Gainesville, Fl. (Special to Informed Comment) – The Affordable Care Act (ACA) was supposed to contain costs and make insurance for health/mental health care affordable. It did bring coverage to 20 million but 30 million remain uninsured. Data indicate that the bad outweighs the good. ACA is too expensive, unsustainable, overly complex and bureaucratic. Even worse, it’s a gift to private insurers and other 1% corporate stakeholders and profiteers in the neoliberal medical-industrial-congressional complex. Since the Affordable Care Act (ACA) was enacted in March, 2010, Big Insurance has lobbied Congress hard to ensure 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
To fix this problem, on May 17, 2023, Rep. Pramila Jayapal, Rep. Debbie Dingell, and Sen. Bernie Sanders and more than 120 other colleagues re-introduced the Medicare for All Act in the U.S. House and Senate. These landmark pieces of legislation would finally establish a single-payer national health program in the United States. These long-overdue bills are most welcomed and Congress is urged to move quickly to guarantee universal coverage, comprehensive benefits, and zero out-of-pocket costs for all U.S. residents.
The nuts and bolts of the new Medicare for All Act-2023 calls for citizens to be guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care. Each of these bills provides all residents of the United States and its territories with a nationally consistent comprehensive benefit design, eliminates nearly all copays and deductibles, is funded through an equitable tax model, protects current benefits and services for veterans and Native Americans while also including them in Medicare for All, and dedicates expanded resources towards improving equity and justice in health care/health insurance.
EVERYBODY IN, NOBODY OUT !
The new legislation 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 the new act 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/ophthalmology 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 / DEDUCTIBLES ENDED
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 2023 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/mental health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.
HEALTH CARE ESTABLISHED AS A BASIC HUMAN RIGHT
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.
With M4A, citizens are guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care.
FINANCING M4A SYSTEM:
We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.
More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.
According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households — one study says 95 percent —would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.
M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. 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.
WHY BIG INSURANCE OPPOSES MEDICARE FOR ALL: ! PROFITS – PROFITS – PROFITS !
I. Highlights from Wendall Potter, Feb 27,2023,” BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets”
Analysis of the 2022 financial statements of UnitedHealth Group, CVS/Aetna, Cigna, Elevance, Humana, Centene, and Molina
- 1. Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans they call Medicare Advantage.
2. The for-profits now control more than 80% of the national PBM market and more than 70% of the Medicare Advantage market.
3. In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.
That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion.
II. Facts and figures to keep in mind as Big Insurance thrives (W. Potter)
- 1. 27.5 million people remain uninsured in the United States.
2. Up to 14 million more will lose their Medicaid coverage once the pandemic emergency period ends later this year.
3. 100 million of us – almost one of every three people in this country – now have medical debt.
4. In 2023, U.S. families can be on the hook for up to $18,200 in out-of-pocket requirements before their coverage kicks in, up 43% since 2014 when it was $12,700.
5. The Affordable Care Act allows the out-of-pocket maximum to increase annually – 43% since the maximum limit went into effect in 2014.
6.44% of people in the United States who purchased coverage through the individual market and (ACA) marketplaces were underinsured or functionally uninsured.
7. 46% of those surveyed said they had skipped or delayed care because of the cost.
8. 42% said they had problems paying medical bills or were paying off medical debt.
9. Half (49%) said they would be unable to pay an unexpected medical bill within 30 days, including 68% of adults with low income, 69% of Black adults, and 63% of Latino/Hispanic adults.
10. In 2021, about $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That’s not surprising when you realize that in the United States, even people with insurance all too often feel they have no choice but to beg for money from strangers to get the care they or a loved one needs.
11. 62% of bankruptcies are related to medical costs.
12. Even as we spend about $4.5 trillion on health care a year, Americans are now dying younger than people in other wealthy countries.
13. Life expectancy in the United States actually decreased by 2.8 years between 2014 and 2021, erasing all gains since 1996, according to the Centers for Disease Control and Prevention.
As these numbers show, the real boogeymen opposing M4A are the wealth addicted private health insurance and pharmaceutical industries who have the most to lose if their huge profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of their insurance and Big Pharma donors — 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 system based on the private insurance industry.
If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House and Senate Bills, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.
Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, the one percenters have elevated self-interest even further above life itself for the ninety-nine percent.
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. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.
A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. By making health insurance available to all age groups, we can have the assurance that this life-saving health insurance program will continue.