Let’s Talk About “HEALTH CARE”

On the Sunday morning talk shows and other broadcast media outlets, I consistently hear the voices of conservative republicans touting the fact that the US has the best health care system in the world. Well I have news for them: The last time I checked the statistics published by the World Health Organization, the United States was listed at 37th with France in first place and Myanmar (Burma) in last at 190th. Spread sheet details are also available at that website.

Another prominent attitude displayed especially by radical right wing conservatives is that “Obama Care is socialized medicine. Let me give you an example of that by Tennessee representative Zach Wamp who represents the 3rd congressional district there. In an interview with MSNBC’s Tamron Hall during the early stages of the health care debate in Washington Wamp stated “I hate to sound so harsh, but…this literally is a fast march towards socialism, where the government is bigger than the private sector in our country, and health care is the next major step, so we ought to be worried about it.”(1) He went on to ramble about how many illegal immigrants were living off the social welfare system of the country and how many individuals were just irresponsible bums, waiting for a handout.

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Historically, America has forfeited its national health care system to private financially motivated interests. In contrast, other developed countries have taken deliberate action to create national health care systems. Universal health care is available today in every industrialized country except one -- ours. However, as early as the beginning time of our country attempts to establish such a system have been taken, by a variety of individuals and politicians.

President John Adams signed a bill in 1798 establishing the Marine Hospital Service. Sailors paid 20 cents a month to be able to have access to a group of hospitals in US seaports. There were other sporadic plans that took place and worked well for their needed duration during the 19th century, but the limitations of space in this article prevent me from describing them all. The next major step was taken not in the US but by the “Iron Chancellor” Otto von Bismarck of Germany who established there his “compulsory sickness insurance program”. What does this have to do with health care in the US? Not much other than the important reason for which he did it, and I quote; “People who know they are cared for are the best building blocks for a strong nation”. (2)

 

1906 was the first time in the US that there were demands for national health insurance plans. That year, the American Association for Labor Legislation (AALL) was formed by a group of progressive academic reformers, to include President Theodore Roosevelt. In fact, he quoted Bismarck this way; “No country could be strong whose people were sick and poor”.

 

At an AALL conference in 1913, the American Medical Association (AMA) and the AALL formed a partnership to propose legislation for a national health care plan. However, by 1917 opposition to it had grown by among others, private insurers (even though none of them offered health insurance at the time) and, the advent of WWI sidetracked the issue. Some so called “Free Choice” plans did become available after WWI, that allowed subscribers to choose their own nonprofit participating hospitals, and soon thereafter the American Hospital Association began to lobby states to permit the sale of hospital insurance by nonprofit corporations. These programs were eventually united under the name of “Blue Cross” and later this common trade group was renamed “Blue Cross Blue Shield”. By 1945, they held about two-thirds of the nation’s health insurance market. “The fact that it was accomplished by government shielded nonprofits doesn’t deter today’s talking point propagandists from extolling its “free market” approach”. (3)

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In the time frame since WWII, attempts by a variety of individuals and politicians to incorporate some sort of a national health care system have been taken. Some have met with success and others have been thwarted. In the early 1960s, Ronald Reagan participated in a program called “Operation Coffee Cup”. This program characterized the moves toward Medicare (which at the time was gaining popularity with a majority of folks) as “socialized medicine”. (4) By 1962 however, in light of the fact that free market health care programs were not working for the elderly and polls were showing that 69% of Americans favored the program soon to be called Medicare, President Kennedy made such a program a legislative priority. After intensive lobbying by groups opposed, it was narrowly defeated in congress.

 

However, after Lyndon Johnson became president and a landslide victory by democrats in 1964, it was finally passed into law in 1965. During the 70s, it became apparent that health care for the non-elderly was under attack by growing health care costs. President Nixon even sounded the alarm by stating that “We face a massive crises in this area. Unless action is taken within the next two or three years … we will have a breakdown in our medical system”. Despite all of the different proposals to solve the problem by various adherents, congress took no action. This was due to several factors which included a recession, Watergate, the end of the war in Vietnam, the Arab oil embargo, and the Iranian hostage crises.

 

During the Reagan and Bush I administrations, the rise of Health Maintenance Organizations (HMOs) prepaid plans with groups of enrollees became popular. Even though some of these plans had origins as early as 1928, by 1992 the dominance of a handful of for-profit insurers had control of the market, and millions of Americans were going without insurance due to the fact that costs and deductibles were so high. Several pro-business amendments in 1988 to the earlier 1973 HMO act were intended to make rates more competitive, but ended up doing the opposite because of business deregulations therein. (5) During the early part of the Clinton administration the attempt by Hillary to establish a universal health care system were thwarted by the so called “socialist medicine” arguments and Hillary’s own unwillingness to compromise. With the election of the republican congress in 1994, all efforts at health care reform were halted. This brings us into the current time frame and the passage of “The Patient Protection and Affordable Health Care Act of 2010”.

