OpEds
DANIEL P. WIRT, M.D.
ObamaCare is a welfare program for those who are in the business of denying health care for a profit.
[dropcap]In 2012[/dropcap] I was one of 50 physicians who submitted an amicus brief to the U.S. Supreme Court arguing that the individual mandate of the Affordable Care Act (ObamaCare) was unconstitutional.</strong>(1,2) The basic premise was that it was wrong to force people to buy the defective products of predators whose loyalty is to profits for stockholders, not to the welfare of people needing health care, and that there was already a clearly constitutional, single-payer program to provide care for a segment of the popluation: Medicare. <strong>The constitutional solution already existed — expand and improve Medicare for the entire population: single-payer, truly universal health care.
The predators who deny health care for a profit in the United States can be divided into two camps: those that actually provide health care and those that provide no health care.
The former camp includes certain for-profit, corporate hospital chains. The latter includes corporate insurance companies. Many of the former are certainly despicable. But the biggest elephants in the room are the insurance companies.
ObamaCare is a welfare program for those who are in the business of denying health care for a profit. And the biggest of these predators are the insurance companies. They provide no health care — zero — they are simply middle-men who impose themselves between patients and providers in order to skim as much cream off the top as possible. And this imposition causes a massive administrative burden on patients, doctors and hospitals.
This enormous administrative complexity and waste is the biggest reason that health care is so expensive in the U.S. (literally twice as much as other industrialized countries, yet the U.S. is way down the list in terms of outcomes in multiple areas — meaning that the overall cost-effectiveness of health care in the U.S. is low). Patients and doctors and hospitals all spend enormous resources to deal with the thousands of different insurance plans, and the insurance companies employ armies of people to impede paying for needed health care. This insanity costs doctors and hospitals about 400 billion dollars per year — and this figure does not count the time that patients spend trying to deal with insurance companies. The effect on patients is devastating. The medical bankruptcy rate in the U.S. is shameful.
Doctors and hospitals are increasingly fed up with the current system. Increasingly, both realize that treating health care as a commodity that some can afford and others cannot — apportioned based on profit motive and the ability to pay, rather than need — is the most irrational and inhumane form of rationing and interferes with their mission of providing high-quality, compassionate, evidence-based, necessary health care to patients, while still maintaining adequate operating budgets, capital budgets and incomes for health care providers and administrators.
Students of health care policy (who are not corporate pawns) and advocates of single-payer, improved and expanded Medicare-for-All, knew from the beginning what ObamaCare was all about.
![Max Baucus: Try finding a more corrupt politico. Many match him but none surpass him.](https://www.greanvillepost.com/wp-content/uploads/2013/09/BaucusMaxObamacare-300x188.jpg)
Max Baucus: Poster boy for political corruption, but in the present system he has a legion of competitors.
We knew that people like Max Baucus were vile, self-serving political puppets of their corporate paymasters. The fix was in from the very beginning. We knew that ObamaCare would put the already high administrative burden of U.S. health care on steroids, that millions would still remain uninsured (about 30 million), that most of those gaining “insurance” would be dangerously underinsured, that premiums/deductibles/copays and other out of pocket costs would continue to rise, that networks of doctors and hospitals available to patients would get more and more restricted, and that people would not be protected against catestrophic illness and injuries. The horror stories continue unabated.
The major promoters of ObamaCare on the academic side are self-serving academic pinhead theoreticians, not fundamentally different ethically/morally than the political puppets. The real scam is not that Professor Jonathan Gruber from MIT sought to obscure the taxation inherent in ObamaCare, but that he promoted a tax-supported welfare program for corporations whose mandate is to deny health care for a profit (also known as ObamaCare). Where is Dr. Marat when we really need him? Calling Dr. Marat, calling Dr. Marat, … (3)
This is yet another reason why the ObombaBots should be deeply ashamed. In the past eight years they have given pass after pass to the crimes of corporate Democrats at home and abroad in the service of the most shallow of partisan politics and in exchange for a few bones thrown their way in the culture wars. Congratulations, ObombaBots, you have truly become an integral part of the “more effective evil” (per Glen Ford).
