DISCUSSION at recent Eau Claire event:
The group watched and discussed this documentary, which was produced by BLTH, a campaign initiated by employers whose mission is to transform the healthcare system so that processes are transparent, evidence-based and priced as a function of measurable value. The narrator, Richard Master, is the CEO of MCS Industries who was motivated to research why the US has the most expensive health care system in the world and why the cost of health insurance for his company increased every year. His findings led him to creating this film, which makes a compelling case for scrapping our complex and needlessly expensive multi-payer system for a single-payer system, similar to Canada’s. The key points include:
- Every physician in the US has to spend $84,000, on average, just to interact with private health insurance companies, which includes staff making multiple contacts with the insurance companies, trying to get payment for services or getting authorization for procedures.
- Of every premium dollar, 3 cents goes to the insurance agent who helps companies select an insurance plan and negotiate rates with the insurer; 20 cents goes to the insurance company to help pay for its sales and marketing and other administrative functions, which includes the work of a huge staff that does nothing more than approve or deny care; another 10 cents goes to cover what it costs doctors and hospitals to handle the massive amount of paper work and phone time required for getting pre-approvals, denials, and other payment issues. So 33 cents of every premium dollar paid has nothing to do with the actual delivery of health care.
- The total spending health care surpasses $3 trillion a year and is growing. It’s more than 17 percent of the GDP, compared with Canada, which spends less than 11 percent of their GDP and Taiwan, which switched to a single-payer system in 1995, spends 1.6 percent of its operating health care budget on administration.
- There are companies who have decided against doing business in the US because of the cost of health insurance for their employees. Conversely, there are American companies that have built plants in Canada who said the reduced cost of health care was an important part of the decision.
- The Conservative political party in Canada supports single-payer because it is the least expensive, reduces waste and inefficiencies, and is most supportive of a free market, which helps businesses.
- More than 60 percent of bankruptcies in the US are related to medical expenses, and many of those people had insurance coverage, but it wasn’t nearly adequate. The costs can bankrupt a small business, which affects not only the owners, but the employees who are out of a job. Many in the US are only one accident away from unemployment.
- The US system discourages people from seeing doctors because insurance companies have become experts in figuring out how NOT to pay for care. The US is the most rationed health care system in the world. Americans are much more likely to defer care, causing unnecessary deaths.
- Medicare has really been a success, partly because it doesn’t incur the marketing and administrative costs that commercial companies have.
- Nurses in US hospitals and clinics are often pulled into administrative duties, taking them away from giving care to patients.
- Providers are frustrated with the inconsistent answers from insurance staff regarding approved length of stays, drugs, tests, etc.
- From a business perspective, commercial insurance doesn’t bring anything to the table – has no added value to the enterprise. Also, health insurance is often a major part of labor negotiations, often a contentious issue with employee-employer relations.
- Single-payer systems reduce confusion and increase simplification and quality of care with no out-of-pocket costs. The revenue comes from a simple payroll fee. Also, single-payer systems have more clout to control costs. (the VA, for example, uses a competitive process and it pays 41% less than the rest of the US)
- There’s no accountability in the current commercial system. The charges of many procedures are variable and no one knows how much they actually cost.
- The film dispels many of the myths about a single-payer system. The government does not take over the delivery of health care. Hospitals are operated privately and doctors are in private practice. Patients have complete freedom of choice of providers. By contrast, many Americans are restricted by their insurance plans in choice of providers (see a provider “out of network” and pay the full cost out of pocket.)
People put on waiting lists do not die; there is a priority process. Canada spends half as much, but life expectancy is higher – 82 compared with 79 in US.
- It could be possible to saves $710 billion a year with a single-payer system. The savings could cover the uninsured and out-of-pocket expenses. Nationally, the money saved could be shifted to investing in infrastructure and improving economic activity.
Group discussion brought up a variety of responses.
- Price Point Wisconsin http://www.wipricepoint.org/ is a good source for finding the average costs of medical procedures and tests. Check it out to see if a provider’s charges are in line with the average cost and, possibly, use the data to contest a bill.
- Commercial insurance companies’ expenses also include the costs of lobbyists. A move to single-payer will be opposed by big Pharma and the insurance lobby. It’s likely that going to single-payer would expose all sorts of hidden profit centers and scams in the current system. The opposition will also employ messaging strategies suggesting that single-payer will move the US to socialism.
- Many people don’t truly understand where their health care comes from, e.g. being opposed to “government-run health care,” but liking their care through the VA.
- Private insurance costs are higher because Medicare reimbursements to hospitals are lower and hospitals bill private insurance companies at higher rate to subsidize Medicare patient costs.
- Future trends: What will be the impact of another hospital in Eau Claire – higher or lower charges? What shortages are on the horizon with the coming “Silver Tsunami,” as Sarah calls it? There already is a shortage of home health care workers. The aging population is increasing, while the influx of young people into Wisconsin is decreasing.
- The documentary suggests that corporate America could be a catalyst for change. The film underscores that insurance companies are just “pass throughs” for our money.
- Reminder: Hillary Clinton was the first to advocate for a universal health care insurance system in the US.
- Suggestion: send Thank You letters to supportive Republicans.
- There is a bipartisan effort underway now to reform the system. Some states are moving to offering an option for people to buy into Medicare. However, we need to remember that Medicare doesn’t cover everything and people still need supplemental policies. Medicare is not a true single-payer system. Canada’s system cover dental, too.
- The question was raised, “Why isn’t the DNC and Democratic Congressional leadership pushing for single-payer?” Part of the answer is “Rome is burning” and Democrats have to focus on priorities, which right now is to get Dems elected in key races. The rank-and-file, however, would like to see leadership be more assertive and vocal.
- Democratic vs Republican messaging was discussed. One observer said that Republicans focus on winning first and then go to working on party unity; Democrats do it backwards and focus on party unity first, which impairs the efforts to win elections. Slogans are more effective than recitation of facts. Suggestion: sloganize GOP – the party of Greed, Oppression, and Power which leads to the Corruption of Democracy. Look to Senator Heidi Heitkamp (D-N.D.) for some good messaging: “We are the party of the many, not the few.” Also, check out Bernie Sanders’ Facebook for key messaging points.
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