. As in most social issues, we are a tragic outlier. Death rates--far more than ankles--underscore this. All "developed" nations and many "undeveloped" nations have forms of universal health care. Not US. American exceptionalism. DR (haha) Rand Paul certainly wouldn't know this :) But his "friend" Tony Fauci does!
When my future wife and I moved to Canada in 1970 for graduate school (and for her to complete her BA and BEd) and take preemptive measures in face of the draft for the Vietnam invasion, we became "landed immigrants" not "resident aliens". And we immediately received free health care in Ontario, passed by the Progressive Conservative Party. We didn't spend a penny on health care, other than prescriptions for five years.
Then we returned to the US in 1975. As they say (both not in this blog), "the rest is history." It's now 2022 ....
Hi Harvey. I'm about to comment on the original post. It is useful but of course limited to conceptualize "The Problem" but here's my attempt: With physician being one of my many hats ", I see THE fundamental problem as our society having excessive trouble achieving "the greatest good for the greatest number" in far too many aspects of our life with healthcare being only one of the most notable ones. We as a society cannot seem to wrap ourselves in thought and action including voting around the idea that giving up some options, including some which we consider as "rights", such as specific health care services is often worthwhile in order to gain better ones overall such as better healthcare, for ourselves as individuals and society. More above. I always enjoy your thoughts.
Universal health care was studied by the OMB as well as conservative groups like Forbes and even Koch- associated. All three huge deep dives into policy concluded over the first decade covering us all with a Single Payer Plan would save billions. All the other studies regarding lack of coverage effects show huge benefits and lives saved if we were all covered from birth. A simple way to see why Medicare for All would save so much money while making us all better off is:
As Reich and others point out, there is so much administrative cost (overhead, marketing, profit, determining who is covered for what and tests authorized at every point in the patient-system encounter, roughly 33% or more, when Medicare has on overhead of about 2%---Canada and other developed countries have overhead of about 12%. Now 20% difference between US and Canada overhead of 4 trillion dollars is a huge saving. With that we could cover everyone and have plenty to transition insurance industry workers into healthcare workers, dental, mental health, and so much more. Just by allowing a Single Payer system to negotiate a volume discount like the VA and Canada do would save billions. (Congress, assaulted by more lobbyists than Congressmen, outlawed volume discounts).
So just by providing a nonprofit system and slashing the nearly trillion dollars in administrative waste, we could cover everyone at birth with a "Cadillac" comprehensive plan far better than any of us have now and save money in the process.
First we may need to agree as a nation that healthcare for All is a right.
Ray Bellamy MD Retired
Medicare for All won't save anybody any money and will make health care worse if it were implemented like the stealth "pilot Program" being implemented by the Innovation Center at CMS. The Direct Contracting Entity program is Medicare Advantage plans fraud on steroids and needs to be stopped immediately. You must emphasize that you are talking about Single Payer traditional Medicare, and no for profit middle men managing billing and payments as the pilot program is doing. Be sure to mention that in your presentation.
For those among us who are incapable of resolving ambiguous acronyms from memory, "CMS" refers to a U.S. government agency named "Centers for Medicare & Medicaid Services". Or at least that seemed to be the best match from the hundreds of possibilities.
Jane, I was so angry when I read that CMS was going to force Medicare recipients into HMOs in ~ 10 metro areas. Are they doing this? I can't find out for sure. They can take their Disadvantage plans and shove them.
I haven’t heard anything about this. It had better not be true.
I found it in this article in the WAPost: https://www.washingtonpost.com/opinions/2021/12/13/medicare-direct-contracting-privatization-health-care/
Time to start writing letters. Unfortunately the last time I wrote to Biden I got a response that was so content-free I couldn’t even tell what the issue was. I was extremely disappointed. We have to stop this.
I suspect Medicare for All is a shortcut way of explaining what they’re promoting, not necessarily a description of exactly how it will work. I get the impression that people have a negative view of the term “single payer,” or they don’t understand it. Just a guess.
A conversation with a student from Germany years ago that still lingers makes me wonder what role our current healthcare system is playing in preventing us from being our most fit and health-conscious. This student said that BECAUSE of the national health care system in Germany, people have the attitude that it is the citizen's responsibility to remain as fit and healthy as possible - for the good of all.
Neither of my twins could afford insurance under the 'Affordable' care act. The deductibles were so high, it just did not make sense. They were uninsured until my daughter's husband joined the Navy and my son got a job paying $30/hour, which included health insurance for himself and his wife that cost $300/month.
Ugh.
We keep having example after example of the failure of the American state capitalist system to effectuate any of these reforms because the battle between laissez-faire capitalism and state capitalism is increasingly one in which the latter triumphs. Corporations have consolidated their control over Congress and the regulatory apparatus and the courts. Soon the state will be deprived of any right to tell private enterprise what to do about preserving the health of the population if it interferes with commerce, not that institutions like the CDC will do so. It might take a few more years before they do away with Medicare via the HMO route but they will.
So when I see all of those members of the progressive caucus, you know the ones who voted to delink infrastructure and BBB bills, I wonder what planet they are on. Is it Planet Fantasy where they sing “would in it be wonderful” from My Fair Lady?
Wasn't the infrastructure bill originally broken out from the BBB bill in the Senate? And then sent back to the House? I thought the progressives were against breaking out the infrastructure bill, and then once it was broken out and sent back to the House, against delinking them.
No what happened was that the House progressive caucus held out from signing off on the infrastructure bill until the Senate passed the BBB bill so that one couldn’t be approved without the other. They demanded this because delinking meant BBB would flounder. They were persuaded by Biden to abandon their opposition on his promises that he could get BBB through the Senate. the infrastructure bill was then passed by the House. Once this lever was lost Manchin did his thing and BBB floundered in the Senate. So this has been a problem with the progressive caucus lacking political nerve and strategy and depending upon the President’s leadership to no avail. It is why Biden’s poll numbers are so low and why the Democrats are about to commit political suicide this Fall and put the Trumpers in control of Congress.