Improved/expanded Medicare-for-All is the only solution to the health care crisis in the U.S. that is compatible with the basic ethical/moral requirements of medicine and humanity.
Daniel P. Wirt, M.D. specializes in Anatomic & Clinical Pathology. He resides in Houston, Texas.
Remove the handle from the health insurance company misery and death pump! (4) And where is Dr. Marat when we really need him?
APPENDIX
For the convenience of our readers, we reproduce below one of Dr. Wirt’s prior articles on this important topic.
Single-Payer Health Care Reform
Americans are increasingly afraid that they can’t afford to get sick, and with good reason. About half of all personal bankruptcies are caused by medical expenses, and 76 percent of these individuals had health insurance when they got sick or injured. Those of us with insurance are paying a greater share of the premium and more deductibles and co-pays as well. Thus, not only do we have 46 million Americans without health insurance, but at least an equal number who are seriously underinsured. With the recent economic downturn, the ranks of those who are uninsured and underinsured are growing. Many are faced with choosing between paying for medicine and needed health care and paying for food and housing. A typical story is: get sick or injured, lose your job, lose your health insurance, go bankrupt.
A majority of physicians (59%) and an even higher proportion of Americans (at least 62%) support single payer national health insurance or “Medicare-for-All”. In spite of this, virtually all we are hearing about today are mandate plans that would require everyone to buy the same private for-profit insurance that is already failing us. The for-profit insurance companies and their plethora of plans make for a terribly complex, fragmented, costly and inefficient system. Administrative overhead consumes about 31% of health care dollars in the United States, and the for-profit insurance companies are responsible for half of this, or 15% of $2.4 trillion. This money, more than $350 billion per year, provides no health care: it is consumed by enormous administrative costs, profits for investors and shareholders, and large salaries for managers of these for-profit insurance companies.
All of the incremental reform programs proposed — tax subsidies, health savings accounts, individual or employer mandates, increased regulation of for-profit insurance companies — keep these proverbial foxes in the henhouse and are doomed to fail to control costs and provide universal access. Competition among the foxes does not benefit the chickens, the patients, the doctors or the hospitals. The for-profit insurance companies fundamentally reduce choice — your preferred doctor or hospital is “out-of-network”? Too bad, we won’t pay, says your insurance company.
The data are in. Incremental reforms, mostly mandate schemes which retain the for-profit insurance companies have been tried in seven states over the past two decades: Massachusetts, Tennessee, Washington, Oregon, Minnesota, Vermont, Maine. In all of these states the reforms have failed to contain costs. In all but Massachusetts, they have failed to reduce the number of uninsured. In Massachusetts, there has been a modest decrease in the number of uninsured, falling from 13% of adults in 2006 to 7.1% of adults in 2007, but at the cost of a substantial increase in public spending (spending for “Commonwealth Care” was $629.8 million in fiscal year 2007, $1089.2 million in fiscal year 2008 and $1317.7 million in fiscal year 2009). Most of the gain in Massachusetts has come from expanding Medicaid and subsidizing the purchase of private insurance; very few people have signed up for the unsubsidized but mandated private insurance. Not to mention that 7.1% uninsured is unacceptably high. Far from controlling costs, these mandate plans will add hundreds of billions of dollars to the nation’s health care costs.
The United States spends about twice as much per capita on health care than other industrialized countries. Yet it is a myth that the United States has the best health care in the world. The United States ranks near the bottom of industrialized countries in terms of important morbidity and mortality outcomes (for example, life expectancy and infant and maternal mortality). Out of 19 industrialized countries, the United States ranks last in reducing deaths from treatable conditions (Health Affairs, 2008). About 18,000 American adults die unnecessarily every year due to lack of insurance (Institute of Medicine, 2002). As reported in the Archives of Internal Medicine in 2003, repair of an aortic aneurysm cost $8,647 in Canada and $13,432 in the U.S. What accounted for the substantial difference? Most of the difference was due to much greater overhead costs in the U.S. The surgeons and surgical facilities are top-notch in Canada. The surgeons are very well-paid. The difference is that Canada has adopted a true insurance system for financing health care, one that spreads risk across a broad population: a publicly funded single-payer national health insurance plan that eliminates the parasitic, investor-owned “insurance” companies that make profits by enrolling the healthy, screening out the sick and denying claims.
