I am a strong supporter of Medicare for All (M4A), but perhaps I shouldn’t be. According to the media, I ought to be one of those mythical creatures who has insurance benefits that are so good that I should love my insurance company and want to keep it. Well, I don’t.
First, let me tell you a little about myself. I am a married, 57 year old while male with three kids who lives in a southern state. I have one child who has graduated college, one in college, and one in high school. All are on my insurance.
My employer pays the full cost of insurance premiums for both me and my entire family. My individual in-network deductible is $250 per year with a maximum family deductible of $750 annually. I pay 10% for coinsurance costs once the deductibles have been met and out of pocket expenses are capped at $1,000 for individuals and $3,000 for the family. My copay costs are $25 to see a general practitioner and $35 to see a specialist.
So, these days, those are pretty good insurance benefits. I mean, I am sure that there are people out there with better insurance benefits than mine, but where I live having insurance benefits like these is practically unheard of. Yet, I am strongly in favor of moving to M4A.
There are a number of reasons that I would like for our country to adopt M4A, but let me start with the most obvious reason. Our entire healthcare system is a scam and I think I can provide ample proof of this. You see, I was diagnosed with B-Cell Lymphoma a couple of years ago and I have since learned a lot about the American healthcare \ insurance \ pharmaceutical billing and payment processes.
When I was diagnosed with cancer, the first thing I had to do was get a PET\CT scan to determine what stage my cancer was in. That involved going to a facility where I drank a radioactive concoction, was given a contrast IV, and was then placed in a CT machine and scanned for about 30 minutes. The entire event took maybe 1½ hours to complete with me doing most of the work trying to lie as still as possible during the scan.
PET technology was invented in 1977 which makes it over 40 years old. This most recent PET scan was billed to my insurance at a cost of $7,240.00. Bear in mind, that this is just the cost of the PET scan itself and does not include the other related charges such as the cost of the contrast and other fees that raised the total to over $8,400. A battery of blood tests also contributed to a total one day insurance bill of over $10,000.
So, my 30 minute scan using 40+ year old technology was billed at $7,240. When I received my insurance company’s EOB, it reported that my membership discount for the scan was $2,027, the amount allowed for the scan was $5,213, and my coinsurance cost was $172. I found it very interesting that these parties were willing to agree to just drop over $2,000 off the original stated cost. Could it be that these charges were artificially inflated to maximize the amount that patients would have to pay as a percentage of the remaining bill? Hmm...
It gets worse. My treatment was 15 doses of radiation over three weeks. I was in and out of each treatment in roughly 15 minutes and the actual treatment itself took only 25 seconds. The billed amount for each treatment was $551, my membership discount was $244 and the allowed amount was $307. So, if I understand this correctly, the insurance and healthcare providers just decided that they were actually okay with only getting $307 instead of $551 for this service.
But, it gets worse still. I saw the doctor once a week for literally 5 minutes per visit. “How are things going? Are you having any side effects? No? Okay, see you next week.” This brief interaction was billed at a whopping $780 per visit, my member discount was $526, and the allowed amount was $254. So, it turns out that the healthcare provider in this case was just fine with their payment being only 33% of the original billed amount.
As you can see, the billing charges for services versus what is actually acceptable to the providers are arbitrary. There are no real numbers in any of this. I mean, should the actual cost of a PET scan be $7000 or $5000? Should the cost of my weekly chat with the doctor be almost $800 or was it really only worth $250? Nobody really knows I guess. The cost of services is whatever they agree with each other that it is and you will never see the charges or the amount that you are responsible for until the insurance EOB arrives in the mail weeks after services are rendered.
I would be remiss if I did not also mention pharmaceutical companies and drug prices, so I also wanted to point out that my insurance was recently billed $1,195 for a one month supply (60 tablets) of a drug called Multaq that is used to help prevent AFIB episodes. It appears that my insurance ended up paying $623 for just 60 tablets of this drug. I guess they got it for about half off, but really… WTF?
If the randomness of healthcare charges is not bad enough, you must also deal with the difficulties involved in understanding the insurance EOBs and getting any mistakes corrected. Suffice it to say that if you get a disease like cancer, you will need to plan on spending a lot of time if you really want to understand how the insurance billing and benefits are calculated. There will be some charges that are denied or only partially covered and others with notes about missing information that you will get to help them chase down. Meanwhile, you will also be trying to pay the bills that you are responsible for which is very difficult to do since the insurance payments to your healthcare providers are often in a state of flux. And, God help you if you overpay for something and you want to get that money back. One biopsy lab failed to bill my insurance and then billed us twice for the full amount due which we accidentally paid (twice). It took us months and numerous phone calls to claw that money back and to get the insurance to pay it.
