When I graduated from medical school almost 25 years ago, I was asked by then U.S. Surgeon General, Dr. C. Everett Koop, to raise my right hand and recite the Hippocratic Oath. In it, I recall "I will abstain from that system which is deleterious and mischievous to my patients."
Unfortunately, in the years since, I have seen far too many of my patients fall victim to a system that is very deleterious, mischievous, and just plan immoral.
While the affordable care act (ACA) was a start and has definitely helped a lot of people, it should be noted that in the run up to the ACA, there were more than 3300 registered healthcare lobbyists spending $1.2 million a day. In total, more than the entire cost of the Bush-Kerry election was spent lobbying Congress, and that is why much of the ACA looks like it was written by the private insurance industry. As a result, it firmly entrenches a for-profit industry that only makes money by denying people care in charge of our healthcare decisions and system.
The inconvenient truth about the ACA is that even with all of the positive aspects of the law, we still have a deeply flawed system where:
1. Our nation still spends twice as much as any other industrialized nation.
2. Our undocumented brothers and sisters are left out and over 30 million people will still be uninsured by 2025.
3. Far too many people with insurance continue to go bankrupt due to a medical illness.
4. This year alone, 10 million insured Americans are projected to accumulate medical bills they will not be able to pay off.
5. Up to 35 million Americans with insurance will delay seeing a doctor due to high co-pays and deductibles.
6. Premiums continue to climb well above wages and inflation, and workers are having to contribute more every year, all while the private insurance industry rakes in record profits and watches their stock prices hit all time highs.
7. Healthcare benefits remain the number one cause of labor negotiation strife.
8. Medicaid remains a second-class system with too many doctors and hosptials refusing to accept Medicaid.
As we lament these continuing deficiencies, many Americans will come together this July 30th to celebrate the 50th birthday of our country's most successful healthcare system, Medicare. When Medicare was established, only 44% of all seniors were insured and nearly 1/3 of all seniors were living in poverty.
While many conservative politicians like to bash Medicare and are constantly trying to privatize it, it is important to remember the facts.
In 1995, Republicans pledged that by placing at least 20% of Medicare beneficiaries in private HMO's would save $270 Billion over seven years. Instead Medicare has overpaid private insurers $282.6 billion since 1985, roughly 24.4% of all Medicare payments. And despite the initial ACA plan to reduce future wasteful payments for Medicare Advantage, there has since been bipartisan and White House approval to actually increase payments despite the fact that beneficiaries continue to rate traditional Medicare more favorably than Medicare Advantage in terms of access and quality of care.
When powerful insurers like United Healthcare and Anthem use their massive market share to negotiate deep discounts in prescription drugs for their members, it is considered good "free market" business tactics. Yet, Medicare Part D enacted by Congress not only prevented Medicare from doing the same, but also saddled Medicare with private administrative costs of almost 10%.
And unlike private insurance companies that constantly get between patients and their doctors, Medicare does not. Medicare does not tell my patients which doctor they have to see or which hospital they can go to. It does not require pre-approval and it is does not tell doctors like me what tests to order or what drugs to prescribe.
Thus it is very important that we all continue to remind naysayers that Medicare despite being undermined by Congress and consistently caring for older and sicker patients, is more cost effective, provides better coverage, and has greater patient satisfaction than the private sector.
So on this 50 birthday, we need to take back the overall narrative about Medicare. We need to fight to not only protect Medicare by eliminating these indefensible subsidies for big powerful corporations, but to make it better and expand it for all.
But, this will only happen once we as a society, wake up and say enough is enough to the private insurance strangle hold that only cares about profits, and not patients.
As more and more private insurers consolidate and merge into a de facto for-profit single payer, we need to fight harder than ever to protect the only single payer that cares as much for least among us as it does the top 1%.
In 1966, Martin Luther King raged that "of all the forms of inequality, injustice in healthcare is the most shocking and inhumane". Sadly, this inequality is worse now than it was back then.
It is therefore time for us to come together with one voice to hold our elected officials who protect the status quo accountable and fight back against this immoral and evil system. It is time for Medicare for all!