Socialized medicine v. incremental improvements

For the last several decades, David Himmelstein and Steffie Woolhandler, the founders of Physicians for a National Health Care Program, have been ardent advocates of a “single-payer” health care system, government-administered improved Medicare for All. They dismissed incremental improvements to hold corporate health insurers in check and stopped short of advocating for socialized medicine. As our health care has moved further away from Medicare for All, in a piece for The Nation they now argue that single-payer is not enough; we need socialized medicine. While that would be wonderful, with health care, slow and steady is more likely to win the race.

Socialized medicine has always been a laudable and important goal for the US because, for the most part, it takes profit out of health care and puts patients first. The Veterans Administration and Federally Qualified Health Plans are forms of socialized medicine–in which the health care facilities are government-owned and the health care providers work for the government–that are known for their excellent care at lower cost. Members of Congress rely heavily on this type of care through Walter Reed National Medical Center, one of the best hospital centers in the nation. We could and should expand these facilities so everyone has the choice of using them.

But, socialized medicine is a pipe dream at the moment. If we don’t focus now on curbing corporate power incrementally, it’s hard to see how there is not a total corporate takeover of our healthcare system in the near-term and fewer openings to achieve an equitable health care system down the road.

For example, Medicaid, which had been administered exclusively by state governments, is now almost exclusively administered by corporations. With Medicare Advantage enrollment growing, Medicare is also increasingly run by corporate health insurers. And, a new government program in traditional Medicare–direct contracting–has opened the door to private equity and corporate insurers overseeing people’s care.

We need to stop the privatization of Medicare and Medicaid. Since we can’t stop it right now, we need to slow it down. Privatization drives up costs and restricts access to care, with virtually no accountability for bad acts from the corporations. While curbing privatization is not easy, at the moment we cannot expect Congress to enact Medicare for All legislation, much less socialized medicine.

We can galvanize Americans to speak up against our current system though. Everyone can see and feel how privatization of Medicare and Medicaid is driving up costs, restricting access to care, and hurting large swaths of the population.

Medicare for All would save over $600 billion in administrative costs. It would generate the funds needed to guarantee good affordable coverage to everyone. It would also give everyone the freedom to choose the doctors and hospitals they want to use, eliminating provider networks. That’s not possible in our current system.

But, today, doctors and hospitals are largely owned by corporations and private equity firms. These entities have been found to engage in practices that can keep health care providers from delivering the care people need. They put profits first and that can compromise quality of care.

Himmelstein and Woolhandler argue that Medicare for All cannot achieve guaranteed affordable health care for all if the government is paying corporations and private equity firms to deliver care. Private equity is only about short-term gains for the purpose of sale. Corporations could be in business for the long-term, but profits always come first. Communities should be in charge of people’s health. Here’s how they describe what’s happening to health care in the US:

“For-profits now own the vast majority of hospices, nursing homes, urgent care and dialysis clinics, imaging facilities, ambulance companies, and home care agencies. They garner nearly one-third of the total revenue of psychiatric and substance-use treatment hospitals, and control a growing share of general hospitals. Meanwhile, insurers are buying up clinics and doctors, eliminating any semblance of clinical independence. Optum—a subsidiary of UnitedHealth, the nation’s largest insurer—controls more than 1,500 clinics with 60,000 doctors, and CVS/Aetna already runs 1,200 Minute Clinics, with plans to expand its offerings in primary and behavioral care. Increasingly, Americans’ insurer is also their doctor.

The rise of corporate ownership of American health care has been stunning. Even more malevolent actors have now entered the fray. Private equity firms’ health care acquisitions totaled about $750 billion over the last decade, more than $119 billion in 2019 alone. KKR and Blackstone now employ or control more than 40,000 doctors, physician assistants, and nurse practitioners, and provide staffing for about one-third of US emergency rooms. Those companies were largely responsible for the epidemic of surprise bills. And private equity has been gobbling up primary care practices and mental health, orthopedics, and vision care providers; they already employ nearly 10 percent of dermatologists.”

This is all scary and bodes ill for the future of health care in the US. Still, given our Congress, the immediate fight should be to level the playing field between traditional Medicare and Medicare Advantage so that people have a meaningful choice between them and we are not overpaying Medicare Advantage plans. Congresswoman Katie Porter, Jan Schakowsky and Rosa Delauro as well as Senator Elizabeth Warren, along with 15 other members of Congress, recently led a letter to CMS arguing for a level playing field. We need scores of members signing on to these letters and driving legislation to strengthen traditional Medicare and end overpayments in Medicare Advantage.

Traditional Medicare needs an out-of-pocket cap, so that people are not at financial risk if they do not have supplemental coverage. Right now, people in Medicare Advantage who want to switch to traditional Medicare are often locked out of traditional Medicare because, even if they can afford supplemental coverage, which can be costly, insurers in most states do not have to sell it to them.

Here’s more from Just Care:

• Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care
• Congressional Budget Office reports benefits of Medicare for all over corporate health insurance
• Coronavirus: Medicare for all would have saved lives
• VA program offers older veterans care in private homes
• Medicare for all would save $600 billion a year in administrative costs