I was a medical director who worked in population health for Medicare, Medicaid, the private insurance sector, law enforcement (white collar medical fraud), as well as being faculty at a university, writer/editor and now part-time consultant with a department of health. In that multi-decades long career I have never -- and I use the term "never" advisedly -- NEVER read a more accurate, complete, yet concise treatise explaining the infrastructural underpinnings of the healthcare non-system we have today. There are many intersecting issues that, while mechanistically significant, would have made the piece too detail-heavy for the audience, such as how the non-profit vision of the Blue Cross and subsequently Blue Shield system was corrupted into investor-owned for-profit agencies whose fiduciary is not to its members. And how the Prospective Payment System of the 1980s eventually led to decimation of the doctor-patient relationship. You culled out the many side issues that could be left for another day and making that editorial choice is very hard to do well, yet you did. The online world is very lucky you've chosen to spend your time in it.
Excellent piece! I haven't seen it summarized this well before. Really puts a point on how institutionalized racism still affects not just minorities, but everyone.
I just read this article and I do not usually leave comments, but I have been a Registered Nurse for 50 years, and this really does resonate with me . It offers an explanation about something I have been trying to understand and make some kind of peace with for my entire career. Thank you for writing it in a way that I hope most people can understand. I am not currently a person that is suffering from a lack of healthcare because have been lucky enough to always access it due to several reasons ( race, education, employment, age)all mentioned in the article. I hope you continue to educate people on these issues. At this time I’m not really optimistic about ever getting universal healthcare, but Will continue to hope for a better system. Enough said. Thank you.
This is one of the best summaries I have read on the history of our healthcare services in the USA. The main points are so well said. It truly shows how this country views the people that are living here. Only certain types of citizens are valued. I’ve always believed that equal assess to healthcare is a basis human fundamental right just like having access to food, housing, and education. And I am hopeful that radical change will happen one day.
This piece means alot to me as a Black woman. It is very difficult to get people, of ANY political stripe, to understand or even believe how many of the issues in this country have a root cause of racism. If we can be honest about the root cause, the diagnosis will be accurate and the correct prescription (universal health care) actually clicks with the layman. This article is inspiring, well done!
This article is magnificent. It is factually supported and thoroughly analyzed. The only problem is that it shows this country for what it is, a racist, hate-filled society dominated by oligarchs. I realize there is a population here that dies not support that racist ideology. But right now we are out of power. And it’s never been strong enough to overcome the haters. I hope some day it will.
I agree - this read was so clear and helpful to me, but also so very depressing. Realizing what people mean when they say "Make America Great Again" makes me feel a little sick to my stomach. Great apparently equals racist and hate-filled, a country of haves and have-nots. None of that sounds great to me. :-(
Thank YOU! I also just sent you an email because I think this is something you might want to participate in. https://www.defendpublichealth.org I hope we can connect!
Your report elicits so many strong adjectives here: Informative. Understandable. Concise. Brilliant. Magnificent. Unbelievable. Horrifying. Exclusive. Racist. Hate-filled. Agonizing. Disparate. Polarizing. Unfathomable.
Sad times for our country and our healthcare system. At least now we all know and understand how—and for how long!—the infrastructure of this “system” has unconscionably thrown up roadblocks to so many.
Perhaps it’s intelligent, involved scientists like you that will continue speaking out and set us on a course correction. Thankful for your expertise, and for your uncanny ability to reach and teach with clarity and grace.
I read with interest your piece about Universal Healthcare and the US. Here in the UK we have had universal healthcare since 1948, and it is a good thing - I've just had a triple coronary bypass operation for free, ie no cost to me, and it is a bad thing, in that people do not ascribe a value to something that is for free. Regularly, people would return to my pharmacy, medicines that their family had had prescribed but hadn't used - and these had been paid for by the National Health Service,(NHS). This represented a loss of money to the service. People had no shame in ordering more medicines, or returning surplus to us. The NHS is paid for by the government and the people who pay a small amount from their wages every week, but the amount they pay entitles them to have (almost) unlimited treatment. The proud boast of the NHS is that it is free at the point of delivery, but the way patients use it, may mean the UK may be searching for a new model.
I appreciated the broad stroke of explanation and the research that it required. I have been on the ground since 1950. From third grade on, I lived in Alabama and remember that the periods of racism and prejudices were most prevalent in the 50-60's. It was a national phenomenon in both the South (where segregation was easily seen0 and the West, Mid and Upper Midwest as well as the Northeast (where racism and bigotry had many different forms). Therefore, I cannot paint the Southern Democrats as the primary cause of our not having a Universal Healthcare entitlement solution today similar to the "wealthy" European and more enlightened societies (who, virtually all, are imploding from the financial burden of their bloated entitlement systems).
