Crusading for Universal, Single Payer Health Care Legislation
By Edwin L. Young, PhD
June 18, 2007
There is an unfortunate set of ironies to this story. The miasma of managed care has been a major contributor to the rising cost of health care. Supposedly, managed care was designed to make health care more cost effective. One ironic consequence has been that the medical and mental health professionals have been forced to surrender their well-earned authoritative expertise to managed care, non-professional, bureaucrats. Managed care companies have been making decisions about what illnesses to treat and what treatments would be allowed for almost two decades. Preventive medicine was virtually discarded since it was typically deemed as unnecessary. In addition, not surprisingly, with this takeover of the health industry by managed care, the quality of care given to mental patients and to patients with physical illnesses has been degraded by at least twenty-five percent. On the one hand, reimbursements to health care providers were reduced by twenty-five to fifty percent. Furthermore, the annual national cost for health care has risen by at least twenty-five percent and continues to rise at a far faster rate than any other industry. There was an interesting inverse relation developing. Insurance premiums, also to no one’s surprise, did not concurrently decline but rather rose as outlays for care plunged.
Some corporations, especially those who preferred to be self-insured, opted out of the managed care schemes implemented by Medicare and insurance alliance. These corporations saw a way to avoid the topsy-turvy outcomes of managed care and instead invented alternatives like the Employee Assistance Programs (EAPs). Some of these new EAPs avoided siphoning off money meant for psychological services that were redirected into contorted, pseudo-medical, mangled Managed care organizations. These corporations saw, early on, that the Managed care companies were headed by profit driven health care bureaucrats who had no legitimate background to be controlling medical decisions. Their EAPs made it possible for psychotherapists and clinical social workers to treat clients without being under the supervision of psychiatrists. This also had the accompanying advantage of obviating the necessity for medically prescribed psychotropic drugs. These factors meant a big reduction in cost to self-insured corporations and EAPs. Some, EAPs of the self-insured, however, eventually returned to the managed care model and became gatekeepers for cutting costs to insurance companies with whom they contracted. Insurance, pharmaceutical, and managed care companies have been benefiting while national health care costs have been escalating, health professionals have been going broke or and driven out, and quality of care was expiring.
By the early nineties, physicians, psychiatrists, and psychotherapists had lost control over their practice and their patients had lost control over self-determination of their physical and mental health care. The people and legislators of the early 21st century decry this development, but no one dares look back into the root cause, which is the callousness and greed of the health insurance-pharmaceutical-managed care-industries complex. The lobbyists for the combined rich medical-industrial-pharmaceutical-insurance complex are now so powerful and strong that legislators are forced to back off from considering how to provide physically sick and mentally disturbed persons with humane, proper treatment. This also discourages emphasis on prevention. The subjugation of health care providers to commercialism is complete. While America has the most advanced technology and highest level of professional skill, it lags far behind many over developed countries in health statistics. The health pharmaceutical-insurance-managed care complex has seriously degraded quality health care delivery.
The pharmaceutical industry, according to a physician recently on TV, began many years ago offering public service, or educational, announcements about drugs. Initially, these were helpful. Over the years, they have evolved into enticing ads that are modern versions of circus hawkers and snake oil peddlers. As an undergraduate, I took abnormal psychology and the professor warned that we would think we had every mental illness we read about. This is exactly what happens when people see these new medication ads on TV. These pharmaceutical ads advise the TV audience to see their doctor and request a prescription for their drugs. Their approach not only runs up the cost to corporations who carry health insurance for employees through excessive demand but also hinders doctors’ practice, and is harmful to patients’ health. This advertising approach has been incredibly successful. The pharmaceutical industry is making multi-billion dollar profits using this approach. The catch is that eighty per cent of the prescribed medications are either wasteful or inappropriate to the point of sometimes being dangerous to one’s health. Media corporations make huge profits from these pharmaceutical ads. So, while managed care is cutting costs for insurance, thus increasing their profits, the pharmaceutical companies are reaping huge profits, media corporations are profiting, and the managed care bureaucracy is profiting and burgeoning. What is the bottom line for all of this? Health professionals are either leaving or going bankrupt and health care is deteriorating. Statistics for the nation’s population show serious health problems are way out of control, and yet the national health care costs are escalating. Is there something wrong with this picture?
If congress were to enact a universal health care system, this would allow medical professional experts to make the correct diagnoses, provide the correct the treatment, and prescribe only the necessary and correct the medications. It would instate a necessary prevention program that could go a long way toward ending the national health crisis. A universal health care system could eliminate the intermediary managed care companies that would greatly reduce national health costs. It could make it possible to negotiate for the lower prices for medications. An enormous amount of costly paperwork could also be eliminated. With all Americans having access to proper health care, businesses would have huge cost reductions since workers would be healthier and more productive, absenteeism would plummet, and workers compensation would be minimized.
Of course, there would be an outcry from the rightwing politicians. They would accuse proponents of universal health care of having adopted the loathsome socialized medicine model, a model, which, ironically, is working so well in many other countries. It seems, therefore, that the only thing that would suffer would be the conservatives’ fanatical devotion to the free enterprise ideology.
We have seen the failure of attempts to privatize human services over the last few decades. Is it not about time to end the reign of terror of rightwing zealots? Attempting to transform sectors like education; corrections; welfare; social security; mental health; and medicine into their free enterprise corporate model is futile and inhumane. To be profitable like corporations, the most reasonable thing to do would be to eliminate or curtail services to those who cannot pay, namely the children, the mentally ill, sick, injured, incarcerated, elderly, impoverished, disadvantaged, retarded, and the handicapped.
Mother of all ironies! Managed care equals unmanageable, skyrocketing costs of healthcare for all, corporations, workers, in short, the entire population. The only reasonable solution is to eliminate managed care, institute universal health care, and create a single payer system.
A survey conducted a year ago by the Physicians for a
National Health Program (PNHP) showed that 59% of this sample of physicians,
taken from a variety of specialties, including family practice, were in favor of
a National Health program. Most of them favor a Universal, Single
Payer health program.
http://www.pnhp.org/news/2008/march/most_doctors_support.php
(Their health care statistics are more current, exact, and
comprehensive than mine are.)
Please pass this on to friends and interested parties and encourage them to write their representatives.
Thank you,
Edwin L. Young, PhD