In actuality, getting to Universal Healthcare is a lot EASIER than most people would think in a country which is seemingly mired in the collective mindset, “America is way different than the rest of the world and far more complex given its size to mount a Herculean endeavor of this scale.”
That could be furthest thing from the truth…and that’s what the “Special Interest” forces originating out of Big Healthcare, Big Health Insurance and Big Pharma working their century-long propaganda spinning in the halls of power in Washington, D.C., have been consistently weaving into the American public narrative about Universal Healthcare. We’ve heard all of the cries: “Socialized medicine is Communism, it’s the rise of the Nanny Socialist State, it’s Big Government which will bankrupt this country!”
What’s lost in all this is that in all of the other 58 countries operating various forms of Universal Healthcare systems is that they all substantially bring down medical and coverage costs. It not only translates to SUBSTANTIAL savings for their citizens and businesses but also has “spillover benefits” by increasing workplace productivity, reducing mortality rates, relieving consumers from ever having to file bankruptcies (because of prohibitive “out-of-pocket” medical costs, and the general physical and mental well-being of their citizenry). And as the bar chart below and from Part III in this blog attest, the closest of the OECD developed nations is 50-percent or more lower in the healthcare expenditures as a percentage of their Gross Domestic Product (GDP) than the world’s perennial cost leader, the United States of America (17.5-percent of its GDP or $3.3 TRILLION goes to healthcare spending).
Switzerland comes the closest to cost-leader USA, about 44%-percent lower with $6,080 in annual per-capita healthcare costs in 2012. Although Switzerland remains a nation offering Universal Healthcare, it is described more as “statutory health insurance,” possibly the closest to the U.S. in having its 26 cantons oversee a number of “licensed third-party insurance providers” which still have to nonetheless following “price control guidelines” in each of the cantons to feed federal statutes – about the closest a Universal Healthcare system comes to America’s largely “private marketplace economy” of “American Have or Have-Not Healthcare” since being left in place at the turn of the 19th to 20th century.
The Canadian version of Medicare has had it share of issues in the 50 years since socialized Universal Healthcare has become a fixture across its 10 provinces and 3 territories of the British Commonwealth nation -- most notably with bottom rankings in Timeliness of Care (11th), Safe Care (10th) and Efficiency (10th) in The Commonwealth Fund ranking report.
When gauging the “popularity” of Universal Healthcare in Canada, an August 2009 poll conducted by Toronto-based Nanos Research pointed to overwhelming support – 86.2%-percent of 1,001 Canadians reached for response to random phone survey – called for “strengthening public health care rather than expanding for-profit services” in answer other outside special interests and political figures looking to “privatize” the provinces’ federated Medicare system.
Perhaps the most indelible statement from the Canadian public came in a 2004 CBC Television poll, when they voted for the late Tommy Douglas, the former premier of the Sasketchewan province who introduced and enacted the first “provincial form” of Universal Healthcare in 1948, to be honored as “The Greatest Canadian” in history for his vision being later eventually adopted across all 10 provinces, 3 territories and on the federal level by 1966.
To get perhaps the clearest yet broadest perspective on so-called “Socialized National Healthcare” practiced globally (if you have a little less than one hour’s time to invest by mouse-clicking the video below), PBS and Frontline’s 2009 “Sick Around the World” documentary provides the most definitive "globe-trotting" exploration of FIVE countries' -- England, Germany, Switzerland, Japan and Taiwan — differing "working models" of successfully applied Universal Healthcare systems. It provides a revealing exploration into the varying structural operational/funding architectures in each of these working models -- government-only, public/private, public/nonprofit, public/nonprofit/for-profit, etc. -- that can be easily deployed with an open-minded, spirit of "humane innovation" and basic government reforms and enactment.
- Insurance companies MUST COVER EVERYONE and CANNOT MAKE A PROFIT on “Basic Care Services” – they may charge a premium for certain “Supplemental Coverage” plans in certain countries. Most of the countries featuring some (if any) participation of “private health insurance providers” do not allow them to be attached to “public stock exchanges” and most governments can set limits on their pricing and profits;
- Everybody is (legally) “mandated” to buy insurance coverage and the governments pay for the POOR to have health coverage – many of the countries pay the “subsidized coverage” through higher taxes on the upper-middle class to the wealthy;
- Doctors and Hospitals have to accept “ONE SET STANDARD ON FIXED PRICING” for their services. Pricing levels are reviewed on either a quarterly or annual basis in some of these countries.
One of the best-kept secrets of American healthcare and representing a tiny sliver of the Medicare Advantage program are several nonprofit-based “Social Managed Care Plans” (aka “Social HMOs”) supplemental coverage plans serving Seniors. Operating within a special Medicare Advantage Part-D (aka “MA-PD”) segment of Medicare’s Part-D “prescription Part-D coverage option”are four of these Social Managed Care Plan organizations — SCAN Health Plan of California, Arizona and Nevada; Elderplan of Brooklyn, New York, and other surrounding boroughs of New York City; Kaiser Health Foundation of the Northwest (Portland-Vancouver metropolitan area, Salem, Ore., and Longview, Wash.), and Health Plan of Nevada of Las Vegas — that secured MA-PD funding from Medicare in servicing several hundred thousand Seniors with broad inpatient/outpatient and preventive health insurance coverage in their respective regions.
