Universal Health Care
People vs. Corporations not Democracy vs. Socialism
Life, Liberty and the Pursuit of Happiness.
That may very well be one of the most common phrases quoted time and again from the Declaration of Independence. But what do those words really mean? One could say that they are interpreted at the very basic definition of each component. Life simply means that no one is allowed to kill you, liberty that you shall not be enslaved or held against your will, and the pursuit of happiness meaning that no one should be able to tell you how to live your life so long as it does not infringe on anyone else’s inalienable rights to the same.
Maybe, just maybe, those who wrote this timeless document actually thought beyond just the bare minimum that we have become so accustomed to accepting in an era where too many others try to do our thinking for us. It is also an era where too many of us allow others to think for us. Perhaps the authors of this Declaration had hoped that future generations to come would be able to define those three items in their own ways. Much the way the Constitution and its Amendments are considered living documents that are open to judicial interpretation, quite possibly the Declaration of Independence was left intentionally vague so that it could adapt.
In the civilized democratic world, there are presently 18 countries that offer universal health care. Before the comments of socialism and communism spring into your mind, please reread the first sentence. These are democracies and the furthest thing from socialist economies. The UK, Germany, Australia, Canada and Israel are all on this list. Not China, Russia or North Korea. These are capitalistic countries that have strong economies and believe in private enterprise without government oversight and regulation, but they have still seen the value in ensuring that every single citizen has access to medical services.
Life should mean more than just expecting to not be murdered. For America, what is supposed to be the greatest country in the world, we have far too many people who are denied life saving treatments and services simply because they do not have insurance or the money to pay in lieu thereof. Liberty should rise to the standard of being able to seek out qualified medical advice when in need as opposed to being forced to wait until a situation is dire enough to get rushed to the emergency room — where if you are lucky enough to survive, you will probably wish you were dead when the bill arrives. And a true pursuit of happiness is hard to attain in any form when life and liberty have been infringed upon at their very core.
America has embraced capitalism to a fault, to a point where it has become synonymous with democracy. Many may not agree with that, and by default automatically see the consolidation of any industry or service that was once private into a public or government managed capacity as socialism. In reality that mentality is either born from a lack of education or willful ignorance. The thought that it is going to cost the average tax payer more money because everyone now has insurance, even when that taxpayer themself is uninsured, if a naïve and dangerous belief ingrained in us by the corporations who profit from the current medical system in place. This is not theory or political allegiance, it is pure fact grounded in indisputable evidence.
Let’s talk about the information in the box above. What you see there are the top 5 insurance companies that operate in America today. Before even digging into the actual data, it is important to note that each of these companies are publicly traded (with the exception of Aetna, and only by default since they were purchased in 2018 by CVS, which is also publicly traded). For those who are not familiar, publicly traded simply means that they are for-profit companies. Any person can invest money in them for a share of the profits in the form of dividend payments, capital appreciation, or both.
This topic is not anti-stock market by any means. It is meant to enlighten as to where the lines between humanity and greed get blurred. In a publicly traded company, the management is not concerned with the well being of their customers, the very people who generate the revenue (in this case those who shell out a ton of money every month for their coverage — but we will come back to that part), but rather the return on their shareholders’ investments. All decisions are made with the shareholders in mind, even if that comes at a direct expense or inconvenience to the insured. So for all those who have their own health insurance at the moment and don’t think this any of this applies to you, please read on.
Of the hundreds of thousands of people employed by the health insurance companies, and again the numbers above only account for the five largest companies, a significant percentage of them are tasked with the responsibility of maximizing profitability for the company. Now as a capitalist that probably doesn’t sound like such a bad idea. But as a moral capitalist, one has to realize that the way these profits are maximized is by cheating the individual policyholders at every possible opportunity. Claims are not paid instantly because they are researched thoroughly for any possible loophole that would allow the insurer to deny payment. Maybe you went to a doctor that was “out-of-network” or did not get a “pre-authorization” to see them. The ways that the claims adjusters, patient coordinators, or whatever they may be calling themselves, are too numerous to count. They have made a science out of collecting your premium and then denying the coverage you paid for in the first place.
Beyond just the brazen policy of cheating policyholders out of their money, the healthcare companies also cheat the doctors and hospitals who accept their insurance. If you have insurance and have ever looked at an itemized list of your charges after a hospital stay or doctor’s visit, you might have noticed some excessive amounts. $200 for an aspirin, $25,000 for childbirth, $75,000 a day for life support. As a “cash pay” patient receiving the same treatments the costs are drastically reduced. The reason for that is because the doctors and hospitals know that the insurance companies are not going to pay the full amount of any claim submitted in their quest to maximize shareholder profitability and therefore are forced into inflating the bill to a ridiculous level just so that they can negotiate somewhere closer to the true cost of service. This “game” between the service providers and the patients results in an increased cost to everyone.