At this point it's important to remember that the Social Security system is not an entitlement program. Those of us who receive that nominal retirement benefit were required to donate a prescribed amount out of each paycheck, for at least 10-30+ years to qualify, until ages 62 to 70. We contributed to Medicaid, too. That those two trust fund systems were plundered by our duly elected politicians to pay for other government system solution is another story.
Pointing fingers is not helping. An associate of mine, when confronted with a problem that needed solving, wisely said: "it's not important who caused the problem, all we should care about now is the remedy."
When you look at our current financial crisis, with a modified Medicare and Medicaid universal medicine approach, other entitlements bleeding us, Social Security virtually bankrupt, and the political mismanagement of the country's tax funds clearly obvious, I cannot agree that a major socialized healthcare upgrade with any other increase in entitlement programs or defense spending is feasible.
We have been beating the same and different political solution drums since FDR's presidency. It's time for the polarizing bickering to stop and for fresh, bi-partisan, real solutions/ideas to be introduced. Maybe we should be seriously asking the best and brightest medical experts and financial planning pros what they think?
Today, we are virtually driving this country over a cliff.
This is incredibly enlightening and so straightforward, thank you! The way racism has galvanized and shaped every aspect of this country is just so tragic it's nearly unfathomable.
Using those kinds of demonizing statements about those that don’t agree with your opinions implicate you as a racist. Don’t you get it? Examining welfare and entitlement rolls to make needed adjustments, especially when identifying those that are abusing the systems, is the responsible thing for grownups to do.
This video has new ideas to win Medicare for All in the U.S. Concentrated and thorough. It wins the debate against market fundamentalism. Part of a graphic cartoon series that rewrites economics to include non-money social organizations. It has lots of applications.
We need single payer, not Medicare for all. The way Medicare is structured now you still need to choose which (private) insurance company administers your plan, and you’re still on the hook for what it doesn’t cover. That’s not how universal care is in other western countries.
So informative. If only more Americans had the attention span for reading something like this and interest in understanding how we got to where we are — and would open their minds to the possibility of truly Universal Healthcare for the USA.
Excellent summary. Another aspect of insurance coverage is the disparity in coverage for surgical and non-surgical (primary care and office-based) services. The initial commercial insurance policies began in the 1930's as Blue Cross/Blue Shield, and were influenced by surgeons and hospitals to cover inpatient procedures as they were more expensive. Primary care expenses like office visits and check-ups were largely seen as penny-ante and not worth covering. They were therefore left as out-of-pocket expenses. As a result, surgeons and hospitals were highly reimbursed. That has continued until today. The surgical procedure that lasts 30 minutes is charged and reimbursed many times more than a physician spending similar time with you in an office, even when caring for serious or complicated acute or chronic problems. Well-care and preventive services were not reimbursed at all until the ACA stipulated that. But, to this day, a procedure-based physician can rack up thousands of dollars of charges in a few hours, whereas a primary care physician could charge only a fraction of that. Of course, in our system, what is charged is only a figment of what is actually reimbursed, whether through commercial insurance, Medicare, or Medicaid. What is paid differs widely from insurance company to insurance company, and (in the case of commercial insurance) from employer contract to employer contract even within the same insurance plan. Someone without insurance, however, is potentially left to pay the whole unadulterated fee. There are those who suggest they can work aut a deal with the providers, which can include surgeons, facilities, anesthesiologists, radiologists, and lab for starters. This is next to impossible for anticipated procedures, much less for acute or chronic treatments, such as for cancer. It is a completely untenable situation and unconscionable that we, as a society, tolerate that.
Thanks for the detailed rundown. You covered a lot of ground, but there's something brewing now that's the next chapter--a divide caused by computers. Older people have harder brains that can make it impossible to keep plowing through all the blocks maintained by customer service chatbots, which are commonplace now for doctors and insurance companies. Even a telehealth visit requires computer knowledge to access. I had a scream fest a few months ago when I finally reached a human being at UHC. He said he was used to it by now. My doctor doesn't even send out lab results, claiming that they need to secure my privacy by using their website with all the pass codes and verification questions. It's agonizing for me to do all this, but when I call the front desk instead, I'm met with irritation that they don't have time to do this with all their patients. It's pitiful! We need to put humanity--not the government or chatbots--back In control of health care.
I was a medical director who worked in population health for Medicare, Medicaid, the private insurance sector, law enforcement (white collar medical fraud), as well as being faculty at a university, writer/editor and now part-time consultant with a department of health. In that multi-decades long career I have never -- and I use the term "never" advisedly -- NEVER read a more accurate, complete, yet concise treatise explaining the infrastructural underpinnings of the healthcare non-system we have today. There are many intersecting issues that, while mechanistically significant, would have made the piece too detail-heavy for the audience, such as how the non-profit vision of the Blue Cross and subsequently Blue Shield system was corrupted into investor-owned for-profit agencies whose fiduciary is not to its members. And how the Prospective Payment System of the 1980s eventually led to decimation of the doctor-patient relationship. You culled out the many side issues that could be left for another day and making that editorial choice is very hard to do well, yet you did. The online world is very lucky you've chosen to spend your time in it.
