A few months ago, I saw a 5-year-old boy, Carter, in my clinic. Carter was born with a lower abdominal birth defect. Thanks to Medicaid, he was able to see pediatricians, specialists, and get surgeries and therapies that gradually fixed the defect over the course of infancy and toddlerhood. Carter’s parents endured a lot of stress in hospital hallways and bedsides. But they told me they had just enough peace of mind from the coverage provided by Medicaid to pursue their educations and get better jobs.
Those jobs came with private health insurance plans which the parents had been led to believe were superior to Medicaid — until they had to actually use that coverage for Carter. When they returned to my clinic, they described how frustrated they were about the endless paperwork and labyrinths of corporate procedures they went through just to get follow-up visits with pediatricians and specialists for Carter.
{mosads}My patient’s mother said, “I thought the whole point of paying for health insurance was because it made health care easier. Between arguing over big bills and little bills, filling out forms, and all the phone calls to the insurance company, nothing about this is easier. I’ve got enough to do as a mother of a child with a rare condition and as a working person. I ain’t got time to be an expert in the insurance company’s BS.”
This family is among millions of Americans who struggle with the for-profit health insurance industry. More of us are contributing ever-increasing portions of our paychecks to premiums. We face skyrocketing deductibles. In return, we get narrow networks of doctors and hospitals, ridiculously expensive prescription drugs, and endless obstacle courses like the ones Carter and his family endure. And after paying thousands and thousands in premiums, deductibles, and co-pays, many of us continue to suffer financially when we get sick: 42 percent of cancer patients lose all of their life savings in just the first two years after diagnosis.
This is the “privilege” of health care for millions of Americans WITH health insurance. For the 28 million uninsured and 50 million under-insured, the perils and pain are worse.
In recent years, members of Congress have proposed several policies with the political rhetoric of “universal coverage”: Medicare X, Medicare for America, Medicaid buy-in, and “Medicare for all,” just to name a few. In terms of coverage, only Medicare for all is truly universal because it guarantees health care to every resident of the United States and affiliated territories. Medicare for all’s competitors don’t just fall short on universality. They also fail to confront the for-profit insurance industry. These corporations pay their executives multi-million dollar salaries. Meanwhile, patients and families lose their wealth while trying to preserve their health.
Medicare X, Medicare for America, and Medicaid buy-in all share a common flaw: They allow the parasitic for-profit industry to continue to exist. By definition, that means that for supporters of these plans, health care as a basic human right is just rhetoric, not reality. While the Affordable Care Act has helped many people, it illustrates the dangers of trying to work with the industry and expecting them to play fair.
The ACA has provisions requiring insurance companies to use 80 cents of every dollar paid in premiums for patient care. The insurance industry’s lobbyists fight this entirely reasonable rule year after year. As long as the industry continues to exist, those same lobbyists will work to undermine any health care reforms that threaten their profits. Private insurance corporations cannot be reasoned with. They can only be defeated.
When patients with private insurance get notifications about an insurance company’s arbitrary decision to drop providers and change already-narrow networks, the Affordable Care Act is often unfairly blamed. Scapegoating the ACA has become a convenient ploy for the insurance industry. We are kidding ourselves if we think they will behave better under Medicare X, Medicare For America, or any other policy that allows them to continue denying care to patients and families.
During the Great Recession, as everyday Americans suffered job losses and foreclosures, politicians said the banking industry was too big to fail and Wall Street was too big to jail. Are the health insurance industry and Big Pharma corporations too big to fight? Are their lobbyists and campaign contributions too enticing to refuse?
Under Medicare X, Medicare for America, and Medicaid buy-in, the answer seems to be yes. Only Medicare for all stands up to the long-held power of these multi-billion-dollar titans and says no more. Medicare for all sends a clear message: The insurance industry and Big Pharma corporations have had a good run of profiteering off patients and families, but that is going to end.
Medicare for all ends the insurance industry’s sham of taking more and more out of everyday people’s paychecks while denying patients the health care they need. Making health care a basic human right requires more than just rhetoric; it requires the courage to confront the comfort of those who put profits before patients, and the resolve to build something better.
Dr. Sanjeev Sriram is senior adviser to Social Security Works.