While much has been made of the 7.1 million people who bought new private health insurance policies under the Affordable Care Act, and the additional millions who newly signed up for Medicaid, two big questions hover over these figures.
Even if they’re insured, will people be able to get the care they need? And what about the 31 million people who the government says will remain completely uninsured?
Medical students are acutely aware of the continuing barriers to health care that our patients face, and I can tell you – based on firsthand experience – that my fellow students are not about to give up the quest for truly universal, comprehensive care that’s readily accessible to everyone.
Their convictions owe a great deal to the late Chicago Cardinal Joseph Bernardin, who fought tirelessly on behalf of the powerless and downtrodden.
In 1995, one year before his death from pancreatic cancer, Cardinal Bernardin said, “Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right.”
But nearly two decades later, the realization of the “right to health care” remains elusive, despite the passage of the ACA.
As a medical student, every day I work with patients who have delayed getting medically necessary care because they were worried about the costs of treatment. In many cases their condition has worsened as a result.
They may have been uninsured. Or they may have had a health insurance policy, but their plan’s high copays and deductibles kept them away.
Such worries are understandable. Studies show the leading cause of bankruptcy in America is medically incurred debt. Impressively, 78 percent of those individuals and families so bankrupted had health insurance when they first got sick.
The ACA doesn’t change this picture as much as some might think. People who signed up for private coverage in the exchanges are finding they have substantial cost-sharing, i.e. high deductibles and copayments, proven barriers to seeking care.
Patients are also finding themselves squeezed into “narrow networks,” which significantly limit their choice of doctors and hospitals. Accidentally step out-of-network, and your costs soar.
The sad truth is that for many health insurance is an umbrella that melts in the rain—when you need it most, it isn’t there.
One thing that's clear: the business of corporate medicine is doing very well under the ACA. Health insurer profits, stock value, and CEO salaries are all up. In fact, the entire law was written around preserving the gluttonous bottom lines in American health care. The ACA handed private insurers $500 billion in taxpayer subsidies to continue profiteering off illness in our country.
Health insurers profit by avoiding the sick, collecting premiums, denying claims, and shifting more and more costs onto the patient.
And for-profit insurance companies aren’t the only ones with a financial incentive to withhold care. “Nonprofits” play the same game. For example, the CEO of the parent company operating Blue Cross & Blue Shield Illinois, a nonprofit, made $16 million in 2012.
In addition, the insurers afflict patients and physicians alike with the highest paperwork burden in the world. Big private insurance companies consume 13 percent of premiums in overhead compared to traditional Medicare’s overhead of less than 2 percent.
Providers are forced to spend tens of billions more dealing with insurers’ billing and documentation requirements, bringing total administrative costs to 31 percent of U.S. health spending, compared to 16.7 percent in Canada.
That difference represents hundreds of billions in unnecessary, wasteful U.S. overhead costs – money that should be going to care.
We have a dysfunctional health care system built around restricting access to care, rather than providing it.
This picture is unjust and unacceptable. That's why an increasing number of students are calling for a streamlined, publicly accountable health care system such as “single payer,” also known as “improved Medicare for all.”
Cardinal Bernardin declared the “affront to human dignity that is occasioned by the lack of universal insurance coverage for even basic care” as the paramount issue of our time. For our nation’s health and dignity, we need to go beyond the ACA to a single-payer system – sooner rather than later.