The Journey to Medicare’s 58th Anniversary
The most successful U. S. health insurance program, Medicare, was enacted ln July,1965, to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 58 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has for-profit/administrative costs above 15 percent.
Medicare’s costs have risen more slowly than those of the private health insurance industry. Medicare provides better access to care, better financial protection and higher patient satisfaction. Although some have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years.
‘ MEDICARE FOR ALL’ STALLED FOR 58 YEARS :
Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national health insurance system that included all age groups, “Medicare for All”, was right around the corner. Unfortunately five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, Big health insurance industry companies/oligarchs and their champions in the White House and Congress.
Because the for- profit, private insurance industry so thoroughly dominates our national health insurance system, the basic concept and purpose of health insurance is defined by them. The U.S. subscribes to a private business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits, maximizing health policy premiums or by not covering people with health problems. Like all businesses, their goal is to make money. Under the business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit .
WEALTH ADDICTION AT THE ROOT OF BIG HEALTH INSURANCE/BIG PHARMA PROFITEERING:
“Money is like salt water. The more you drink, the thirstier you get”. Roman proverbs say that the more money a rich man has, the more driven he is to accumulate more. Limitless greed for money the Greek dramatists said, becomes a disease of the psyche. In the 388 B.C. play, “Ploutos”, Aristophanes writes that a person may become over-saturated with food….but no one ever has enough wealth. Wealth addiction is a greedy compulsion to obtain more and more wealth, and specifically obtain what belongs to others. The effect is to injure others because it is adversarial/harmful to society as a whole. The related condition of “affluenza” reflects an inability of wealthy/oligarchs to understand the consequences of their behavior because of financial privilege.
Although health insurance affordability for the majority of US citizens still remains elusive, President Biden’s health insurance plan still wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of public health insurance, as with Medicare Advantage plans, REACH plans and others, by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the basic source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system that requires large profits. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.
SOME BASIC PRINCIPLES OF PRIVATIZATION – how to maintain wealth addiction :
* With privatization, increase transfer of ownership and control of economic programs/services from the government to the private sector;
* promote the private sector’s influence on the economy by achieving deep reductions in government spending via austerity and large cutbacks;
* discourage/block spending on all social welfare/mental health / public jobs programs (similar to the Works Progress Administration (WPA) of the 1930’s) and other state/local/federal government programs.
* governmental austerity paves the way for more profiteering by those who seek to replace government programs with private corporate entities.
* always maintain, strengthen and increase privatization—relentlessly promote the transfer of ownership, property, or business from the government to the private sector.
* Some examples of privatization include the health insurance industry, the correctional system in the form of for-profit private prisons/jails, interstate highway system construction, privatization of public schools into private charter schools, privatization of medical diagnostic and treatment services such as dialysis centers, speciality hospitals and other outpatient units.
* Promote deregulation—working/lobbying for the removal of government (local, state, federal) control over the industry. Historic examples of deregulated industries in the U.S. include the airline,telecommunication, and trucking industries.
OPPOSITION TO PUBLIC INSURANCES- defending addiction:
During the dangerous coronavirus pandemic, Big Insurance and Big Pharma continued to oppose legislation for new, improved Medicare for All. These resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Wealth addicted individual and corporate predators regard democracy, government and community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of Big Insurance and Big Pharma, industries that spent $371 million on lobbying in 2017.
HEALTH INSURANCE PROFITS – feeding the addiction:
US health insurance companies beat analyst expectations and reported billions in profits in the first quarter of 2021, after making a windfall in the first year of the Covid-19 pandemic. The insurers’ success comes as small healthcare providers faced unprecedented financial stress and millions of Americans struggled to cover health costs.
* The nation’s largest health insurer, UnitedHealth Group, reported $4.9bn in profits in the first quarter of 2021 compared to $3.4bn in the same period in 2020 – a 44% increase. The higher than anticipated profits prompted the company to raise its projections for the year.
* Anthem also beat estimates in its report of $1.67bn in profits in the first three months of 2021, a 9.5% increase from the same period last year.
* Humana’s net income was $828m in the first quarter, a 75% increase from the same period the year before.
* CVS Health, which owns the Aetna health insurance provider and drugstores, reported $2.2bn in profits, up from $2bn in the same quarter a year before.