I meant to say in the battle between state capitalism and laissez faire capitalism in the US it is laissez faire capitalism that triumphs.
As Michael Moore pointed out, Medicare for All was a huge giveaway to the insurance industry, and the name 'Affordable Care Act' is a misnomer; it is neither affordable nor is it 'caring'.
@Laurie. I am so glad you brought this up - in this country nothing gets through Congress without a big paycheck attached for one or the other interest group. The "cost of doing business" to get Medicare for All past our nominal representatives and particularly past the so-called deliberative body is to have a bill that preserves at least some of the "rents" that go to the medical insurance companies. This insurance industry employs thousands of people too, so if they were suddenly cut off completely there would result job losses and a certain amount of economic dislocation. I'm not trying to put words in anybody's mouth, but it seems that support for the current legislative efforts is the pragmatic approach, to not let perfection be the enemy of progress.
Every time they privatize something they build up a huge infrastructure and then when people propose doing away with that Republicans cry “job losses.” It’s happened over and over and it’s intentional. Of course doing away with government jobs doesn’t bother them one bit. We can’t let this manipulation derail us.
Agreed.
There is nothing in the American health care system that can be considered progress on any level. We are an outlier, this system is awful, lowest mortality rates, Americans are the sickest among rich nations, it is a wholly owned subsidiary of the corporate elite. No other comparable nation lives like this. Oh, and those jobs? People won't lose jobs they'll be plugged into the new system that also will require administrative work, etc.
@Claire. I hope nothing in what I wrote can be construed as a defense of the current situation? I was talking about the role of money, lobbyists and industry influence in what happens to legislation in our Congress.
By t he way, 58 countries have some form of universal health care. 58! No, this is not acceptable.
Sounds like an argument to continue the sell out. Jobs! Maybe we support 'clean coal' ? Just sayin'!
@Laurie. You keep a clear and consistent view!
Unfortunately, "the cost of doing business" is what keeps us from getting anything meaningful or worthwhile ever done or done right, which is then always followed by our representatives telling us how wonderful it is, but people know it's BS and just despair of Congress ever getting anything right. Why do we keep doing stupid and stupider? When do we ever learn? Because government doesn't work for the majority, as most of us here would probably agree. And those who support the other guy, they just want to do away with all of government for probably many of the same reasons.
@Jim. This can be a very valuable conversation! For example, is it really a majority of Americans that get nothing (or too little) from government? Or is it really the media circus pushing misinformation that makes a lot of people think that a lot of other people are unhappy? I think Reich has shown in this column that there is a gap between way people say about themselves (doing ok, feeling pretty good) versus what people in the same poll say about the state of the country (going to hell, people very unhappy). As you can easily see the "majority unhappy" is a perception, a big lie and a piece of leverage to influence votes. In our country a clear majority vote Democratic; it is the operation of the Electoral College, the design of only 2 senators per state regardless of population, the role of money in Congressional influence and the malicious, cynical manipulation of the media by corporations, the super rich and international oligarchs that reduces the Democratic majority enough to keep Republicans in government.
The only way to efficiently, cost effectively and reduce worsening of death rates and chronic illness is the Medicare for All Act. The continued move to privatize (DCE) Medicare and for profit middle men will only continue to raise the costs, while making a few for profit entities richer. Decisions need to be between the provider and patient period. The Medicare for all Act is the best solution as far as I can see
The fundamental problem is not that there are a lot of specialists and not enough generalists. That is somewhat symptomatic. The fundamental problem is that almost all of the medical profession adheres to the mistaken ideology of allopathic medicine....that only man made chemicals can cure disease. It is a cult belief (with no scientific basis) which has prematurely killed millions, injured millions more and rarely cures anything. But it does massively enriches drug companies, insurers, hospitals, government gatekeeper "regulators", practitioners, their instructors and a whole plethora of associated professions. The belief in our allopathic medical practices sustains the pill illusion because pills may "cure" some bacterial diseases, and some inoculations may prevent some fatal childhood scourges. They have no curative effect on the vast majority of chronic diseases that plague modern life (heart disease, cancer, diabetes etc.) The patient is grateful for the symptom relief of "modern medical practice". The symptoms have been suppressed but the disease is still raging and will likely prematurely kill them. In short, not only is modern U.S. medical practice outrageous expensive, the practice is a fraudulent unscientific deception.
@Kendrick. The science is clear on the other side - homeopathic attempts at treatment are ineffective across the board. This is proven fact. Also, many formulations are toxic and/or dangerous by enticing people to avoid modern medical treatments. So far as I have been able to find, there are no exceptions. Meaning there are no homeopathic, traditional or shamanic treatments that are better than modern medical practices.
I agree that homeopathic or shamanic practices are just as unscientific cults as allopathic medicine.
Thank you Robert for going to Congress. Health care in this country is one of the most deplorable aspects of American life. It is patently a cruel system. In many cases the quality of health care (not if you have money*), access to physicians and pharmaceuticals, ugh.
*The money, I know people who cannot get a general practitioner unless they'r willing to pay for "concierge medical service." The strictures, if you will, are tightening between rich people's access to health care and everyone else. The system, as it is now, is only getting worse.
Yes! It’s almost impossible to find general practitioners who are taking new patients. Even the concierge doctors have waiting lists. The only alternative seems to be Kaiser, which both my husband and my mother like but I feel like it’s a factory and don’t want to use it, especially as it’s far away. Things never used to be like this.