In Southern California, for example, a key ingredient of SCAN’s success is its broad area roster of 17,000-plus registered “in-network” doctors and specialists and over 200 hospital choices. SCAN’s care menu is so broad and comprehensive, it includes other types of “Special Needs” in-patient hospital care; out-patient doctor/hospital care; at-home care; emergency admittance and transportation services coverage; a prescription brand/generic drug program; vision services; dental coverage; hearing; other no- to low-cost co-pays on a variety of screenings and exams; and a wide array of preventive and health-and-wellness services — features necessary for senior care but MUCH GREATER than what could be found in either standard Medicare and so-called “Cadillac Plans” from PRIVATE/FOR-PROFIT insurance carriers either similarly participating in the Medicare Advantage (Part A & B) programs or for the general under-65 population as well.
Most notably, out-of-pocket costs, or so-called co-pay expenses to senior subscribers, come at mere fractions in two of SCAN Health Plan’s choices — “Classic” and “Connections” plans. “Connections” is offered for “Special Needs Plans,” which are offered (under Medicare Advantage guidelines) to Seniors who have long-term chronic illnesses/diseases, reside in special advanced care institutions (like a nursing home) and require a broader array of drug formularies coverage.
Perhaps the most intriguing figure comes from a Wikipedia.org estimate that SCAN earns $1.9 billion in revenue from its direct reimbursement billings to Medicare, which translates to a premium cost of up to $103 per month for each of its 170,000 subscribers or $1,236 per year for its full array of covered services — although Medicare’s database factors in the potential additional surcharge of up to $56 per month for SCAN’s Special Needs Plan (SNP) subscribers and other “options-based” premium charges.
If FOR-PROFIT/PRIVATE health insurance carriers can so boldly market their so-called top-of-the-line plans as “Cadillac Premiums,” than several nonprofit “Social HMOs” including SCAN’s Medicare-based plans for seniors should be coined the “Rolls-Royce Premiums” of health insurance. It just proves that a greatly expanded menu of benefits and lower deductibles and co-pays are very achievable at a fraction of the monthly/yearly costs of what FOR-PROFIT/PRIVATE health insurers offer.
If you are a Senior or nearing the age of 65, there is an online directory of Medicare Advantage plans (at https://www.medicare.gov/find-a-plan/questions/home.aspx) listed on a state-by-state and plan-specific basis, which reveals a convenient database for searching out a wide array of mostly FOR-PROFIT/PRIVATE health insurance carriers that offer senior “option” plans. Some of the plans are sponsored by the American Association of Retired People (AARP), but they originate from FOR-PROFIT, pay subscription plans (outside of standard Medicare-provided health insurance) typically featuring considerably higher co-pays/deductibles and far fewer coverage areas. ANUH has also embedded below a “Directory of NONPROFIT-based Medicare Advantage Plans” from across the country (about 300 in all).
Some of the data and structural points about American healthcare, particularly since the later 2014 rollout of the “state-run marketplace insurance exchanges” of ACA/Obamacare became a reality, may appear dated; but if you have under an hour to spare, the video presentation below gives you a picture of the outstanding “working models” of NONPROFIT-based “Social HMOs” of the Medicare Advantage Part-D program as well as locally-rooted “Nonprofit Community Health Plans” that operate today around the country.
Stemming all the way back to the founding roots of American healthcare during Colonial Times (from the 18th to 19th centuries), NONPROFIT-based ecumenical and community health care organizations were the predominant providers of medical treatment…well, until the country’s labor unions began offering healthcare services to their members through “private insurance plans.” From about the turn of the 20th Century, the economic and legislative tides tilted massively in favor of the For-Profit/Big Health Insurance carriers — formally cementing into place a highly-unusual, hugely-punitive “antitrust-exempt” status from the federal government for Big Health Insurance to form UNREGULATED MONOPOLIES, thanks to Congress passing the McCarran-Ferguson Act of 1945.
Even though the federal passage of the Affordable Care Act in 2010 set mandates to ban the insurance industry’s one-time practice of “rescinding/cancelling premiums” for people discovered with “preexisting medical conditions,” there have still been widespread reports of For-Profit/Big Insurance carriers back to “denying claims” on some routine diagnostic and major experimental surgical procedures (as discussed in Part III of this blog). And as such major For-Profit Health Insurers as UnitedHealthGroup and Humana, among others, hinting at “product exits” from the federally-backed “ACA state healthcare insurance exchanges” by 2017, these still-very profitable companies are threatening the near-term viability of the so-called Obamacare national “health safety net” that had been built up since 2014.
Bottom-line what America has witnessed is how millions — likely billions -- of Americans have suffered and died unnecessarily from the 1) punitive business practices; 2) artificial price manipulations; 3) monopolizing of local markets across the country; 4) unfair/anticompetitive business activities, market allocations and collusion; 5) and out-of-pocket cost burden shifting onto consumers conducted by For-Profit/Big Insurance Carriers for over eight decades…and counting. For those reasons (and others), these For-Profit/Big Health Insurance Carriers have violated any number of federal statutes pertaining to criminal business practices (not mention to possible murder charges for denials of claims and rescissions of premiums for consumers awaiting life-saving treatments, but later died in the interim) and now looking to strangle Obamacare into repeal, they do not deserve any right to hold business licenses to serve the public as “for-profit” entities.
- Michael A. Freeman