I appreciate this so much. Thank you!
Excellent piece! I haven't seen it summarized this well before. Really puts a point on how institutionalized racism still affects not just minorities, but everyone.
I just read this article and I do not usually leave comments, but I have been a Registered Nurse for 50 years, and this really does resonate with me . It offers an explanation about something I have been trying to understand and make some kind of peace with for my entire career. Thank you for writing it in a way that I hope most people can understand. I am not currently a person that is suffering from a lack of healthcare because have been lucky enough to always access it due to several reasons ( race, education, employment, age)all mentioned in the article. I hope you continue to educate people on these issues. At this time I’m not really optimistic about ever getting universal healthcare, but Will continue to hope for a better system. Enough said. Thank you.
This is one of the best summaries I have read on the history of our healthcare services in the USA. The main points are so well said. It truly shows how this country views the people that are living here. Only certain types of citizens are valued. I’ve always believed that equal assess to healthcare is a basis human fundamental right just like having access to food, housing, and education. And I am hopeful that radical change will happen one day.
This piece means alot to me as a Black woman. It is very difficult to get people, of ANY political stripe, to understand or even believe how many of the issues in this country have a root cause of racism. If we can be honest about the root cause, the diagnosis will be accurate and the correct prescription (universal health care) actually clicks with the layman. This article is inspiring, well done!
This article is magnificent. It is factually supported and thoroughly analyzed. The only problem is that it shows this country for what it is, a racist, hate-filled society dominated by oligarchs. I realize there is a population here that dies not support that racist ideology. But right now we are out of power. And it’s never been strong enough to overcome the haters. I hope some day it will.
I agree - this read was so clear and helpful to me, but also so very depressing. Realizing what people mean when they say "Make America Great Again" makes me feel a little sick to my stomach. Great apparently equals racist and hate-filled, a country of haves and have-nots. None of that sounds great to me. :-(
Make America White Again.
I guess you can’t read and understand at the same time, so best to keep your pen quiet and your prejudices to yourself!
Sorry David. I meant my reply for Liz (Karen)
Oh, forgive me for expressing myself. You must be the truth and the light. Bless your heart!
Don't be that way.
There you go using your own hateful, bigoted platitudes again.
In my 30 years of working in health & science Communications, this is the best break down I’ve ever seen.
Thank you 🙏
Thank YOU! I also just sent you an email because I think this is something you might want to participate in. https://www.defendpublichealth.org I hope we can connect!
Your report elicits so many strong adjectives here: Informative. Understandable. Concise. Brilliant. Magnificent. Unbelievable. Horrifying. Exclusive. Racist. Hate-filled. Agonizing. Disparate. Polarizing. Unfathomable.
Sad times for our country and our healthcare system. At least now we all know and understand how—and for how long!—the infrastructure of this “system” has unconscionably thrown up roadblocks to so many.
Perhaps it’s intelligent, involved scientists like you that will continue speaking out and set us on a course correction. Thankful for your expertise, and for your uncanny ability to reach and teach with clarity and grace.
I read with interest your piece about Universal Healthcare and the US. Here in the UK we have had universal healthcare since 1948, and it is a good thing - I've just had a triple coronary bypass operation for free, ie no cost to me, and it is a bad thing, in that people do not ascribe a value to something that is for free. Regularly, people would return to my pharmacy, medicines that their family had had prescribed but hadn't used - and these had been paid for by the National Health Service,(NHS). This represented a loss of money to the service. People had no shame in ordering more medicines, or returning surplus to us. The NHS is paid for by the government and the people who pay a small amount from their wages every week, but the amount they pay entitles them to have (almost) unlimited treatment. The proud boast of the NHS is that it is free at the point of delivery, but the way patients use it, may mean the UK may be searching for a new model.
I appreciated the broad stroke of explanation and the research that it required. I have been on the ground since 1950. From third grade on, I lived in Alabama and remember that the periods of racism and prejudices were most prevalent in the 50-60's. It was a national phenomenon in both the South (where segregation was easily seen0 and the West, Mid and Upper Midwest as well as the Northeast (where racism and bigotry had many different forms). Therefore, I cannot paint the Southern Democrats as the primary cause of our not having a Universal Healthcare entitlement solution today similar to the "wealthy" European and more enlightened societies (who, virtually all, are imploding from the financial burden of their bloated entitlement systems).
