On July 30, 1965, at the Harry S. Truman Presidential Library in Independence, Missouri, former President Harry S. Truman and his wife, former First Lady Bess Truman, became the first recipients of the new Medicare health insurance program. President Lyndon Johnson and the U.S. Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history and Medicaid for those whose incomes were below specific levels.

Medicare was a momentous act because it provided new health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 59 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 administrative costs above 15 percent.

Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national, single-payer 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/profiteers and their champions in the White House and Congress.

Big insurance and Big Pharma continue opposing legislation for the new Medicare for All because these resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. 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.

WEALTH ADDICTION OF BIG HEALTH INSURANCE/BIG PHARMA/CONGRESSIONAL PROFITEERING COMPLEX:

“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 net effect is to injure others because it is adversarial/harmful to society as a whole.

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 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.

ABC News Video: “What to know about Project 2025”

PROFITEERING SURVEY FROM GOVERNMENT PROGRAMS: (data from ” BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets”, Wendall Potter,HEALTH CARE-uncovered,02/23/2023)

1). Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.

2). The for-profits now control more than 80% of the national PBM market and more than 70% of the Medicare Advantage market.

3). In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.

4). 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

5). More than 90% of health-plan revenues at three of the companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular.

6). Enrollment in government-funded programs increased by 261% in 10 years; by contrast commercial enrollment increased by just 10% over the past decade.

7). Commercial enrollment actually declined at both UnitedHealth and Humana.

8). 85% of Humana’s health-plan members are in government-funded programs; at Centene, it is 88%, and at Molina, it is 94%.

9). The big insurers now manage most states’ Medicaid programs – and make billions of dollars for shareholders doing so – but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders.

10). This is especially apparent when you see that the Big Seven’s combined revenues from taxpayer-supported programs grew 500%, from $116.3 billion in 2012 to $577 billion in 2022.

11). Changes in health-plan enrollment over the past decade show how dramatic this shift has been. Between 2012 and 2022
enrollment in the companies’ private commercial plans increased by 10%, from 85.1 million in 2012 to 93.8 million in 2022.

12). By comparison, growth in enrollment in taxpayer-supported government programs increased 261%, from 27 million in 2012 to 70.4 million in 2022.

13). Within that category, Medicare Advantage enrollment among the Big Seven increased 252%, from 7.8 million in 2012 to 19.7 million in 2022.

14). Nationwide, enrollment in Medicare Advantage plans increased to 28.4 million in 2022 (and to 30 million this year). That means that the Big Seven for-profit companies control more than 70% of the Medicare Advantage market.

MEANWHILE, AS BIG INSURANCE THRIVES:(data from Potter)

**27.5 million people remain uninsured in the United States. Up to 14 million more will lose their Medicaid coverage once the pandemic emergency period ends later this year.

**100 million of us – almost one of every three people in this country – now have medical debt.

**In 2023, U.S. families can be on the hook for up to $18,200 in out-of-pocket requirements before their coverage kicks in, up 43% since 2014 when it was $12,700.

**44% of people in the United States who purchased coverage through the individual market and (ACA) marketplaces were underinsured or functionally uninsured.

**46% of those surveyed said they had skipped or delayed care because of the cost.

**42% said they had problems paying medical bills or were paying off medical debt.

**Half (49%) said they would be unable to pay an unexpected medical bill within 30 days, including 68% of adults with low income,

**69% of Black adults, and 63% of Latino/Hispanic adults.

**In 2021, about $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That’s not surprising when you realize that in the United States, even people with insurance all too often feel they have no choice but to beg for money from strangers to get the care they or a loved one needs.

**62% of bankruptcies are related to medical costs.

**Even as we spend about $4.5 trillion on health care a year, Americans are now dying younger than people in other wealthy countries.

**Life expectancy in the United States actually decreased by 2.8 years between 2014 and 2021, erasing all gains since 1996, according to the Centers for Disease Control and Prevention.