Single-payer national health insurance for financing health care is NOT “socialized medicine”. Under a single-payer, “Medicare-for-All” system, delivery of health care remains private. The providers of health care remain private. Patients choose any doctor and any hospital. Parenthetically, replacing the wasteful for-profit insurance companies with a single-payer national health insurance program for financing health care in the United States would save enough money (more than $350 billion) to not only achieve universal coverage, but allow the coverage to expand and be more comprehensive, while not spending any more than we do now.
We have an American system that works. It’s Medicare. It’s not perfect, but Americans with Medicare are far happier than those with for-profit insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. And keep in mind that Medicare insures people with the greatest health care needs: people over 65 and the disabled. We should improve and expand Medicare to cover everyone. In contrast to the wasteful for-profit insurance companies, Medicare has a very low overhead — about 3 percent. Unfortunately, the for-profit insurance companies have been infiltrating Medicare in the form of “Medicare Advantage” plans, substantially raising costs when compared to traditional Medicare.
A single-payer “Medicare-for-All” system — improved and expanded Medicare — is embodied in a bill currently in the U.S. House of Representatives, H.R. 676, sponsored by Rep. John Conyers, D-Mich., and cosponsored by 93 other members of Congress in the last congressional session. Its features are: automatic enrollment for everyone; comprehensive services covering all medically necessary care and drugs; free choice of doctor and hospital, who remain independent and negotiate their fees and budgets with a public or nonprofit agency; processing and payment of bills by a public or nonprofit agency; promotion of job growth and the entire U.S. economy by removing the excessive burden of health care costs from businesses; coverage for everyone without spending any more than we are now.
The growth in health care costs must be addressed if any proposal is to succeed. Single-payer offers real tools to contain costs: budgeting, especially for hospitals, planning of capital investments (to avoid wasteful duplication and concentration of expensive technology), and an emphasis on primary care and coordination of care. Mandate plans offer only false hopes: competition among for-profit insurance companies, computerization and chronic disease management. Competition among the shrinking number of for-profit insurance companies has already failed to contain costs and, in the absence of single-payer and reformed primary care (so that everyone has a primary care home), computerization and chronic disease management will raise costs, not lower them.
Single-payer “Medicare-for-All” for financing health care is the right answer. It is right on choice: it provides free choice of doctor and hospital, the choice Americans want and value. In mandate plans, we lose those choices. It is right on efficiency and quality: single payer would slash administrative costs and promote efficient primary care. It would also enhance evidence-based quality assurance. It is right on accountability: it will be a public, nonprofit system that will respond to what doctors and their patients need, not what corporate executives and their stockholders want. The nation will pay about the same, while covering all Americans (no more exclusions based on “pre-existing conditions”). A modest increase in employer/employee payroll taxes would be offset by savings in out-of-pocket costs for insurance premiums, deductibles and co-payments, as well as by more comprehensive health services coverage.
The single-payer program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. No co-pays or deductibles are allowed. The program will negotiate reimbursement rates annually with physicians, allow for global budgets for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment.
Business leaders are well on their way to understanding how the current system makes their businesses uncompetitive with those in industrialized countries that have cost-effective health care systems not based on profit. Doctors and hospitals are increasingly fed up with the current system. Increasingly, both realize that treating health care as a commodity that some can afford and others cannot — apportioned based on profit motive and the ability to pay, rather than need — is the most irrational and inhumane form of rationing and interferes with their mission of providing high-quality, compassionate, evidence-based, necessary health care to patients, while still maintaining adequate operating budgets, capital budgets and incomes for health care providers and administrators.
Finally, the most important group is patients. We are all sometimes patients. All patients must rise up and remove the foxes from the henhouse. Foxes are not evil, but their nature is such that they must not be allowed in the henhouse.
Daniel P. Wirt, M.D. is a Pathologist, Houston, Texas and member ofHealth Care for All Texas and member of Physicians for a National Health Program. He can be reached at: boojum@wt.net
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