Gainesville, Florida (Special to Informed Comment) – March 17, 2021, was a very bright day in the history of single-payer health insurance and public health in the USA. Reps. Pramila Jayapal (D, WA) and Debbie Dingell, (D., MI) introduced the modern MEDICARE FOR ALL ACT of 2021 (H.R. 1976) in Congress. M4A 2021 is new legislation establishing a single-payer national health program in the United States that addresses decades of health/mental health-related injustices that have been made even more painfully apparent by the COVID-19 pandemic.
MODERN MEDICARE THEORY AND PROGRAM: EVERYBODY IN, NOBODY OUT !
HR 1976 upgrades Medicare with a 21st century modern and improved “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. Benefits of HR 1976 health insurance include the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic disease management.
(4) Prescription drugs and medical devices, in- cluding outpatient prescription drugs, medical de- vices, and biological products.
(5) Mental health and substance use treatment services, including inpatient care.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn care.
(8) Dentistry/Oral health, audiology, and vision/opthamology services.
(9) Rehabilitative and habilitative services and devices.
(10) Emergency services and transportation.
(11) Early and periodic screening, diagnostic, and treatment services.
(12) Necessary transportation to receive health care services for persons with disabilities, older indi- viduals with functional limitations, or low-income in- dividuals (as determined by the Secretary).
(14) Hospice care.
(15) Services provided by a licensed marriage and family therapist or a licensed mental health counselor.(In addition to psychiatrists, licensed clinical psychologists, licensed clinical social workers, psychiatric nurses.)
Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100 percent.
All residents are guaranteed access to quality health care while achieving significant overall savings compared to our existing Medicare system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.
Good health care is established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees. Health insurance is based on residence, not employment.
PROFITEERING INDUSTRIES OPPOSE M4A 2021
The real boogeymen opposing M4A 2021 are the profiteering health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of Big insurance and Big Pharma — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma and Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present obsolete system based on the private insurance industry.
Our private health insurance system is designed so that the 99% can never free themselves from debt to the 1%. Currently, the richest 1% hold about 38% of all privately held wealth in the United States, while the bottom 90% hold about 73% of all debt. The richest 1% in the United States now own more wealth than the bottom 90%. The 1% impose the intrinsic instability of their system on the entire population, and then get the government to respond with deficits that even further benefit and reward the greed of the very same 1% oligarchs of Big insurance / Big Pharma corporations.
MENTAL HEALTH SERVICES LIMITED
Today, America is facing an unprecedented mental health crisis, yet many can’t get needed care. Even though many families are covered by private health insurance, these plans discriminate against mental health care by limiting choice of providers and by routinely denying treatments such as medication, psychotherapy, counseling and hospitalization.
Mental health treatment services in general and talk therapy in particular have been negatively affected by insurance and drug company domination of the U.S. health insurance system. Talk therapy includes psychotherapy, psychoanalysis, counseling, marriage therapy, family therapy, group therapy, psycho-educational groups, addiction treatment groups and programs, parent training groups, anger management programs and many others. There are dozens of effective means to deal with human distress that involve talk between qualified professionals and people seeking help. Talk therapy is not one-size-fits-all. It is focused on emotional problems in relationship with oneself or others. Private insurers, with their focus on profit, seek to spend as little as possible on mental health care and treatment. Talk therapy sessions have been drastically cut by insurers. Privacy has been invaded and is no longer assured. Choice of therapist is no longer under patient control.
Likewise, drug companies with profit motive want to sell expensive drugs. Drug and insurance companies often view talk therapy and qualified practitioners (clinical social workers, clinical psychologists, marriage and family therapists, mental health counselors, psychiatrists, psychiatric nurses) as a threat to their control over the health care/insurance system. These companies insist that mental health problems are due to “biological imbalances” which require only expensive medications.
A systematic campaign to discredit the value and competence of talk therapists exists when drug and insurance companies assert, for example, that most types of long-term therapies are not “evidence based.” Insurance coverage for talk therapy has in fact steeply declined and people seeking talk therapy increasingly must pay for those services out of pocket.
Many people with emotional and psychological problems make good progress with talk therapy or with a combination of talk therapy and medication. While drugs can indeed by helpful, they alone do not “cure” emotional distress and sometimes have uncomfortable side effects. Certainly, there are biological aspects to many emotional and psychological problems, but biology is not the only cause (or cure) for these conditions.
