A little note about Health Care For Everyone (as opposed to “Hooray! most people not getting Medicare or Medicaid or one of the several other public government health care delivery systems, bless their hearts, now have access to a MARKETPLACE to buy ‘medical treatment UNsurance’ (more on that below).” In light of this little snippet: https://www.youtube.com/watch?v=BG7w3Oey3xs
Lots of progressives, and a whole lot of other-preference Americans, have finally noticed that one of the many ways Americans are manipulated into going along with neoliberalism and neocon-ism and the Great Panopticon and various “social agendas” is the creation and fomenting and fostering of FEAR. Even pundits have noticed that too many of us are fear-ridden; some suggest we ought to be less so; the more perverse, on all sides of the political economy, do everything they can to pour gasoline on the fear fire. So one set of studies, reported here, ranks our fears for us: http://www.huffingtonpost.com/2014/10/22/americans-biggest-fear_n_6023124.html
One area subject to a lot of fear-frakking is of course the issue of “universal health care,” which Bernie Sanders has made into a substantive matter in this moment’s war over what the ongoing outcomes of our political economy will look like — more megayachts and private jets and tent villages and hopeless jobless people, more of that Rugged Individual Inequality Where I Might Become The Next Zuckerburg or Gates or Shkreli, or something else? Even Hillary, for the moment, is saying “Me too! Me too! sort of...” about health care. And so is Il Douche’, Donald “Everyman” Trump.
A recent comment on dkos offered the argument that “If the 28 nations that make up the EU/EC can’t have a common health care system based on single payer or something like it, how can you expect 50 states and Our Great Nation to manage that level of socialized medicine? And besides, think of all the UNsurance company employees that will be out of jobs if Bernie gets elected?” So what if those 28 nations, with their various versions of universal health care, in some cases include, along with publicly funded socialized medicine, some closely regulated privatemedical UNsurance corporations, which are, somehow, limited in the profits they can skim? Those places, and Canada and many other “advanced nations,” spend a whole lot less on medical care than the US does, and have better health outcomes. But this is the US Empire! We have to be TPPexceptional!
Oh, the 50-state fright threat, and Job Loss! But — hey, we already have socialized-medicine programs that cover all 50 states and the territories and the District of Columbia, and a large part of our population:
On the privatized side, in addition to the ACA and various Cadillac and Maserati options for the Favored Elite Few, we have
The public part of that is subject to a lot of privatizing pressure, like the recent Medicaid FAIL that our Governator Scott arranged, one of MANY neoliberal corruption scams in the Sunshine State, for one of his cronies: http://www.sun-sentinel.com/business/fl-univita-auction-20151102-story.html . And like Medicare Part D, and so many other little inroads the K Street looters are constantly bribing into existence, to continue the looting of the rest of us. At least one can eat the donut holes one buys at the Donut Shop…
WHY CALL IT “UN”SURANCE?
As a back-office nurse in a clinical practice, I spent a quarter or more of my work day doing what I call institutional judo — trying to get authorization, “coverage,” for policy-holders, aka “patients,” for needed medications and procedures and stuff like commodes and wheelchairs and canes. Via hours of waiting, hung in a phone tree, to figure a way past the opening bid from the “customer service representative” or “patient care advocate” that sounded so often like “Department of Denial, how may I not help you?” Trying to figure out how to use the policy terms to overcome the “presumption against coverage” and “denial of service” front-office filters of the UNsurance companies that under ACA and other privatized medical treatment entities are now “providing access (sic) to health (sic, should be “medical treatment”) UNsurance.” UNsurance, because the “policyholder” is UNsure if their needed medications will be “on formulary” and in the same “tier” from this week to next. UNsurance because they are UNsure whether their accustomed provider will be “in network” or “on plan” this week or next, or whether the massive crushing bureaucracy that privatizing all this entails, coupled with the transfer of wealth inward and upward to corporate rulers and interests, has just driven their doctors and nurses out of the professions altogether. In the same vein, UNsure whether their providers have declined to sign on to the ‘adhesion contracts’ that privatized UNsurance corps present them with. UNsure where their “individually identifiable personal private medical information” that goes inexorably into all those Electronic Medical Records that turn out to be about LOOTING, not improving care, is collected, and who it is sold to as part of “big data” that also enriches the few at the expense of the many. UNsure whether the treatments and procedures and specialists they need, NEED, not “want,” access to are covered now or will be next week. UNsure what their “deductibles” and “co-pays” and other surprises will be today or going forward. PRETTY SURE that “medical bankruptcy” is still a very serious likelihood in the event of any serious medical problem.