At this point it's important to remember that the Social Security system is not an entitlement program. Those of us who receive that nominal retirement benefit were required to donate a prescribed amount out of each paycheck, for at least 10-30+ years to qualify, until ages 62 to 70. We contributed to Medicaid, too. That those two trust fund systems were plundered by our duly elected politicians to pay for other government system solution is another story.
Pointing fingers is not helping. An associate of mine, when confronted with a problem that needed solving, wisely said: "it's not important who caused the problem, all we should care about now is the remedy."
When you look at our current financial crisis, with a modified Medicare and Medicaid universal medicine approach, other entitlements bleeding us, Social Security virtually bankrupt, and the political mismanagement of the country's tax funds clearly obvious, I cannot agree that a major socialized healthcare upgrade with any other increase in entitlement programs or defense spending is feasible.
We have been beating the same and different political solution drums since FDR's presidency. It's time for the polarizing bickering to stop and for fresh, bi-partisan, real solutions/ideas to be introduced. Maybe we should be seriously asking the best and brightest medical experts and financial planning pros what they think?
Today, we are virtually driving this country over a cliff.
This is incredibly enlightening and so straightforward, thank you! The way racism has galvanized and shaped every aspect of this country is just so tragic it's nearly unfathomable.
Using those kinds of demonizing statements about those that don’t agree with your opinions implicate you as a racist. Don’t you get it? Examining welfare and entitlement rolls to make needed adjustments, especially when identifying those that are abusing the systems, is the responsible thing for grownups to do.
Brilliant summary. As a UK doc, I read this with horror. It’s as if Slavery continues to define America. Keep up the good work!
This video has new ideas to win Medicare for All in the U.S. Concentrated and thorough. It wins the debate against market fundamentalism. Part of a graphic cartoon series that rewrites economics to include non-money social organizations. It has lots of applications.
https://www.youtube.com/watch?v=_-3CSl7yo_I
We need single payer, not Medicare for all. The way Medicare is structured now you still need to choose which (private) insurance company administers your plan, and you’re still on the hook for what it doesn’t cover. That’s not how universal care is in other western countries.
I agree, what we need is single-payer, as the video shows. For some reason, in the United States this is called Medicare for All.
It's just a phrase. But Medicare is so convoluted now. I keep telling people, that needs to be scrapped for single payer as well, full stop.
You might enjoy the YouTube animation, which makes it simple
Totally free for all is unrealistic. Socialism is a very bad and failed ideology
It's not "free". Everybody pays in, as the video shows.
So informative. If only more Americans had the attention span for reading something like this and interest in understanding how we got to where we are — and would open their minds to the possibility of truly Universal Healthcare for the USA.
Excellent summary. Another aspect of insurance coverage is the disparity in coverage for surgical and non-surgical (primary care and office-based) services. The initial commercial insurance policies began in the 1930's as Blue Cross/Blue Shield, and were influenced by surgeons and hospitals to cover inpatient procedures as they were more expensive. Primary care expenses like office visits and check-ups were largely seen as penny-ante and not worth covering. They were therefore left as out-of-pocket expenses. As a result, surgeons and hospitals were highly reimbursed. That has continued until today. The surgical procedure that lasts 30 minutes is charged and reimbursed many times more than a physician spending similar time with you in an office, even when caring for serious or complicated acute or chronic problems. Well-care and preventive services were not reimbursed at all until the ACA stipulated that. But, to this day, a procedure-based physician can rack up thousands of dollars of charges in a few hours, whereas a primary care physician could charge only a fraction of that. Of course, in our system, what is charged is only a figment of what is actually reimbursed, whether through commercial insurance, Medicare, or Medicaid. What is paid differs widely from insurance company to insurance company, and (in the case of commercial insurance) from employer contract to employer contract even within the same insurance plan. Someone without insurance, however, is potentially left to pay the whole unadulterated fee. There are those who suggest they can work aut a deal with the providers, which can include surgeons, facilities, anesthesiologists, radiologists, and lab for starters. This is next to impossible for anticipated procedures, much less for acute or chronic treatments, such as for cancer. It is a completely untenable situation and unconscionable that we, as a society, tolerate that.
Thanks for the detailed rundown. You covered a lot of ground, but there's something brewing now that's the next chapter--a divide caused by computers. Older people have harder brains that can make it impossible to keep plowing through all the blocks maintained by customer service chatbots, which are commonplace now for doctors and insurance companies. Even a telehealth visit requires computer knowledge to access. I had a scream fest a few months ago when I finally reached a human being at UHC. He said he was used to it by now. My doctor doesn't even send out lab results, claiming that they need to secure my privacy by using their website with all the pass codes and verification questions. It's agonizing for me to do all this, but when I call the front desk instead, I'm met with irritation that they don't have time to do this with all their patients. It's pitiful! We need to put humanity--not the government or chatbots--back In control of health care.