at I am a long-time member of Physicians for a National Health Program (PNHP), a national nonprofit pushing for the adoption of a single-payer health care system.
As a nonprofit, they cannot and do not endorse any political candidate but rather promote the idea that our population would be better and more cheaply served by “improved Medicare for All.” As part of their educational efforts, PNHP has developed a series of “kitchen table issues” that require fundamental reform rather than minor tweaks.
The first two of these issues are surprise billing and racial health inequalities. More issues follow and will be the subject of future columns.
Surprise billing
“Surprise” medical bills are probably of no surprise to any of us, as over half of Americans have received bills for something that they thought was covered by insurance.
Out-of-network billing rose from 32 to 43% for emergency room visits and from 26 to 42% for hospitalizations from 2010 to 2016, with average outlays rising from $220 to $628 and $804 to $2,040, respectively.
These amounts are a financial disaster for most families. Only about a third of us can pay an extra bill of $500 without difficulty. Remember: these are insured patients! It is obvious that allowing insurance companies to be part of our health care “system” means that this problem will continue to grow.
Therefore, a public option or continuation of “Obamacare” that depends on these companies will not solve the issue. It makes me suspect that those who claim to like their insurance haven’t had to use the emergency room or been admitted to a hospital or else they are afraid that switching to another company will be worse than what they now have.
“Medicare for All” means that no patient will be billed directly, that there will be no insurance networks and all emergency rooms and hospitals will be covered. Those of us who have passed the age of 65 did not experience the dread of switching that is so often talked about.
Racial health inequalities
It is interesting to note that hospitals became integrated after 1965 because the legislation that created Medicare required it. Improved Medicare for All now has the potential to decrease the huge disparities that have continued to exist between whites and blacks, with blacks born in 1980 having a life expectancy six years shorter than their white counterparts.
This discrepancy is a uniquely American problem not seen in other countries. While there are racial disparities in violent deaths accounting for some of the difference, 86% of it could be prevented by medical prevention and treatment. Medicare for All would eliminate the differences in insurance coverage, eliminate deductibles, copays and coinsurance and allow anyone to use any health care facility.
By depending on insurance companies to “give” us health care, we are relying on an outdated model that rewards them for not providing us with that health care. Insurance companies and other entities, for-profit and nonprofit, are too often subject to profiteering, the taking of excess profits. Yes, nonprofits make money. They just call it by different names.
Why do doctors and hospitals submit “surprise” bills? Because they can! A fundamental change in the way Americans pay for health care is needed. Bandaids won’t fix these major medical problems.