Reflections on the Status Quo of Health Insurance in the USA

By Prof. Aaron Milavec

1. The United States is the only industrialized country where medical insurance is regarded as a benefit of employment.  In this system, employees lose this benefit as soon as they are laid off.  Accordingly, at the very time when unemployment compensation abruptly reduces their income by half, families have to decide whether to scrimp in order to pay monthly insurance premiums on a Cobra Plan or to put their family at risk by dropping health insurance.  If they decide to shop around for a less expensive health insurance plan, they quickly discover that insurance companies are in the business of making profits and they routinely refuse to insure persons with a history of poor health or a disposition toward cancer or kidney failure.
2. One major difficulty in reforming our healthcare system is the fact that four hundred different plans for healthcare insurance create enormous bureaucracies whose sole purpose is to revise and interpret changes in their plans.  Even among federal employees, there are nearly three hundred distinct insurance plans being funded by the federal government.  Meanwhile, every local doctor has to have a billing office that is able to manage the four hundred different forms and the four hundred different set of requirements for coverage.  In a 200-bed hospital in the United States, a staff of ten to twelve persons is employed full-time to negotiate the complexity of billing.  In a comparable hospital in Canada or Europe, two persons manage the entire billing department.
3. The business of insurance companies is to make money and, like any other business, chief executives and stockholders are rewarded on the basis of gross annual profits.  The quest for increased profits, unfortunately, runs headlong into the pledge of the company to provide a comprehensive healthcare package to its clients.  Fewer people are getting to the doctor of their choice.  Pre-existing illnesses are being used to deny coverage.  Fine-tuned restrictions are being dictated to physicians as to how they must treat patients if remuneration is to be forthcoming.  All in all, the bottom line is that insurance companies increase their profits whenever they are able to restrict or deny medical coverage.
4. Medical doctors are frequently forced to order diagnostic tests and use procedures covered by the patient’s insurance carrier while, all the time recognizing that, if the patient’s health were the prime consideration, they would act otherwise.  This conflict of interest is felt by some doctors so acutely that they ultimately leave their profession because they feel that insurance carriers have dictated the course of medicine to such a degree that physicians can no longer act for the well being of their patients.
5. The lobby against healthcare reform is keen to frame the debate as entailing “Government bureaucracy vs. free choice.” This is a false opposition since, as things now stand, the big HMOs routinely curtail a patient’s choice of doctor and choice of treatment.  For doctors to return to the practice of medicine focused upon the health of their patients, the redundant bureaucracy of four hundred different insurers needs to be eliminated.

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Big Pharma will have to answer to the American people

One of my top priorities is to substantially reduce the price of prescription drugs in America

By Sen. Bernie Sanders, January 31, 2024 5:00am EST

It is no great secret that millions of Americans feel that Congress is more interested in protecting large corporations than looking out for ordinary people.

That is never clearer than when we talk about our broken health care system, and the outrageous price of prescription drugs in this country.

The truth is, if you ask most Americans – Democrats, Republicans, independents, progressives, conservatives – they will agree: we are getting ripped off, big time, by the pharmaceutical industry.

As a nation, we spend almost twice as much per capita as any other country on health care – over $13,000 for every man, woman and child. Even for those with insurance, costs are so high that medical bills are often the number one cause of bankruptcy in the United States.

And one of the major reasons for the high cost of health care in America is that we pay, by far, the highest prices in the world for prescription drugs.

You tell me: why does Merck charge diabetes patients in the United States $6,900 for Januvia when the exact same product can be purchased in Canada for $900 and just $200 in France?

Why does Johnson & Johnson charge Americans with arthritis $79,000 for Stelara when it can be purchased for just $16,000 in the United Kingdom? And why does Bristol Myers Squibb charge patients in our country $7,100 for Eliquis when the same product can be purchased for just $900 in Canada and just $650 in France?

On and on it goes. Almost every prescription drug costs far more in the United States than it does in other countries.

The good news is that we are beginning to take on the greed of the pharmaceutical industry. Medicare, for the first time ever, is negotiating the price of some drugs, including Januvia, Stelara and Eliquis.

The bad news is that the pharmaceutical industry is doing everything it can to stop these negotiations, and prevent Congress from making prescription drugs affordable for all Americans – not just those on Medicare.

The giant pharmaceutical and health insurance lobbies have spent huge amounts of money over the past decades to ensure that their profits come before the health of the American people.

Over the past 25 years, the drug companies have spent $8.5 billion on lobbying. Today, they have some 1,800 well-paid lobbyists in Washington, D.C. – including former leaders of the Republican and Democratic parties. Unbelievably, that is more than three lobbyists for every member of Congress.

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The working principles found in the Physicians’ Working Group for Single‑Payer National Health Insurance

Four principles shape our vision of reform.

1. Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. . . .
2. The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.
3. Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing, and useless or even harmful medical interventions must be shifted to needed care.
4. In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

We envision a national health insurance program (NHI) that builds upon the strengths of the current Medicare system. Coverage would be extended to all age groups, and expanded to include prescription medications and long term care.[i]

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[i]..             “Proposal of the Physicians’ Working Group for Single‑Payer National Health Insurance” http://www.physiciansproposal.org/embargoed/angell.html

Some would argue that a National Health Insurance program should cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment.