Step back. Look at us. Trumpcare versus Obamacare? Obamacare versus Trumpcare? We are fighting over competing approaches to the same problems–and ignoring a solution that would be better than both combined. Medicare.
No matter what, we need a better solution, and quick. While Congress continues its political tug-of-war, we are suffering, individually and as a country. We spend more and get less. The system is rife with inefficiency. Tens of millions are still without health insurance, and tens of millions more stand to lose it. People are dying.
We spend more and get less. Of all the countries in the world, the US spends the most on healthcare (and health insurance), yet health outcomes here are worse. Our average life expectancy is shorter and we have more chronic health problems.
Medical goods and services are more expensive here. Citizens of other countries are charged far less. For example, an MRI in Switzerland is is ten times (10x) cheaper. Canadians pay at least half as much for medicine.
So we tend to put off taking care of ourselves. Sound familiar? Americans visit the doctor less often, even though an annual checkup and other preventative measures could avoid problems or catch them early. Or even save your life. If you are like me, this has too often been about saving money–with the hope/fantasy that the problem will go away.
And, as a group, we and the politicians are downright dumb. As a country, we spend less on social services than other countries, even though a few dollars for things like clothes and shelter could reduce chronic and expensive health issues among the most vulnerable members of our society. And face it, everyone else, including you and me, ends up paying for unpaid emergency health care, through rate or tax increases. In this case, an ounce of prevention really would be worth a pound of cure.
Oh, and by the way, of the 13 countries shown in the chart above, ours is the only one without a publicly financed or mandated health care system that assures coverage for all its citizens.
Are we fighting over wrong solutions? Market-centric mechanisms common to both Obamacare and Trumpcare fail to care for everyone and lead to economic exploitation. As argued in previous posts, free markets do not perform well in the health care arena.
I have already given examples of exploitation, with fabulous sums extracted by health insurance providers like Aetna and Humana. Under Obamacare, those two companies alone distributed around $22.0 billion to shareholders. They will do even better for their shareholders in the years to come, particularly if Trumpcare becomes the law.
And then there’s the inefficiency of this whole dog pile of insurance providers. Massive duplication of overhead expenses–identified in accounting as “Selling and General Administrative Expense.” (Think of stuff like management salaries, marketing and rent. Then think of competing insurance company each paying these kinds of costs, over and over and over again.)
Looking at just Aetna and Humana again as examples: Since 2010, under Obamacare, Aetna reported around $60.5 billion of Selling and General Administrative Expense. During this same period, Humana spent around $44.0 billion, for a combined total of over $104.0 billion. That’s a lot of overhead, and that’s just two companies.
Aetna and Humana argued that their combination would achieve efficiencies known euphemistically as “economies of scale” (aka “people losing their jobs”). Nonetheless, eliminating just one $15 million/year CEO could create savings that would pay for a lot of health care.
If you believe accident and disease are not conditions to be exploited by the “free market,” if you agree that squeezing some of the redundant costs out of the system is a good idea, and if you agree that more people having access to health care and taking care of themselves would be good for our whole society, you should want the efficiency and accessibility of a “single-payer” system.
Like Medicare. For everyone.
For comparative country statistics, see this report: Squires & Anderson, “U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries,” Issues in International Health Policy, The Commonwealth Fund (Oct 2015) at http://www.commonwealthfund.org/publications/