Our mental health care system needs to get private health insurance out of it. Little of value is offered by private insurance when 15 percent to 25 percent of the health care dollar is skimmed off for profit and overhead. Our health insurance is being rationed, with care guidelines determined by profitability and secrecy decided in private corporate boardrooms. To realize large profits demanded by Wall Street investors, our private health insurance system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill. A study by the New England Journal of Medicine showed that a large number of Medicare HMOs engaged in favorable selection by “cherry picking” healthier individuals.
MENTAL HEALTH BENEFITS OF MODERN MEDICARE FOR ALL 2021,H.R.1976
1). A trusting relationship with your mental health provider can be built because coverage stays with you for life. Unlike private profit health insurance, you will always have free choice of provider.
2). Medicare for All covers all licensed psychiatrists, psychologists, clinical social workers, mental health counselors, and marriage and family counselors across the nation. You can select any provider in your area who meets your needs.
3). No more surprises at the pharmacy counter — Medicare for All covers all medications prescribed by your doctor, without copays or deductibles.
4). Medicare for All covers everyone for life, regardless of employment status or disability. Medicare for All also fully funds community-based mental and behavioral health programs, which are integral in coordinating care for those with more serious conditions, especially in “provider deserts” — communities that have been historically underserved by large hospitals and private providers.
5). Unlike commercial insurance, Medicare for All doesn’t discriminate against mental health care services or providers. Medicare for All reduces providers’ overhead costs (and headaches) by eliminating the time and money spent on billing multiple insurers and patients, and navigating insurers’ authorization requests and denials. This administrative simplicity means professionals can spend time with patients, not insurance paperwork.
6). Most commercial plans require enrollees to pay a certain amount upfront (called a “deductible”) before they provide coverage; the average deductible for a family plan is nearly $4,000 — totally unaffordable for most families. Unlike commercial plans, Medicare for All provides coverage for all medically necessary care, including hospitalization, prescription drugs, and follow- up care, with no premiums, deductibles, or copays. Medicare for All funds hospitals directly, so patients will never get a medical bill ever again.
7). Private commercial insurers discriminate against mental health care by restricting choice of provider. In contrast, Medicare for All gives patients free choice of hospital and provider, so you can choose someone who is right for you. Medicare for All coverage stays with you for life, so you can build a relationship with a trusted provider and create a long-term plan for care.
8). In today’s Medicare, coverage for mental and behavioral health is not as extensive as coverage for other services — and so-called “Medicare Advantage” plans have all the same problems as commercial insurance. However, under Medicare for All (often called “Improved Medicare for All”), all mental and behavioral health services and medications would be fully covered, without copays or co-insurance. As noted, improved Medicare for All covers psychiatrists, psychologists, clinical social workers, licensed mental health counselors, and licensed marriage and family therapists.
9). Treating mental illness is proven to improve health and reduce costs in the long term, but private profit insurers routinely deny treatments such as medication and therapy just to protect their short-term profits. Unlike commercial insurance, Medicare for All is not-for-profit, and protects you for life. It covers the medically necessary care that your doctor prescribes, without pre-authorizations, denials, or cost-sharing like copays and deductibles.
It is very clear that private health insurance is the problem, and Medicare for All 2021 is the solution because, as noted above, Medicare for All 2021 covers everybody in the U.S. for all medically necessary care, including medications and behavioral and mental health services, with no copays, deductibles, or gaps in coverage. And unlike private insurance, Medicare for All provides free choice of hospital and professional. Everyone in, nobody out!
BIG INSURANCE/BIG PHARMA OPPOSITION TO M4A
To protect and enhance high profits by opposing improved Medicare for All 2021, the private health insurance industry has mounted a huge campaign using myths, scare and fear tactics ever since ‘Obamacare’, the Affordable Care Act (ACA), was enacted in March, 2010. The U.S. health insurance industry lobbied Congress hard at that time to enact a requirement that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.
The expedient health insurance industry seeks to protect high profits using scare/fear tactics against the new and improved Medicare for All 2021,HR-1976. One tactic deliberately confuses the public by not honestly telling individuals what would change if their private insurance is replaced by the new Medicare for All health insurance program. Lack of specificity and avoidance behavior promotes confusion, misunderstanding and great fear because it conflates loss of private health insurance with loss of their own physicians, other health professionals and hospitals. The for-profit health insurance industry knows full well that people are most interested in keeping their own doctors and that the new Medicare for All 2021does not interfere with that. By conflating private health insurance with the direct provision of medical treatment itself, many patients are mislead into thinking they could lose all their health professionals. Fortunately, once folks understand that losing their expensive, for-profit private insurance plans is the only thing that will change, support for Medicare for All sharply increases. The huge profits of Big Insurance and Big Pharma are threatened once folks become aware of this tactic.
