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Michael Miller


By Michael Miller
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We Haven’t Fixed Health Care Yet

Forgive me if I don’t join in all the merriment and celebrating over the Affordable Health Care Act decision by the Supreme Court. The delivery of millions of Americans into the clutches of the insurance companies, without adequate cost controls, is not going to fix what is making our health care system sick. We don’t even need a single-payer system or a “public option” to make important changes that will lower costs, although either would be improvements to the non-systemic mess we have now. We can maintain a profitable role for private insurance companies, which are still an important element in the health care systems of some other industrialized countries whose citizens enjoy outstanding health care and lower costs.

But only in the United States are insurance companies allowed to make profits off of a certain basic, core level of care. Making profits off of even the most basic and preventative medicine, off of every bandage and every aspirin is an American thing. In Germany, the health insurance companies compete and profit by creating efficiencies and reducing costs. German insurance executives drive big luxury cars, though they don’t earn $1.7 billion over ten years, as did the CEO of one of New York’s two largest health insurance systems.

We’re told that our health care industry continually reduces costs and increases efficiency. If you stay in a Long Island hospital for more than a few days, then for a year or more you are very possibly going to receive bills or insurance payment notices for doctors, maybe dozens of them, that you can’t identify, for procedures you can’t remember or confirm. Maybe they just peeked into the room on rounds. Who knows? Having good insurance makes patients a target in some places, often out of necessity to make up for important procedures for which the billing people will be hassled by the insurance companies.

One doctor told me that when insurance companies start paying his bills without a hassle, he knows it’s time to raise his rates. This is the system we have built in the Land of Lincoln and Roosevelt.

The consolidation of most Long Island hospitals and thousands of individual health care providers into vast networks hasn’t lowered costs to patients and hasn’t even reduced paperwork, bureaucracy, efficiency, waiting times or mistakes.

Recently, a member of my family had two tests performed one after the other by the same large health care company on different floors in the same building, and had to fill out the same frustrating paperwork in both waiting rooms, with pencils. I have a lot of horror stories, and they aren’t all about mere inconveniences.

The same Congress that cobbled together ACA also created the Dodd-Frank “Wall Street Reform” whatever. Both do rein in some of the most egregious, antisocial abuses by large corporations, but keep the same basic system in place. We have politicians crowing about having “fixed Wall Street.” Keep saying that to yourself. It may comfort you over the next year or so. Now we’ve “fixed health care,” but we still have this hodgepodge, state-by-state system that continually increases in complexity and administrative costs to small businesses, consumers and governments.

Most bankruptcies are caused either primarily or in part due to medical bills, and most of those declaring bankruptcy for medical reasons had health insurance, at least at the beginning of their illness. ACA is not going to substantially change anything about that sentence. Right now, most Democratic officials are patting themselves on the back for having fixed everything, and Republicans are doing street theater about revoking the entire program, including things like maintaining coverage for kids with cancer and other provisions nine out of 10 readers of these newspapers can support.

Insurers play game after game, and politicians are years behind.

Already, many Americans are anticipating paying the fine instead of joining a state insurance exchange, for reasons that politicians don’t acknowledge but which reflect the grinding down of middle and working class Americans. Some people with health issues don’t take out health insurance not just because of costs, but because prospective employers will see them as a high risk to raise group costs or miss work by employers. Health history is already part of the standard corporate background check. Medical records are confidential, but drug store value card databases, Facebook, web browser history and other potential sources of health information aren’t.

Some feel ACA will do nothing to stem forces encouraging doctors with small, independent practices to sell their practices to hospital systems and other larger companies. This saves small providers some administrative costs, but many are actively discouraged or banned from recommending needed providers and services from outside the system, or from spending too much time with patients (ten minutes maximum in one local case I know about). How is that encouraging quality, personalized, preventative medical care?

The insurance companies have two years to play regulators to make sure things come out their way. Neither Congress nor federal regulators can compete with the army of lawyers, lobbyists and strategists employed by Big Insurance, Big Pharma, Big For-Profit Hospitals and the rest of the health care industry. So many millions of legal corporate and CEO dollars can be injected into political coffers that the vigilance we need from Congress while this plays out is no longer part of the overall game plan.

The ACA, far from reforming a broken system, was a backroom deal with sops to every special corporate interest with enough pull to get into that room. We have a largely taxpayer-financed system (60 percent of all health care bills are now paid by governments, a figure which is rising with chronic unemployment, poverty and job insecurity), but with all the worst parts of a free market pigout. Studies have shown that emergency room visits by the uninsured aren’t the big items driving up health costs. The prohibition against Medicare negotiating directly with drug companies over prices for Medicare recipients is given no chance of being rescinded by either house of Congress in any nearby future. The $350 billion a year spent on administrative overhead in this mixed up system could pay for the extension of Medicare to everyone.

Saying that ACA will solve our big health care problems is like saying that property tax caps have solved our education and finance problems because tax rates are rising at a slower rate. We’re still not getting value, equity or fairness in either system.

Twenty-four million people have a pre-existing medical condition and no health insurance coverage. Each year, millions of Americans are losing company-based insurance. Consumers who are sick can’t just walk away and decide to buy the product next year, or never, so we can’t fix problems with health care costs with just a “free market” fix. There can’t be a more life and death issue than access to health care. We can’t just stop and cheer about “winning” when this isn’t fixed, likely isn’t going to work as advertised, and will still leave out millions of Americans. We still need to fix this, for real.

Michael Miller is a freelance writer, designer and strategic consultant who has worked in state and local government. Email: