By Margaret Flowers, Health Over Profit for Everyone (HOPE).
As it was in the 2008 election, health care is at the top of voter’s list of concerns. This means that we have the opportunity over the next few years to push National Improved Medicare for All (NIMA) over the finish line. But there is no guarantee that we will succeed.
Healthcare profiteers will fight to remain in control. They are making themselves an integral part of the healthcare system through mergers and acquisitions and something called vertical integration – owning many parts of the healthcare system such as health facilities, health professionals and health insurance. And while Democrats are feeling pressured to support Medicare for All, they are mostly promoting lesser proposals – “fixing” the ACA and variations on the public option theme – and saying that we’ll have Medicare for All later. We all know that later never arrives, and that’s why we will have to be clear and uncompromising in our demand for NIMA now.
The Healthcare Crisis is Worsening
David Nather, in Axios, writes that “The cost of health care — both for individuals seeking coverage and the government seeking sustainability — promises to return as the biggest domestic issue once the Trump obsession burns off.” Recent polls show this is already happening. In a June NBC News/Wall Street Journal poll, health care was the top issue, with 22% of respondents making it the number one issue and 38% making it an issue in the top two chosen. The economy was a close second.
Despite efforts to “stabilize the insurance market” at the state level through programs to re-insure health insurers, which means giving them more money, private health insurers are continuing to demand higher premiums for next year. Some are requesting increases by as much as 90%. These increases mean greater hardships for families and that we can anticipate another significant increase in the number of people without health insurance because premiums are rising faster than wages and inflation. In 2017, 3.2 million more people became uninsured, the largest increase since the passage of the Affordable Care Act (ACA).
Private health corporations are also consolidating at a rapid rate. Deloitte estimates that 50% of healthcare systems will disappear in the next ten years through mergers and acquisitions. In this consolidation, it is the patients and health professionals who lose. Large for-profit systems mean fewer choices and fewer choices mean that healthcare systems can demand higher prices. Timothy Hoff explains this further in the Healthcare Blog.
Healthcare professionals are hurt because health systems prioritize profits over health. Health care is treated as a business and decisions are made based on what is good for business, not what is best for patients and communities. Consolidation also means health professionals have less control. They are just a number in the system.
In Maryland, where I live, we are experiencing this with MedStar, a large system that owns hospitals, medical practices and long term care facilities and has its own health insurance products, including Medicare Advantage plans and Medicaid managed care organizations. MedStar has been closing essential services at community hospitals, such as obstetrics, pediatrics and psychiatry, without notice. They are firing physicians and other staff members and pushing low income patients to outside facilities. They also have power over physicians who remain. If a physician is not making money for them, they can drop them from their insurance “without cause,” which means losing patients. MedStar is increasing its profitable services such as cardiology, orthopedics and outpatient surgery.
As it was before Medicare and Medicaid, we are experiencing growing discrimination in healthcare. Hospitals are closed if they are unprofitable, mostly in rural and low income areas, making timely access to care impossible. Services are cut if they are unprofitable, which also hurts the poor the most because they often lack the ability to travel to hospitals that have the services they need. The costs of pharmaceuticals are also rising exponentially, making access to necessary treatments dependent on wealth or access to public programs such as Medicaid, which require being in poverty.
All of the above factors mean the healthcare crisis is coming to a tipping point and legislators are running out of solutions that allow the status quo to continue. The debate over whether health care is a commodity or a public good is prominent. The current national conversation is shifting toward what type of single payer system we will have as more people view it as inevitable.
Elections Reflect the Political Culture
It was evident in the recent primary elections in seven states that political reality is shifting. Candidates who ran on Medicare for All platforms ran important races, knocking out establishment and party machine-backed candidates. Joe Crowley, who is in leadership in the House and who spent millions on his race, was defeated by a first-time candidate, Alexandria Ocasio Cortez, who raised many times less in donations.
This is sending an important message to other candidates and party leadership that they must get on board with supporting Medicare for All or lose their races. It should be a message heard by both major parties because support for Medicare for All is rising among conservatives, especially voters at the lower end of the income spectrum.
Supporters of NIMA can congratulate themselves, because credit is rarely given, for their work over the past years and decades to educate people about NIMA and to organize in their communities. It is this work that is shifting the political culture so that candidates feel compelled to support NIMA, and this shift is fundamental to winning. But, there is more to do.
We can anticipate, and indeed it is already happening, that elected officials and candidates will attempt to give the appearance of supporting NIMA while offering something less. Over the past year, members of Congress have proposed incremental plans such as starting with a public option or lowering the age of Medicare or phasing in a Medicare for All system over a number of years. These proposals keep the profits in our healthcare system and they should be rejected. We have to choose whether health care is a commodity, in which people only get as much health care as they can afford, or a public good so that people get the health care they need without fear of financial ruin. It can’t be both.
Let’s remember that the United States is spending enough on health care right now to provide high quality comprehensive care to everyone. The US spends twice the amount per person per year on health care as the average industrialized nation and those nations cover everyone and have better health outcomes. There is no need to delay or phase in a system. People need health care now. They are suffering and dying now. Delays mean more preventable deaths.
When we talk about National Improved Medicare for All, we are talking about a single universal system that people are automatically enrolled in. Current Medicare consists of original Medicare, which is a public insurance, and what are called Medicare Advantage plans, which are private insurance. Medicare Advantage private plans should be eliminated because they cost more and enroll healthy seniors while pushing sick seniors out. Proposals that include Medicare Advantage plans will keep the profits in our system and won’t have the savings of single payer systems, so they will fail to solve the healthcare crisis.
We are in an exciting era. We have the opportunity to win National Improved Medicare for All, but to do so, we must avoid the mistakes of the past. Our current tasks are to keep educating and building the movement for NIMA and to pressure all members of Congress and candidates to support it. It is also important to see lesser proposals for what they are, distractions designed to throw us off the path to NIMA. We can have NIMA now and that is our demand.