Another very effective industry scare tactic is to stoke public fear and confusion by conflating the “socialized medicine” label with single-payer, “socialized (public) health insurance”. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. The U.S. Veterans Administration is an example. In contrast, most European countries, Canada, Australia and Japan have ‘socialized health insurance’, not ‘socialized medicine’.
The term “socialized medicine” is often used by the private insurance industry and politicians to manufacture frightening images of government bureaucratic interference in medical care. In countries with socialized health insurance, health and mental health professionals and patients often have more clinical freedom. This is in sharp contrast to the U.S., where private health insurance bureaucrats attempt to direct/interfere with care .
Manufactured confusion and fear of socialism by the health insurance industry and their political spokesmen impede the public’s ability to differentiate and thereby reduce support for Medicare for All . This allows the private health industry to successfully maintain control of the U.S. health care system for its own profitable purposes.
Opposition to Medicare for All is also based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in the mid-1960s. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.
Although many have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. The only thing that exceeds government inefficiency is the private health insurance industry itself. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject myths about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.
MODERN MONETARY THEORY-MMT AND MODERN MEDICARE THEORY-MMT
The US healthcare system is notorious for its high costs and below par outcomes. We already spend 18 percent of GDP on healthcare, and that is projected to reach 20 percent soon. This is approximately twice as much as our peers, other rich, developed, capitalist countries with no discernably better health outcomes (and even worse on a number of measures). Our excessive spending when compared to that of our peers can be attributed to the use of for-profit private insurance to pay for healthcare, higher pharmaceutical and provider costs, and higher administrative costs. Study after study has confirmed that prices and administrative costs in the US are out of line with those in the rest of the developed world, and especially compared to countries that have some type of a single-payer.
Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2021 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. Economists at the Levy Institute of Economics of Bard College alert us how opponents of M4A typically warn of the high financial costs, and hence of prospective dangerously high government deficits. From the perspective of Modern Money Theory (MMT), these fear mongering arguments are beside the point and are a myth. A sovereign government’s finances are not like the budgeting by households and firms; the government uses the monetary system to mobilize the nation’s real resources and to move some of them to pursuit of public purposes, such as social welfare programs, public health, public health insurances etc. Whatever the financial costs, we already have a financial system that can handle them.
MMT economists Wray and Nersisyan at Levy/Bard College maintain that “a sovereign government like the USA is not financially constrained; it spends by fiat, i.e., printing money, and/or through electronic computer entries in bank accounts and can neither run out of them nor save them for the future. What should constrain the spending of a sovereign government is the nation’s available real resources. Excessive spending, therefore, creates problems not in terms of higher government deficits and debt, but in terms of true inflation. Similarly, taxes are used not to finance government spending, but to withdraw demand from the economy, creating space for government spending to move resources to the public sector without causing inflation”.
“The adoption of a single-payer system (replacing for-profit private insurers) would significantly reduce the resources devoted to our unusual way of paying for healthcare. It would eliminate the private insurance sector’s participation, reduce employers’ costs of administering healthcare plans, reduce the costs incurred by doctors and hospitals due to billing insurers as well as pursuing patients for uncovered costs, lower the costs of appealing denials, and cut costs associated with patients avoiding early treatment of diseases (because of the actual or expected out-of-pocket costs) that become chronic and expensive maladies. If M4A could control prices and lower administrative costs, we could spend significantly less on healthcare than we do currently, while expanding coverage to everyone. All else equal, if we were able to reduce our spending on healthcare to the level of our peers, we would be creating deflationary pressures, not inflation”.
Nersisyan and Wray estimate that “in the short term M4A could save about 3.7 percent of GDP while providing healthcare to the whole population. Even if we lowered healthcare spending by 3.7 percent of GDP, we would still be spending more on healthcare than all of our peers. We believe our estimates are just the savings possible in the short term. In the long term, increased use of healthcare could reduce spending on chronic diseases. With universal access, cost controls, and elimination of a highly inefficient private insurance system, the single-payer system could shrink US spending on healthcare by much more, bringing us in line with other rich countries at about 10 percent of GDP.”
“Some will object that the savings largely accrue to the private sector, while the government will face additional costs. While it is true that the distribution of spending between the private and public sectors would change, there is nothing about government spending that necessarily makes it more inflationary than private spending. If private spending on healthcare costs falls by more than the increased government spending, the movement to single payer will be deflationary, not inflationary. Only a net increase in demand for resources would be inflationary.”
The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is , using our MMT guide, without ambivalence or avoidance behavior, to immediately implement H.R. 1976, MEDICARE FOR ALL ACT 2021.
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