The fixed costs of having numerous insurance companies also contributes to the excessive premiums that policyholders are forced to pay, and we will see just how excessive and disparate shortly. But look at the total number of healthcare employees in the top five companies — half a million! Keep in mind each company has its own claims management system that doctors and hospitals must use to submit paperwork for payment. That means individual practitioners need to be versed in all of them or risk making a simple mistake that will potentially cost them payment for services rendered and their patient having their claim declined and being asked to pay out-of-pocket in the process. On a scale that large, just how many of those 500,000+ jobs might be considered redundant if there was one centralized system that handled all medical claims in the country?
I’m not advocating the loss of jobs, but rather the redistribution of them into a more functional and cost effective model where everyone does everything the same way. If that idea sounds outlandish, one only needs to look at the Medicare and Medicaid systems to know that it already exits. While many may not have the highest opinion of how those systems work, the one thing that cannot be denied is that the process is streamlined and uniformed. There is far less ambiguity in what is covered through those plans, how to submit for reimbursement, or the timeframe for processing. The same cannot be said when there are five to ten different ways of doing things. Think of your local utility company for a moment. There is a reason there are not five different electric companies offering to run power lines on your street. Can you imagine how convoluted and messy that could become?
Okay. So we covered a lot of theory and mechanics that may or may not have hit home. Now let’s jump into the aspect of this equation that just about everyone can understand — money! That’s right, health insurance is prohibitively expensive for most people in this country. Even if your employer offers you group insurance as a perk for working there, chances are you still have a hundreds of dollars a month being deducted from your paycheck only to receive the same subpar service as those who are paying entirely out of pocket. To illustrate that point, I have included the charts below:
For illustrative purposes, I compared the cost of insurance in two New York counties. Westchester has the fourth highest median income in the state at $90,578 while Chautauqua has the lowest at $45,332. In the first chart where I analyze the cheapest possible plans, two things should jump out at you. The first is that the total cost of insurance for a single person is over $12,000 per year. That is basically a rent payment on a studio apartment. The second is that there is virtually no disparity in the cost of coverage between counties where the median income has a disparity of 100%. The second chart illustrates the most expensive possible plans in each county and I will let you draw whatever inferences from that data as you will.
The third chart looks at the cheapest possible family plan (by definition 2 adults and at least 1 child). We are now talking in excess of $20,000 per year or roughly the rent on a 2-bedroom apartment. Once again, there is hardly a difference in price between counties that have a massive income gap. When you move to the fourth chart, which illustrates the most expensive plan available, the annual premium for both counties is roughly 70% of the median income. That is insane. That leaves only 30% of a family’s income to pay for food, housing, transportation, etc. Is it any wonder why so many people opt to risk going uninsured?
Just how many people go uninsured and what does that mean to support the argument for universal healthcare? Well, at last estimation the United States has a population of 327 million people (128 million households) and approximately 27.5 million (8.5%) are uninsured. This number tells us two very important things.
First, we have 27.5 million people who have no means of receiving preventative care, something that can be integral to avoiding more costly and life threatening issues later on. These are people who, a some point in their life, may (more than likely) need to receive some type of costly medical treatment that they will not be able to pay for. When they are unable to pay, those losses get redistributed back into the cost of care and insurance that the other 300 million are paying for. So the argument that universal healthcare will cost the average American more money is contradicted by the pure fact that if everyone were covered, the cost for services would be more stable and affordable.
Second, a large percentage of the 300 million who have coverage are paying the exorbitant premiums referenced in my earlier charts and contending with the capitalistic red tape required to receive the treatment they are paying for to begin with, and oftentimes still settling for doctors and providers that would not have been their first choice because the rules of their plan dictate so. For the sake of simple math, let’s work with the household number and the low cost family plan premiums, which I will reduce by 20% to account for national variations.
128,000,000 x $16,000 = $2,048,000,000
Over 2 trillion dollars in potential health care premiums, of which companies like United Healthcare, who happens to rank #6 on the Fortune 500 list by the way, are absorbing, squeezing, and then filtering back to their top executives and shareholders. Not to mention that these companies have hardly paid any income taxes on their earnings in comparison to the effective rates the average American pays, and continue to receive federal incentives like the Trump tax reform that boosted United Healthcare’s after tax income by 1.7 billion dollars a year. How many people could have received insurance off of that tax break alone?
The only opinion I will insert into this piece is that healthcare reform is not as difficult as the government would have you believe. It is not as black and white, Republican and Democrat, or us and them, as those in power would have us believe. They prey on our fears and beliefs so that the corporations, the ones who donate billions of dollars to their campaigns and special interest groups, can continue to operate with impunity at the expense of the average citizen. Should anyone’s health, the possibility between life and death, really be discussed in the same breath as corporate greed and moral bankruptcy when there is clearly a better way?