From Wiki, a snippet: “Bruce Vladeck, director of the Health Care Financing Administration in the Clinton administration, has argued that lobbyists have changed the Medicare program "from one that provides a legal entitlement to beneficiaries to one that provides a de facto political entitlement to providers." https://en.wikipedia.org/wiki/Medicare_%28United_States%29
That’s the older formulation, designed to drive a wedge between patient and doctor. The more accurate statement is that it provides a “demonstrable political entitlement to loot to the mecial industrial behemoths.”
Yah, there are people that over time, if the beasts of K Street and the other embedded agents of inequality could be overcome somehow, would have to find other work, including my daughter whose employer, an ACA and ‘other private UNsurance’ third-party servicer, was just bought in a $500 million acquisition from the private-equity owner, to "consolidate" (that grossly misleading word – a precursor to "monopoly') another part of the privatized-UNsurance Overhead Bureaucracy and its expenses, including of course executive payouts and bonuses — I almost said “compensation,” but that implies payment for some actual useful work. (Note that millions of Americans have had to TRY TO “find other work” as a result of NAFTA and other elements of the neoliberal “giant sucking sound” “Feee Markets RULE!” program, but who’s counting, and besides, Bernie has a shiny forehead and Hillary wears a yellow outfit and Trump’s HAIR is on fire!”)
Interesting to look at what I can find about the number of people who actually “work for the government” in Medicare and related entities — from this 2013 source, it looks like out of the 2.7 million federal public employees, about a max of 70,000 work for Health and Human Services and CMS, in all HHS departments. I’m sure there are other Cato and Heritage numbers that look a lot different, maybe people here have better reads, but here’s the source I cite:
Data, Analysis & Documentation Federal Employment Reports
Employment and Trends - September 2013
TABLE 9 -- FEDERAL CIVILIAN EMPLOYMENT AND PAYROLL (IN THOUSANDS OF DOLLARS) BY BRANCH, SELECTED AGENCY, AND AREA, SEPTEMBER 2013 https://www.opm.gov/policy-data-oversight/data-analysis-documentation/federal-employment-reports/employment-trends-data/2013/september/table-9/
The parent source is one people who want fact-basing for their arguments ought to get familiar with: https://www.opm.gov/policy-data-oversight/data-analysis-documentation/federal-employment-reports/employment-trends-data/2013/september/
Compare that “inefficient socialist not-operated-like-a-business” (thank God) bureaucracy (with all its acknowledged flaws and friction losses and subjugation to privatizing lobbying pressures) to just the 365,000 direct health-care “jobs” reported in UNsurance corporations by BLS in this chart: http://beta.bls.gov/dataViewer/view/timeseries/OEUN000000052411400000001
Maybe others have some numbers on how many “jawbs” would need to be displaced into the Public Sector to accommodate something like Medicare for All?. Medicare, by the way, apparently can manage to pay better wages to workers than the UNsurance corporatocracy chooses to – excepting, of course, the 450-times-working-stiff "compensation packages" for Corner Office corporate barons. Along with providing more “service” to the "patient," as opposed to “profit for the corporation,” per employee. And what a stupid measure, privatized medical UNsurance as a “jobs program,” when it’s kind of hard to argue that other countries, like Canada with its provincial/national health care (NOT UNsurance) system, don’t get a whole lot more for their dollar of “health care” than we do here. And how many of those people in private UNsurance are knowledgeable about coding, which is apparently an inevitable part of our future medical care management? A skill set that will migrate directly into gub’mint service? By the way, "Myths about Canadian, US healthcare debunked," http://www.marketwatch.com/story/myths-about-canada-us-health-care-debunked-2012-08-09 And on US "superiority" and access to medical treatments, why do maybe nearly two million Americans go to foreign countries for medical treatments, supposedly so very accessible (if not so very "affordable") here? Wandering the world in CO2-generating airliners, in what is euphemistically called "medical tourism?"
"While most would think that medical travelers seek cheap and fast medical attention, some facts in a May 2008 McKinsey and Company report regarding medical tourism indicated otherwise. The report states that 40% of medical travelers [from all national destinations, not just the US] seek advanced technology, while 32% seek better healthcare. Another 15% seek faster medical services while only 9% of travelers seek lower costs as their primary consideration.
A lack of health insurance is the most common factor for medical travel.
- Singapore has been a growing medical tourism center in South East Asia with 850,000 medical tourists arriving in 2012.
- Due to its close proximity to the U.S., Mexico has become a top medical tourism destination with 40,000 to 80,000 American seniors spending their retirement there with a considerable number receiving nursing home and health care.
- After more than doubling in the last 5 years, Malaysia is also becoming a famous destination with 770,134 medical travelers in 2013.
Potential Cost Savings among Nations offering Medical Services
Satisfied American patients reported gaining savings from 25% to 75% depending on the type of services required and can reach as high as 90%. Savings vary per country and depend on the type of procedure required.