So, even with having employer provided insurance for my family with no premium cost to myself and fairly low deductibles, copays, and coinsurance rates, it is still an absolute nightmare working within our current healthcare system.
Let me summarize what I feel are some other important reasons why we need to move to a single payer Medicare for All system as soon as possible:
- Healthcare is not free market driven like Republicans try to pretend it is. Nobody knows what anything healthcare related is going to cost and no hospital or doctor’s office posts a list of prices for the procedures they perform. Therefore, it is impossible to “shop” for good healthcare “deals” even if you had time to do so. Medicare for All would ultimately require justification for exorbitant fees which would help rein in out of control costs.
- Healthcare procedure and service charges are not currently regulated or standardized. For example, an MRI at one facility versus the same MRI and another facility across town can vary in price by thousands of dollars. The same can be said for surgeries and related charges. We need some standard fee structures to be put in place so that the cost of an appendectomy will fall within a predefined price range no matter where it is performed. Adopting Medicare for All would in effect force that to happen as a side-effect of being a single payer system.
- The current insurance\healthcare provider relationship is a total scam. Procedures and services should cost consumers the same amount regardless of whether or not they have insurance. Having a flexible fee structure that is based upon whether you have insurance is just wrong. And, the idea that an insurance company has “negotiated” a lower price for you is completely and utterly bogus. If anything, these entities have agreed to artificially inflate prices for the purposes of (a) making you feel like they are helping you by saving you from the inflated costs, (b) making your percentage of coinsurance much higher due to the inflated costs, and (c) creating a system with costs so high that you are screwed if you need healthcare, but have no insurance.
- As shown with my previous example above, drug prices are running rampant in the U.S. Under Medicare for All, we could finally put some price controls on drugs. If the single payer for drug purchases is the government, then we could pass (with just a 51 vote majority in the senate) a bill to prevent the drug price inflation via reconciliation because there is no doubt that the government would save a lot of money by adopting such a bill.
- Our healthcare system is an outlier in the world. On average, other wealthy countries spend about half as much per person on healthcare than the U.S. spends. A 2016 Harvard Study also found the following to be true:
- Administrative costs of care--activities related to planning, regulating, and managing health systems and services-- accounted for 8 percent of total health care costs in the U.S., compared with a range of 1 to 3 percent for other countries.
- Per capita spending for pharmaceuticals was $1,443 in the U.S., compared with a range of $466 to $939 in other nations. For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next-highest price.
- Even if you have good healthcare insurance now, there is no guarantee that you will always have it. My employer has changed our insurance provider several times over the years and we have simply had to adapt to those changes. Who knows what the coverage or costs will be the next time it is changed. And, under our current system if you lose your job, you will lose your insurance. Worse, if you contract cancer or some other dread disease and get to the point where you cannot work, you could lose your job, your insurance, and your life. I can tell you first hand that I have had to consider contingency plans for how to keep my family from losing everything in the event that my cancer takes a turn for the worse (and that is not a good place to be).
- Medicare for All won’t cost too much. M4A will actually save us all money by drastically reducing bureaucracy, eliminating insurance middlemen, allowing for negotiated drug prices and standardizing medical service charges. Whatever tax increase will be deducted from our middle class payroll checks will not compare to the wildly variable and grossly inflated healthcare costs that Americans incur today.
- Our current healthcare system is simply unsustainable and it is bankrupting the country. We simply cannot continue overpaying for our healthcare without severe consequences down the road. Efforts to fix the existing system have thus far failed miserably and there is little reason to believe that tweaking around the edges will resolve our large systemic problems.
The media has pretty much been saying that M4A is a pipe dream. However, we really need to take their proclamations with a grain of salt. I mean, have you ever wondered WHY there are so many drug advertisements on cable news shows? Think about it. Shouldn’t your doctor be the person who recommends which drugs you need to take? The truth is, our media is just as addicted to healthcare money as our members of congress are. All those commercials for drugs that you cannot buy without a doctor’s prescription are the very same thing to cable news networks as lobby money is to congressmen. Those ads represent enormous monetary incentives for the media to promote specific healthcare reform outcomes.
Finally, don’t let anyone tell you that we can’t have Medicare for All in America because it is just too hard. In the 1940s we passed Social Security. In the 1960s we passed Medicare. We even sent men to the moon! Those were all hard things, but we eventually got them done. The rest of the western world provides their citizens with single payer healthcare, so to say that the richest nation in the world cannot do the same thing is just plain wrong. And, even someone with relatively good health insurance benefits like I have can see the enormous value in adopting Medicare for All.