* Cigna reported its net income fell to $1.17bn from $1.19bn in the same period last year, but it still raised its forecasts for the year. Together, the companies represent the country’s five biggest health insurers by membership. (The Guardian, May, 2021).
AFFLUENZA UNLEASHED – MORE PROFITEERING- New York Times bestselling author, health care and campaign finance reform advocate, Wendall Potter, reports on recent profiteering:
1). big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the insurance companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.
2). the for-profits now control more than 70% of the Medicare Advantage market.
In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.
That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion.
3). big insurers’ revenues have grown dramatically over the past decade, the result of consolidation in the PBM business and taxpayer-supported Medicare and Medicaid programs.
4). what has changed dramatically over the decade is that the big insurers are now getting far more of their revenues from the pharmaceutical supply chain, Medicare, Medicaid and from taxpayers as they have moved aggressively into government programs. This is especially true of Humana, Centene, and Molina, which now get, respectively, 85%, 88%, and 94% of their health-plan revenues from government programs.
5). the two biggest drivers are their fast-growing pharmacy benefit managers (PBMs), the relatively new and little-known middleman between patients and pharmaceutical drug manufacturers, and the privately owned and operated Medicare replacement plans marketed as Medicare Advantage.
6). huge strides in privatizing both Medicare and Medicaid have been made. More than 90% of health-plan revenues at three of the health industry companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular. Enrollment in government-funded programs increased by 261% in 10 years.
WEALTH ADDICTION OF THE BIG PHARMA MONOPOLY:
Gerald Posner, author of the book “Pharma: Greed, Lies, and the Poisoning of America”, writes, “The ability to make money off of pharmaceuticals is already uniquely large in the U.S., which lacks the basic price controls other countries have, giving drug companies more freedom over setting prices for their products than anywhere else in the world. During the C-19 pandemic crisis, pharmaceutical makers had even more leeway than usual because of language industry lobbyists inserted into an $8.3 billion coronavirus spending package, to maximize their profits from the pandemic.”
Posner calculates that since the 1930s, the National Institutes of Health has put some $900 billion into research that drug companies then used to patent brand-name medications. The advocacy group “Patients for Affordable Drugs” notes that every single drug approved by the Food and Drug Administration between 2010 and 2016 involved science funded with tax dollars through the NIH, with hapless US taxpayers spenting more than $100 billion on that research.
Among the drugs that were developed with some public funding and went on to be huge earners for private companies are the HIV drug AZT and the cancer treatment Kymriah, which Novartis now sells for $475,000.
Posner gives many more examples of Big Pharma making exorbitant profits from drugs produced with public funding. The antiviral drug sofosbuvir, which is used to treat hepatitis C, stemmed from key research funded by the National Institutes of Health. That drug is now owned by Gilead Sciences, which charges $1,000 per pill — more than many people with hepatitis C can afford; Gilead earned $44 billion from the drug during its first three years on the market.
Other examples include Mylan Pharmaceuticals, who have been price gouging the life-saving injectable epinephrine, EpiPen, by charging $300 for a product that costs less than $10 to make. The lack of ethics and price gouging from Mylan and other drug industry entities is an oft-repeated scenario by Big Pharma. They created nothing but paid billions that must be recovered through sales for a company that made their targeted product. They then generated skyrocketing returns through escalating price gouging, and even avoided taxes through inversion.
This is not the first time that Mylan has attempted to monopolize a drug to raise prices on a relatively cheap product to produce profits. In 2000, Mylan entered into agreements with the providers of the active pharmaceutical ingredient for widely prescribed anti-anxiety drugs lorazepam and clorazepate. The effect was to deny competitors access to ingredients necessary to produce these drugs generically. Having done so, Mylan inflated the drugs prices by 2,000 percent and 3,000 percent respectively. Mylan was dragged into court by 32 state attorneys general and the U.S. Federal Trade Commission. The settlement basically required Mylan to disgorge all of the ill-gained profits in what was then the largest settlement with a drug manufacturer, amounting to well over $100 million.
But Mylan is not the only offender. Valeant Pharmaceuticals between 2015 and 2016 raised the prices of Isuprel and Nitropress by 528 percent and 212 percent respectively; from 2013 to 2016, Cuprimine by 5,787 percent and Benzaclin and Retina-A Micro by 1,800 percent each; and from 2011 to 2016 Carac and Targretin 1,700 percent each. The drug Syprine went up by 3,200 percent since 2011.
