Debunking the Myths About National Healthcare

An analysis of the Myths of National Healthcare Constipating Real Reforms

Myth #1 A government run healthcare program eliminates your private insurance

 No, this is incorrect and a good example of a government run healthcare program is Medicare, which has been around for over 50 years. Medicare is made up of several parts; Part A which is for inpatient coverage, Part B, which requires a monthly premium provides outpatient coverage, Part C, which is the Medicare Advantage Plan-a somewhat integrated health plan, and Part D, the prescription drug coverage added by President George W Bush. This was back in the day when Republicans wanted to provide benefits for people rather than take them away. Private insurance companies’ partner with Medicare to lower cost-sharing for seniors, improve drug coverage, and increase access to specialty care, and these are known as Medicare supplements. Though this may seem a convoluted way to get the various components of healthcare met, it does work. Medicare also is very effective for several reasons.

1.  All seniors, persons age 65 and up are covered on Medicare, which is also a group that private insurance companies are glad to have the government insure. This is a demographic group that is highly likely to need healthcare services and whose access to healthcare would not be possible without government healthcare.

Myth #2 A government run health plan will cost too much

This assertion is also incorrect as every country with a national government run health system spends far less than the United States and boast better results in many clinical areas. For example, according to the Petersen/Kaiser Health System Tracker in 2016 the US spent $10,238 on average per person for healthcare. (Petersen/Kaiser Health System Tracker, 2019) But as we know, many people went without healthcare at all, so this figure, although higher than other industrialized countries by 50% represents the skewing of healthcare services to a much small percentage of the national population. France spent $4,600 per person and everyone has had access to an integrated health system for decades. Japan spent $4,519. The average spent by industrialized countries was $5,198, less than half of what the US spends. Further, an integrated national health system will be less expensive to administer and a good example of that is Medicare and here are some reasons why:

1.  Medicare administration expenses are 6% of total plan expenses as opposed to 12-18% for private sector plans, which means it is less expensive. 
2. Medicare requires Medicare Advantage plans, which are supplemental insurance, to spend at least 80 to 85% of the premiums collected on actual medical claims, which mutes excess profiteering. And CMS requires them to issue customer rebates if they do not meet those loss ratios for benefits paid out. This is similar to the standards private sector insurance must adhere to in Europe. 
3. Medicare already determines what services are approved for reimbursement, which all private sector insurance plans adopt, so it would be efficacious for it to set national standards.

Myth #3 You won’t be able to see your private doctor

This assumption is also incorrect as other countries with government run health systems do have private clinics and private doctors which their citizens enjoy. In fact, the United Kingdom Health System which is a totally government run health system is not the norm. Other countries with national health systems, like France the Netherlands, or Australia use a combination of public and private programs to provide healthcare. The difference is, a much smaller segment is provided by private insurance companies. Of course, the behemoth insurance industry in the US is not going to be in favor of a smaller market share. However, this does NOT mean this position is better for you, the consumer or the patient and I state this as a former insurance broker.

Myth #4 Most Americans have Access to Health Insurance Through Employer Provided Plans

Again, this assertion is false as only half of US employers provide medical plans to their workers. (Kaiser Health Facts, 2019) And of that number, employers are increasingly forcing more of the costs of medical care onto their employees through higher premiums, higher co-payments, and reductions in benefits. Ergo, people already realize they are paying for the cost of their healthcare, and paying more than anyone else in any other nation, but we need to move toward the discussion of value. The question needs to be, is that $1,000 monthly insurance premium and that $5,000 co-payment for surgery less expensive than a national healthcare plan and that answer is profoundly no. No one in any country with a national health system is expected to pay a $5,000 co-payment for medically necessary surgery. In fact, the joint replacement surgery to which I refer could be done for that co-payment price in many European countries. Americans need to start discussing value-what are you getting for that extremely high cost of care.

