“Health hampered by ill will” by Joshua Golden

“I think what we need to ask ourselves when we talk about healthcare is why we are the 

only major country on Earth not to guarantee healthcare to all people, 

why we have a life expectancy which is significantly lower than in other countries, 

why working-class people die five to 10 years shorter than the people on top.” 

– Vermont Senator Bernie Sanders

Frustration towards the institutions we rely on to deliver what passes for health care has become common in the U.S.  A system enmeshed in bureaucracy and the ever present specter of financial ruin by injury or disease does little to support healthy lifestyles. Doctors often seem to be scrambling to diagnose, reduced to mitigating complaints with drugs, and limiting their liability with exhaustive diagnostics.

Chronic diseases in the US has been steadily increasing over the past 20 years. Growing by a steady 7 to 8 million people every 5 years, chronic disease now affects 50% of the population, consuming more than 85% of health care costs According to the CDC, around 129 million people in the United States have at least one major chronic disease. This includes conditions like heart disease, cancer, diabetes, obesity, and hypertension. Over 20% of the U.S. suffers from chronic pain.

Not all disease is chronic, acute disease takes its financial toll following recovery, as does the chronic rate of accident and injury. Private industry employers reported 2.6 million nonfatal workplace injuries and illnesses in 2023. The National safety council reports that Four deaths and 1,119 medically consulted injuries caused by preventable incidents occurred every 10 minutes in the U.S. during 2022. a car accident occurs every 13 minutes, Around 42,514 people died in motor vehicle crashes in 2022 and for every fatality, there are eight people who are hospitalized due to car crashes, and 99 people who are treated and released from emergency rooms.

The U.S. spends nearly twice as much per capita on health care as other wealthy nations, but health outcomes are not better. Life expectancy is below average, and the U.S. has the highest rates of preventable and treatable deaths for all ages. The ongoing substance use crisis and the prevalence of gun violence in the U.S. contribute significantly to its poor outcomes, with more than 100,000 overdose deaths and 43,000 gun-related deaths in 2023 – much higher than other high-income countries.

The industry is feeling fine

It’s paradoxical that all the suffering of disease, injury and disability are an economic engine that helps drive the economy. Overall, healthcare spending in the United States is projected to increase from $4.8 trillion in 2023 to $7.7 trillion in 2032. This is equivalent to a per person cost of $14,423 in 2023 and $21,927 in 2032. Seems like prioritizing the efficient delivery of healthcare should be at the top of government to-do lists. 

United Healthcare, which insures more than 10 percent of the American population, made $8.9 billion in profit through the first three quarters of this year. Their product, administrative service, is designed to reduce access to the health care to increase profits for shareholders. The Affordable Care Act capped insurance profit margins, but not profit levels. The law requires insurers to spend 80% of every dollar on care and only 20% on administrative costs. 

Eliminating the private insurance industry could have a huge direct impact on our health care spending – diverting perhaps $4 trillion over the next ten years from administrative waste, and redirecting it to patient care.

In the wake of the shooting of United Healthcare CEO Brian Thompson, highlighting widespread disgruntlement with health insurers in general and United Healthcare in particular, the company has done damage control. The company circulated talking points to its employees that journalist Ken Klippenstein obtained. One section about customers seeking to cancel their plans over the killing instructs employees to counter that “there is no need to change your plan due to this incident.” The communications guidance directs employees to say that their mission includes “ensuring that everyone we have the privilege to service has access to the health care they need.” But that lack of access being the very reason that people are upset at the health insurance industry.

The leaked talking points included specific mention of “social media reports on claim denial rates,” directing employees to say they’re fake news. “The information circulating online about our claims is false,” one talking point reads. “A chart being widely spread on social media is false.” With no reference to any specific “information,” One type of query employees are told not to engage with under any circumstances. “If you receive a call from anyone in the media, do not engage,” 

Not exactly Robin hood

Mainstream media widely reported finding now indicted shooter Luigi Magione’s 318 word “manifesto” with a NYPD detective’s assessment that: “It does seem he has some ill will toward corporate America.”  

The actual wording was quietly circulated but eventually made public. The document explicitly pointed to Mangione’s motivation: “…I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy…the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allowed them to get away with it. Obviously the problem is more complex…But many have illuminated the corruption and greed…It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.”

The system is broken, and a lone gunman, celebrated by some as a hero for committing murder, is a sign of the illness the system is causing. The way we deliver care needs to change. It’s not like there aren’t examples on how it can work better. Every other country in the world guarantees healthcare for its people. And a majority of U.S. doctors agree, we need medicare for all.

A British friend was visiting years ago when a property tax assessment for the local hospital district was on the ballot, she asked innocently, “so if it passes, that means you’ll get health coverage?” Sorry, no, all we get is the potential for local health care, at cost.

The prognosis

The activism toward universal health care in Canada, the system most likely to be a model for the U.S., started around 1916. By 1962 a single province had passed hospital care into law. It took many years to create the nationwide coverage Canadians enjoy today. Making it happen wasn’t easy, with political fights and threats all along the way. Doctors went on strike, people held rallies and signed petitions for and against it. They burned effigies of government leaders, jeered, and booed at the doctors, or the Premier depending on whose side they were on. There was plenty of resistance in the making of the national health system, but in 1984 the universal Canadian healthcare act was enacted. Now, despite the rhetoric that you may hear to the contrary, Canadians wouldn’t have it any other way.

The way  single payer works economically is by huge administrative cost savings. The Canadian single-payer system has administrative costs that are just barely half of what administrative costs in the United States are. The U.S. spends 31 cents on every healthcare dollar on billing and administration, Canada spends about 16-and-a-half percent. Projected to the United States, we could say that a single payer would save over $400 billion a year in administrative costs, and that’s the money that you use to pay for expanded care, both for the uninsured and for people who now have only partial coverage.

But when change is incremental, the politically expedient route demonstrated by the Affordable Care Act, because those administrative savings of implementing single payer coverage don’t happen there is no way to pay for it. That’s the problem with the widely prescribed, “take it slow, don’t upset the industry” incremental approach. This may work politically but is not sustainable economically, a true single-payer system is. 

When you add up all government direct spending for Medicare and Medicaid, the Veterans Administration, the benefits of public employees, and the tax subsidies to private health insurance, you get to over 65% of  health spending already being funded by taxpayers, not that far below the tax-funded share of Canada’s single payer, where the taxpayers pick up about 71 percent of total health spending. The increased taxes that are needed to cover single payer health care are not huge, equivalent to about 4 percent of the healthcare budget to get us to the level of taxpayer funding in Canada. and would be offset by the elimination of insurance premiums. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care. And just maybe we would all feel better knowing that everyone has access to the care they need.

Joshua Golden,

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