By misleading physicians about the safety of OxyContin in order to earn $35bn in sales revenue from the toxic pain drug between 1995 and 2015, many addiction specialists say that Purdue Pharma owners, the Sackler family, bear the lion’s share of the responsibility for many deaths and today’s opioid crisis.
Few know that Sackler wealth comes from Purdue Pharma, a private Connecticut company the family developed and wholly owns. In 1995, the company revolutionised the prescription painkiller market with the invention of OxyContin, a drug that is a legal, concentrated, chemical version of morphine or heroin. It was designed to be safe; when it first came to market, its slow-release formula was unique. After winning government approval it was hailed as a medical breakthrough, an illusion that many now refer to as “magical thinking”.
It was marketed to physicians, many of whom were taken on lavish junkets, given misleading information and paid to give talks on the drug . Patients were wrongly told the pills were a reliable long-term solution to chronic pain, and in some cases were offered coupons for a month’s free sample. DEA data says that the US has been flooded with about 10 billion pain pills a year. Most pain drugs were sold by a small number of pharmacies, with prescriptions for these drugs written by a small number of physicians at pill mill clinics that charged cash for prescriptions. Data has shown these clinics were good OxyContin customers for the Sacklers/Purdue Pharma. Launched in 1996, Purdues OxyContin sales strategy was highly successful for twenty years because it alleged concentrated aggressive OxyContin marketing programs on what Purdue labeled ‘supercore clinics’, i.e., pill mills.
In a New Yorker Magazine expose, Allen Frances, M.D., former chair of psychiatry at Duke University school of medicine said, “Their name (Sackler/Purdue Pharma) has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”
NEOLIBERAL/PRIVATIZATION PHILOSOPHY- fighting anti-monopoly legislation by the Wealth Addicted !
U.S. political and oligarch support for privatization of health insurance and Big Pharma is grounded in the philosophy espoused by University of Chicago economist, Milton Friedman. Friedman said “the corporations should not take into account the public interest” and added that “the government itself should not take into account the public interest. The job of the government is to simply let everybody make as much money as they can, however they can”.
Classical economist Michael Hudson notes that Big Pharma , like Big Insurance, doesn’t want any kind of anti-monopoly legislation . “Essentially you have what is called a free market, as advocated by Milton Friedman. A free market means the wealthiest people dominate the market and the supply of credit, the management of the economy that allocates credit, and who gets what shifts from Washington to Wall Street. It shift’s from the government to the private financial sector, and allows the financial sector to do the planning. One problem with this is the financial sector lives in the short run. So, it means that they only look for the next three months, the next year’s balance sheet, because the free market is so complex you don’t know what’s going to happen. Well, of course, since you’re managing it from Wall Street you in reality do know what’s going to happen but you don’t want to tell people exactly what’s going to happen”.
U.S.VOTERS WISHES DON’T MATTER:
Since a reality TV star and real estate developer was elected president of the US, it’s clear that celebrity culture is an essential component of the corporate controlled economic system that govern our lives under the “business party”. Buffoon politicians from both parties have become shameless, beholden tools and lackeys of corporate America. They offer us a devil’s bargain mix of self-serving toxic programs and policies, frequently changing their positions as fast as others change socks. Will Rogers got it right when he noted that, “a fool and his money are soon elected”.
U.S.voters popular desires cannot be achieved because there’s no vehicle to express their unhappiness, and there’s no way in which American voters can express what they want either in the Democratic or the Republican parties because they are really the same party and are in full agreement with what they are doing.
The voters don’t matter because the American definition of democracy is oligarchy, where a small group exercises control especially for selfish purposes. Polls have shown large popular support by citizens for Medicare for All, but neither political party nor Wall Street donors have supported it. Michael Hudson writes that by “conquering the brains of a country by shaping how people think, you can twist their view into ‘unreality economics’ and make them think you are there to help them and not to take money out of them, then you’ve got them hooked.” This is how Big Insurance and Big Pharma maintain control of U.S. health insurance. Our system is privatized, financialized and unregulated so that private, big insurance companies can make money”.