Further, the Republicans promote the idea that worthwhile residents have health insurance and the others must be lacking in some social value and this is not in keeping with current employment practices. The gig economy includes highly specialized and educated workers from throughout the globe and they work without benefits. It is not only farm workers who lack healthcare, but a huge swath of the workforce. An excellent reference for the impacts of this work force change is Mary Gray and Siddharth Suri’s Ghost Work-How to Stop Silicon Valley from Building a New Global Underclass. (Suri, 2019)

 A Better Approach

A better approach to improving US healthcare needs to consider who is paying for services, not just how much they are paying, because more and more the middle-class workers are being gouged for the cost of their healthcare. This needs to stop and the solution is to reform the US health system into a saner, less expensive, inclusive one, that is used by all other industrialized countries in the world (national healthcare). Some things to consider in streamlining the US healthcare system include things that Medicare is already doing with a national impact:

1.  The Centers for Medicare and Medicaid (CMS) are part of Health and Human Services Agency and are the main fraud detection arm to prevent criminal activity in the healthcare system. It is in the best interest of all patients and tax payers to have an independent government agency monitor and enforce anti-fraud efforts and prevent the use of unapproved medical devices and products in the healthcare system.
2.  Medicare is best suited to bargain with private sector entities for pricing of products and with the largest customer base, also in the best position to get lower prices than anywhere else. Private sector companies exist to make money, which means you pay more. If CMS through Health and Human Services has the power to bargain with pharmaceutical companies, you will see an immediate drop in the cost of your prescription medications. Why should Americans continue to pay more for medications that are sold to patients in Europe, with socialized health systems for significantly less?
3.  Medicare already uses medical evidence to inform changes in approved treatments and these are piloted through demonstration projects. Medicare with its huge patient population can provide excellent data for future health system improvements. An example of this was the move to spend Medicare money to keep seniors in their homes because it was proven to reduce hospitalization costs and improve patient health.

 A national health system for all will eliminate some of the conflicts of health system profit making procedures versus lower cost more efficacious health treatments that are less lucrative. The current health system relies on up-selling of medical imaging, laboratory, and elective surgeries to generate margins and produce financial results. Healthcare should be focused on helping people live quality lives, not producing profits. And the health of a nation needs to be devoted to population health measures, methods, and outcomes, not designed to benefit a few winners of the healthcare lottery.

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases for medical procedures which require hospitalization, do specify that for which you agree and that which you decline. And try to bring a healthcare advocate with if you are mystified by medical terminology.

Roberta Winter is an independent health policy analyst, patient advocate, and author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

References

Kaiser Health Facts. (2019, September 1). 2018 Employer Health Benefits Survey. Retrieved from Kaiser Family Foundation.org: https://www.kff.org/report-section/2018-employer-health-benefits-survey-summary-of-findings/

Petersen/Kaiser Health System Tracker. (2019, September 1). How Do Healthcare Price and Use in the US Compare to Other Countries. Retrieved from Health System Tracker.corg: https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/

Suri, M. L. (2019, September 1). Review of Ghosst Work. Retrieved from New York Journal of Books: https://www.nyjournalofbooks.com/book-review/ghost-work

Drug Shortages in the U.S. and What We Can Do About It

Critical shortages of prescription medication in the United States (and globally)

The United States has chronic shortages of certain medicines, especially those used in critical care and surgical treatments. Recently, both the New York Times and the Wall Street Journal published articles on medication shortages. This analysis looks at current drug shortages, whether there are substitutions, the reasons for this phenomena, and what we could do about it. To help you understand the reasons for shortages in medications, I reviewed detailed information from the American Society of Health System Pharmacists, which tracks medications and posts an almost live-time report on drug shortages on its web site.[1] This chart shows several categories of drugs, both preventive and interventional medications which are in short supply as of February 2016.

Drug Shortages as of February 2016

Drug Type	Ampicillin injectable	Aminocaproic Acid Injectable	DtapIPVHib Vaccine
Purpose	Surgical antibiotic for critical care	Hemorrhage prevention during surgery	Childhood disease prevention
Manufacturer	Fresenius, Sargent, Santos	American Regent, Hospira	Sanofi Pasteur
Length of Shortage	1 to 2 months	Unspecified	In short supply since mid-January
Reason for Shortage	Increased demand	American Regent is no longer making it; Hospira indicated manufacturing issues	Manufacturing delay
Availability of Substitute	Yes, Unysn	None listed	Yes, Pentacel

Source: American Society of Health-System Pharmacists

The venerable Cleveland Clinic has a sterile room and the ability to compound its own drugs in a pinch, but this is certainly not the case with most hospitals.[2] Anesthesiologists must determine how to ration some drugs used in surgeries and hospitals should have a policy for determining this process. Still, much of it is in the dark, because when you consent to a hospital procedure, it is giving broad consent for the surgical team and the facility to make decisions for you while you are incapacitated in the procedure. This in and of itself isn’t bad, as it is a basic tenant of medical triage, and this is what the medical team is trained for. However, as a society, can we be doing more to assure adequacy of necessary medications and even preventive care immunizations?