Most U.S. citizens traveling abroad for medical services usually choose the following categories of medical tourism procedures:
- Dental;
- Cosmetic;
- Orthopedic;
- Cardiovascular.
Americans prefer Mexico, Costa Rica or Panama for dental services or cosmetic surgeries due to their proximity. Southeast Asia and India are the choice destinations for orthopedic and cardiovascular cases due to the high quality of healthcare, and a significant number of U.S accredited hospitals and physicians.
The following are some of potential savings and services that can be acquired in various medical tourism destinations.
- Medical care in Panama would cost up to 40% to 70% less in comparison to the U.S.
- A 40% to 50% savings in dental work and cosmetic surgery can be obtained in Hungary.
- Mexico is a favorite destination offering 25% to 35% savings for dental and cosmetic surgery.
- Costa Rica offers 30% to 40% savings for dental and cosmetic surgery services.
- Brazil offers cosmetic surgery services at 40% to 50% less.
- India provides various healthcare services at 20% of the U.S. cost.
- Various healthcare services can be obtained at 30% less than U.S. prices in Thailand.
- Singapore offers various medical services in 13 JCI accredited hospitals for only 35% less than U.S. prices.
- Cosmetic surgery and alternative medicine can be obtained in Malaysia for 25% of the U.S. cost.
https://www.health-tourism.com/medical-tourism/statistics/
By the way, it appears that the number of Canadians coming to the US for medical services is statistically kind of minuscule, maybe 40-45,000 a year, maybe a whole lot less recently. There's also some strange reason why medications are far cheaper and far more accessible in Canada than they are in the US… Though I understand it is against US law to buy from Canadian pharmacies, because FEAR! And Profit! And Markets!
Regarding comparisons to Europe, from what I read, the Brussels EU-NATO technocracy, per Herr Wolfgang Schaeuble, plans to force a centralized ruling bureaucracy over all those “28 countries,” to pack them into one neoliberal "free (sic) markets RULE!" entity. https://euobserver.com/political/129799 So can a single, centralized, probably privatized (in that neoliberal horror show that's killing "social democracy" over there) entity for medical treatment be forced onto those countries that have their separate versions of national health care coverage, where even the private parts are currently subject to regulation and cost control limits, and provide better and cheaper care than the US structure? As many say, “we shall see...” In the meantime, here's a paper on how the German "mixed, trending neoliberal, away from social democracy" scheme works – not what one tends to see in the Narrative: http://www.howtogermany.com/pages/healthinsurance.html Note there are some pretty German cost controls in place, even for the private insurance side.
In the meantime, can I dare to note that as a disabled Vietnam veteran, going on age 70, I get VA health care and qualify for Medicare too? From my own decades as a worker, part of it as a lawyer for the EPA and then in a big law firm (itself now eaten by a still bigger supranational law firm) and in several subsequent wage-earning careers as a retail worker and finally as a nurse, I was the "beneficiary" subject to various kinds of privatized “health insurance.” The whole gamut, from old-style fee-for-service, to capitation, to “managed care,” to the Blues, and now via "socialized sort of single payer actual health care." For my money, I’ll take the VA and Medicare any freakin’ day. Especially VA, which employs some 325,000 people in its COMBINED functions of caregiver and worker’s comp/”disabled veterans programs,” that same VA which is “allowed” to negotiate with the effing Big Pharmas over the price the government agency will pay for medications, and other silly stuff like durable medical equipment and now increasingly "outside privatized" treatment. As a result, my meds are a max of $9 for a 90 day supply. And yes, that is for “formulary” drugs, which is still a huge set, but if my primary provider does a little paperwork, it can be extended to cover meds that are not on formulary. No "donut hole," no deciding whether to pay the rent, buy food, or pay an increasing amount for cardiac and other meds and office visits that sort of help keep me alive.
I know this is a Yooge Complex Problem With Nearly Infinite Numbers of Moving Parts, and no one sees it all and how to “fix it.” The Big Money is being spent on just more of the same, less “care” for more “money.” It looks more and more like the “conservative” neoliberal structure that says “work ever harder for ever-fewer pennies, and when you can’t labor any more, die quickly and quietly.” But there’s a groundswell that seems to be building, across the narrow boundaries of identity politics. One can hope...
But let's keep on selling the dissembling, Narrative-supporting, Kill The Socialist! fear stuff, the Narrative that a crumb of "medical UNsurance" is worth a pound of actual single-payer or even Medicare for All health care stripped of most of the neoliberal "socialized-cost, privatized profit" crap that is now all that most of us not getting "socialized health care" from the government health programs listed above, can expect… "Single payer is never, ever going to happen," isn't that the meme? That, after all, is What Made America Great! and What It Is Today!...
