Sick and Without Medicare or Employer Healthcare – Good Luck with That

All those billionaire and centimillionaires are so generous with their gifts to major hospitals where they live, fostering upgrades, research and operational support? Right? Kindness on steroids, even though they do get their names prominently featured on buildings, clinics and donor walls. Oh, and there is one more unwritten benefit: in the event of severe injury or catastrophic illness, these donors, in direct proportion to their gifts, get special hospital rooms, catered food and doctors who will drop just about anything else they are doing to provide medical services worthy of the President of the United States.

But many of these donors are often the same critics of “unsustainable” Medicare, excessively “generous” Medicaid (even where it isn’t fully available) and “confiscatory” taxes. They are often those who claim that those who are accorded the universal healthcare in every other developed nation on earth are truly denied full-level emergency care, always face interminably long lines and are provided with inferior healthcare. Funny, even with some delays where medical treatment is not critical, there are very, very few complainers in the rest of the developed world when they can walk out of a hospital after a long stay without paying a dime. Or where there monthly cost for prescription medicines is capped at between $10 and $20. Ask them if they would trade for a US-based healthcare system and most would laugh derisively.

For those who claim our federal and state taxes unfairly burden the rich, you’d have to explain to me why all those loopholes continue (like the infamous “carried interest” rule that accords fund managers capital gains rates even when they made no investment) and why we lowered the federal corporate tax rate from 35% to 21% and still major corporations pay far less, if anything. A tax cut that was supposed to pay for itself and create first-rate jobs instead hemorrhages the federal deficit, promulgated stock buybacks but not jobs. You would also have to justify why the United States has more billionaires and centimillionaires, even corrected for inflation, than at any other time in history or why major corporate CEOs earn over 600 times their median employees pay (in the 1950s, it was 50 times). See also my recent How to Earn More as Fortune 500 CEO: Fail blog.

Our Social Security and Medicare systems were built on the financial assumption that the US population would continue to grow, and that there would be an increase in working Americans to support elder Americans. But American citizens’ birthrates have fallen below replacement rates, so we have a contracting population combined with new federal policies aimed at cutting back immigration. Since the underlying structure is no longer one capable of supporting these vested social programs (hardly “entitlements”), it doesn’t take a rocket scientist to tell you that if you do not want to punish older Americans, financing for these programs has to come from “somewhere else.” Instead, the fundamental GOP approach is to cut the programs or delay the benefits… but leave those rich folks alone.

While US-driven research has produced some of the most advanced medical technology on earth and pharmacological research like no other, access to that technology may just depend on what kind of healthcare coverage you can afford… knowing that Americans pay more for the same prescription meds than any other nation on earth. Daniel Stone, a Los Angeles physician and writing for the March 4th Los Angeles Times, notes that the “U.S. is spending trillions of dollars for substandard care, and patients are suffering…

“In calling out the system I intend no disrespect to the talented and heroic overachievers in nursing, pharmacy, medicine and the other providers who fight the system every day on behalf of our patients… Despite such efforts, the sad but undeniable fact is that our healthcare system — the way the U.S. distributes and pays for healthcare — makes it the most expensive failed enterprise in the history of human civilization.

“Part of what set me off that week was a series of examples of my patients’ chronic struggles to access mental health services. After years of poor funding and a deluge of demand since the pandemic began, providers are in short supply. Scarcity is coupled with barriers imposed by insurance networks. Absent reasonable access to services, primary care doctors like me become the psychiatrists of first and last resort, pushing the bounds of our competence. But what else can we do?

“A second part of the week’s grind was the latest obstacles to drug therapy. The costs are so high for so many medicines that even insured patients struggle. Take Ozempic. There’s no generic, and it’s a financial stretch at nearly $900 a month, but it helps my diabetic patients — until last week, when they couldn’t find it. Why? Because of its newly recognized use for weight loss. It’s suddenly so popular that pharmacies run out. How can a system allow wealthy individuals looking to shed a few pounds to use their cash to elbow aside diabetics who actually need the drug?

“A third conspicuous failure of our healthcare system, looming in the background every week for physicians like me, is hospital funding. Hospitals have survived for years by collecting high fees from commercial insurers to subsidize losses from treating Medicaid and Medicare patients. With a rise in the cost of care, and a shift toward patients on government plans and away from private insurance, even the most prestigious and well-managed hospitals, both locally and nationally, face an emerging flood of red ink. Many are cutting costs sharply to preserve solvency. In a rational system, the revenue that supports critical institutions like hospitals would not be subject to perennial financial crises.”

What seems to underlie legislative efforts to “fix the system” is the massive flow of campaign contributions (or negative ads for those who do not fall in line) to ensure that those who generate the most profits from healthcare keep those profits in any purported “fix.” Unless the underlying costs of powerful special interests are addressed and contained, until getting through medical school (including nursing) is no longer a lifelong drag on the graduates struggling with loans, we are going to keep complaining… and making sure that the mega-rich can get even mega-richer. Meanwhile, our healthcare and retirement systems are shuddering and quaking in disrepair.

I’m Peter Dekom, and if our underlying political and economic systems are supposed to be predicated on fairness, we truly have the most failed economic reality in the developed world.