 Mark Baum, CEO of Imprimis Pharmaceuticals, has some interesting observations, expressed in the January 26^th Wall Street Journal Op Ed article.[3] His tenant is that federal regulatory policies interfere with free market competition for drugs and he has some interesting ideas to provide more of a supply of medicines and to lower the cost to the health system. He has several suggestions to improve the marketplace for less expensive drugs including:

1.       Allowing compounded-drug makers, which are companies who make the off-patent generic drugs, to create new formulations of expired patents for medicines and make them available at drastically reduced costs. This practice was not allowed until November 2013, when the Drug Quality and Security Act was passed.

2.       At present, Medicare or the Centers for Medicare and Medicaid (CMS), which is the largest drug purchaser in the nation, does not pay for compounded drugs, which means it is paying only for brand names, when a far less expensive substitute may be available. His example, Medicare will pay $750 for the Daraprim made by Turing Pharmaceutical, but not for the 99 cent generic alternative. I can just hear the swoop of lobbyists rushing for the beltway to scare Congress out of this good idea.

3.       Medicare also pays doctors a percentage of the cost of the drugs they prescribe, so there is no incentive for clinicians to prescribe the lower cost medications. This is especially true now when doctors are required to complete so much paperwork and receive so little in the way of reimbursement for primary healthcare.

 Since pharmaceutical manufacturers are privately held companies, often of a global nature, their entry into drug markets is controlled by the FDA, but their exit from the supply chain-not as much. Though the U.S. government is still one of the largest investors in healthcare research, through the department of Health & Human Services, product approval is regulated, but in general the drug companies use market pricing for their products. This means, if they have a monopoly, they can charge a lot more, which is what Valeant and Turing did, as detailed in a previous article.[4] Though Mr. Baum brings some good ideas to the fold, I don’t have quite as much confidence in the efficacy of the private sector marketplace as he does. Americans already pay more for their cardiac devices[5], orthopedic devices[6], and other medical gear than other nations, because these companies gouge the U.S. health system for the sake of their profits.  However, I am all for making the ninety-nine-cent pill available, as an alternative to the opportunistic price gouging of companies like Valeant and Turing. And finally, let’s stop blaming the physicians for everything, they are merely actors in a health system that rewards many of the wrong things and slights those that could make a difference. We need to focus on systemic changes and Congress should also pay the promised fee increase to physicians for primary care, which the Republicans refused under the budget sequestration process. Sequestration means the act of confiscating something or forcibly taking possession. It is unconscionable that physicians and health systems are encouraged by law, to provide health services, based on a certain rate of reimbursement and then jerked around by Congress in some power play.

And this is the healthpolicymaven signing off and encouraging you to share this article virally.

The healthpolicymaven is a trademark of Roberta E. Winter and Praevalere Inc. Ms. Winter is a healthcare writer and analyst and author of Unraveling U.S. Healthcare-A Personal Guide. http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

This article in no way provides medical advice.

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[1] http://www.ashp.org/drugshortages/current/

[2] http://www.nytimes.com/2016/01/29/us/drug-shortages-forcing-hard-decisions-on-rationing-treatments.html?_r=1

[3] http://www.wsj.com/articles/a-new-prescription-for-lower-drug-prices-1453767509

[4] http://healthpolicymaven.blogspot.com/2015/11/factors-driving-high-drug-costs-and.html

[5] http://healthpolicymaven.blogspot.com/2015/03/based-on-evidence-cardiac-and.html

[6] http://healthpolicymaven.blogspot.com/2014/02/a-closer-look-at-hospital-prices-for.html