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First let us discuss the term “Socialized Medicine”. As mentioned above, the United States is the only major industrialized country that does not have some sort of a national health care system. Of the countries that do, such as Norway, Sweden, Finland, Denmark, Germany, The UK, France and even South Korea (the list could go on and on) could hardly be called socialistic.* Let’s ask the chairman of Mercedes Benz, Rolls Royce, Hyundai, British Petroleum, DHL etc. (the list could go on and on as mentioned above) if they really think their countries are socialist. (Rush Limbaugh however has no problem calling these countries socialistic.)

Most of you reading this article live here in Korea as I do. Most of us, if not all, participate in Korea’s “National Health Insurance Corporation” (NHIC).  I pay W78,000 per month for enrollment that covers both my wife and I, and it even includes most dental care. I have no problems getting appointments, as I call the foreigners clinic at the hospital a few days in advance, and am usually able to get an appointment with the needed specialist, on the exact day and time of my preference. Could I do this in the US through a private insurer? Not hardly! The best part however, is that when I go to the counter to pay for my services, the amount being paid by the NHIC has already been deducted from my bill. Private insurers, “I dare you”. And what's all this talk by anti national health care system folks about maintaining a "Doctor - Patient" relationship? I'll go one better. I have a "Whole Hospital - Patient" relationship.

Americans spend more on health care per person than any other advanced nation and get less for their money. Yearly healthcare spending amounts to $7,538 per person. That’s almost two and a half times the average of other advanced nations. The typical American lives 77.9 years while the average in other advanced nations is 79.4 years. (6) Some of the reasons for this are as follows: America spends $30 billion a year correcting medical errors – the worst rate among advanced nations. That’s twice the rate of most other countries. The reasons for this are varied but one of them is that the medical computers don’t share their data, a problem that will be fixed by “The Patient Protection and Affordable Care Act of 2010”.

 

Another point is that administrative costs are 15 to 30 percent of all healthcare spending. That again is twice the rate of most other advanced countries. Much of this time is spent documenting procedures so that private insurers will pay the amount due. As much as one third of a billing clerk and nurses time is spent on these activities. (7) By the way, I might add the Medicare’s administrative costs (a government program) are 3 percent. We can compare that to the 5 to 10 percent cost to large companies that self insure, and the cost of 25 percent in the small group market, and the 40 percent cost to individual private insurers. (8)

Let’s now talk about the private insurers. Most for profit insurers provide a quarterly report to their investors of how well they have performed financially. One of these measurement tools is called the “Medical-Loss Ratio” (MLR). If the MLR is lower than the previous quarter, it means the company paid less out in medical expenses and had more money left over to pay marketing, underwriting, and other administrative costs.

 

Most importantly, however, it means that they had more money to pay stockholders and company executives. Investors and stockholders want the MLR to decline every quarter. This has pushed the insurers to a degree of vigilance for cutting medical expenses over time, that the average MLR in America has dropped from 95 percent in 1993 to around 80 percent today. How have they done this? By dropping insurance from folks who get sick and make claims too often and by denying coverage to those with pre-existing conditions, among other methods. Both of these issues are addressed in “The Patient Protection and Affordable Care Act of 2010”. (9)

Another talking point by conservatives and right wingers is the so called “TORT” reform. Let’s take a closer look and see what its real impact on health care costs would be. Basically what we’re talking about is restricting people’s access to the civil justice system. It helps companies avoid paying out settlements to complainants when their products fail or are proven unsafe (hazardous). It is tied to health care because of the continually rising premiums doctors have to pay for their malpractice insurance. The solution proposed by conservatives is to place caps on the amount of money that can be awarded in a malpractice lawsuit. In fact several states have adopted malpractice reform by putting caps on the amount of awards that can be granted. These states include California, Nevada, Florida, Michigan, Ohio, and West Virginia. Did this work?

 

Here is a list of some of the states that still have some of the highest malpractice insurance rates in the country: Florida, Michigan, Nevada, Ohio and West Virginia. (10) To close out this point, lawsuits, payouts, damage awards - all - of these amount to less than 1 percent of health care costs. Is “TORT” reform really the solution?

Unfortunately the items presented in this article can only scratch the surface of the overall issue of health care reform. There is no doubt that this debate will continue for some time to come and at great lengths. This article also brings to light a basic disagreement between liberals and conservatives, (Republican and Democrats) and that is as to how much the private sector vs. the public sector should be involved in the well being of our citizenry. A couple of items in closing: First an essential reading recommendation for everyone: “Deadly Spin” by Wendell Potter. Wendell is a former health insurance company insider who speaks out about how corporate public relations of the private health care industry is killing good health care and deceiving Americans (us). Secondly, I cannot close without a little humor in the form of a cartoon that
represents one of the far right complaints about the so called “Obama Care” “Death Panels”.

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Raymond “Gene” Gerth spent 22 years on active duty with the US Army. Eight years and four months of that time were spent stationed here in the ROK. After his retirement from active duty, he spent another twelve years as a Procurement Analyst for the Eighth Army's MWR division at their headquarters in Seoul and worked as an Adjunct Assistant Professor at the University of Maryland's University College. Prior to his government service, he was a public school teacher in three different US states and managed his own Entertainment Booking Agency "Musicians Services Limited". His political activities prior to his military service included serving on his local precinct election board as a poll judge.

 

As in my previous article I have included note references (1), (2) etc. available from myself upon request, as well as an extensive bibliography.