Economist Hudson further notes that, “Biden’s long political career has been right-wing. He’s the senator from Delaware, the country’s most pro-corporate state—which is why most U.S. corporations are incorporated there. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy “reform” written and put into his hands by the credit-card companies. As a budget hawk, he’s rejected Modern Monetary Theory (MMT), and also “Medicare for All” as if it is too expensive for the government to afford—thereby making the private sector afford to pay 18% of US GDP to health-insurance monopolies, far more than any other country. That means blocking governments from providing basic services at cost or on a subsidized basis—education, health care/health insurance, roads and communications. Privatized and financialized economies are high-cost.”
The assumption that whatever the market produces is rational and functional is the bedrock of Western economies. “And it’s wrong” , says economist Michael Hudson, “because It negates the fact that you really need some government power strong enough to override the self-serving special interests of oligarchs and other 1% corporate interests. And that takes a very strong government, which is why the free market /privatization people have always opposed strong government and why their economic models don’t give any acknowledgement for government investment in infrastructure that Biden wants or any government activity that is able to override that of the 1% rentier class, the financial class, the property-owning class and the corporate monopolists. That’s the problem we have”.
MEDICARE FOR ALL MEANS HEALTH CARE FOR ALL – the antidote :
Commercial health insurers discriminate against health and mental health care and keep Americans from getting the services they need. There is a better way: Single-payer Medicare for All would eliminate the greed and administrative waste of commercial insurance and cover everybody in the U.S. for all medically necessary care, including behavioral and mental health services, substance use disorder treatment, and prescription medications. With Medicare for All, coverage is lifelong and portable, and services are provided without the copays, deductibles, and surprise bills that keep patients from getting care. And unlike commercial insurance, Medicare for All provides free choice of any hospital or health professional.
EVERYBODY IN, NOBODY OUT – stopping the addiction:
New legislation now filed in Congress upgrades Medicare with a 21st century modern and improved “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end.
BENEFITS OF NEW MEDICARE LEGISLATION – include the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment or rehabilitation of a health condition:
1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic disease management.
(4) Prescription drugs and medical devices, including outpatient prescription drugs, medical de- vices, and biological products.
(5) Mental health and substance use treatment services, including inpatient care.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn care.
(8) Dentistry/Oral health, audiology, and vision/ophthalmology services.
(9) Rehabilitative and habilitative services and devices.
(10) Emergency services and transportation.
(11) Early and periodic screening, diagnostic, and treatment services.
(12) Necessary transportation to receive health care services for persons with disabilities, older individuals with functional limitations, or low-income individuals (as determined by the Secretary).
(14) Hospice care.
(15) Services provided by a licensed marriage and family therapist or a licensed mental health counselor.(In addition to psychiatrists, licensed clinical psychologists, licensed clinical social workers, psychiatric nurses.)
MEDICARE FOR ALL NOW! or recovery now!
Let’s never forget that universal Medicare for All is a solid investment in all citizens of our country by simply promoting a social service for universal access to affordable health care insurance for all. Aren’t we a society that cares enough to see that everyone receive the health care they need? That’s the basic purpose of Medicare for All. The history of our most successful national health insurance program, Medicare, provides one of the best arguments for expanding the program to cover everyone. It’s time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for individuals and families.
American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the wealth addicted, neoliberal, privatization, 1% self-serving oligarchs/vested interest/profiteering/affluenza crowd.
THE MEDICARE FOR ALL ACT-2023: H.R. 3421– S.1655:
Celebrate Medicare’s 58th anniversary by joining the majority of Americans who support improved Medicare for All. The USA is a country where health insurance for medical and mental healthcare is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.
“As we lurch from crisis to crisis in our health care system, insurance companies and private investors continue to rake in billions while Americans suffer and physicians are prevented from carrying out their sacred duty,” said PNHP president and adult and pediatric intensivist Dr. Philip Verhoef. “We need to eliminate this greed and guarantee health care for each and every person in this country. We need Medicare For All today, and this bill gets it done.”
Ask your legislator to support new legislation now filed in Congress, “The Medicare for All Act of 2023” House Bill (H.R. 3421) and Senate Bill (S. 1655) that would establish this badly needed reform.
[F. Douglas Stephenson , LCSW, is a retired psychotherapist and former instructor of social work in the University of Florida Department of Psychiatry. He is a member of Physicians for a National Health Program.]