WENDALL POTTER CONCLUDES:
“The companies that comprise Big Insurance are vastly different from what they were just 10 years ago, but policymakers, regulators, employers, and the media have so far shown scant interest in putting their business practices under the microscope. Changes in federal law, including the Medicare Modernization Act of 2003, which created the lucrative Medicare Advantage market, and the Affordable Care Act of 2010, which gave insurers the green light to increase out-of-pocket requirements annually and restrict access to care in other ways, opened the Treasury and Medicare Trust Fund to Big Insurance. In addition, regulators have allowed almost all of their proposed acquisitions to go forward, which has created the behemoths they are today. CVS/Health is now the 4th largest company on the Fortune 500 list of American companies. UnitedHealth Group is now No. 5 – and all the others are climbing toward the top 10”

OPPOSING MEDICARE BY PRIVATIZING PUBLIC SERVICES:

The U.S. Congress/government permits private health insurance companies to exact large profit from its cItizens, Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

Fully backed by Wall Street, the for- profit, private insurance industry thoroughly dominates our national health insurance system and defines the basic concept and purpose of health insurance . 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 addictive 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 .

INCREASED CORPORATE POWER/PRIVATIZATION OVER PUBLIC RESOURCES:

A new report from OXFAM, 01/24/24, “Inequality. Inc.”, describes how “around the world, corporate power is relentlessly pushing into the public sector, commodifying and segregating access to vital services such as education, water and healthcare, often while enjoying massive, taxpayer- backed profits.This can gut governments’ ability to deliver the type of high-quality, universal public services that can reduce inequality.

The stakes are huge. Essential services constitute trillion- dollar industries and immense opportunities for generating profit and wealth for rich shareholders. The World Bank and other development finance actors have prioritized private service provision, effectively treating basic services as asset classes and using public money to guarantee corporate returns rather than human rights. Private equity firms are snapping up everything from water systems to healthcare providers and nursing homes, amid a litany of concerns about poor and even tragic outcomes”.

OXFAMS “inequality Inc.” report further warns that ”privatization often entails giving corporations control over significant areas of policymaking, as well as access to public resources and capacity that could otherwise be dedicated to providing universal services and reducing inequality. Despite the promotion of privatization as a cost-saving measure, many contemporary arrangements such as PPPs and outsourcing can be highly costly to the state and require taxpayers to guarantee private sector profits. The fiscal risks of PPPs are particularly extreme, earning them the nickname ‘budgetary timebombs’. That such arrangements often place a high burden on public coffers and routinely cost more than public delivery undermines arguments that privatization is necessary because the public sector lacks sufficient resources.

Institutional investors are turning to PPPs and other forms, (eg., Medicare Advantage, ACOs) of privatized services to generate stable returns. Major development agencies and institutions, many of which have adopted policies that prioritize private provision of services, have found common ground with investors by embracing approaches that ‘de-risk’ such arrangements by shifting financial risk from the private to the public sector. This new ‘Wall Street Consensus’ reframes the ‘Washington Consensus’ in the language of contemporary development speak, and envisions the transformation of basic services such as education, healthcare and water into financial assets backed by public resources”.

STRATEGY OF PRIVATE INSURANCE INDUSTRY:

To protect and enhance high profits by opposing improved Medicare for All 2024, the private health insurance industry has mounted a huge campaign using myths, scare and fear tactics ever since ‘Obamacare’, the Affordable Care Act (ACA), was enacted in March, 2010. The U.S. health insurance industry lobbied Congress hard at that time to enact a requirement that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

FEAR: The expedient health insurance industry seeks to protect high profits using scare/fear tactics against new and improved Medicare for All 2024 legislation. One tactic deliberately confuses the public by not telling individuals what would change if their private insurance is replaced by the new Medicare for All health insurance program. Lack of specificity and avoidance behavior promotes confusion, misunderstanding and great fear because it conflates loss of private health insurance with loss of their own physicians, other health professionals and hospitals. The for-profit health insurance industry knows full well that people are most interested in keeping their own doctors and that the new Medicare for All 2024 does not interfere with that. By conflating private health insurance with the direct provision of medical treatment itself, many patients are mislead into thinking they could lose all their health professionals. Fortunately, once folks understand that losing their expensive, for-profit private insurance plans is the only thing that will change, support for Medicare for All sharply increases. The huge profits of Big Insurance and Big Pharma are threatened once folks become aware of this tactic.

SOCIALIZED MEDICINE: Another industry scare tactic is to stoke public fear and confusion by conflating the “socialized medicine” label with single-payer, “socialized (public) health insurance”. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. The U.S. Veterans Administration is an example. In contrast, most European countries, Canada, Australia and Japan have ‘socialized health insurance’, not ‘socialized medicine’. The term “socialized medicine” is often used by the private insurance industry and politicians to manufacture frightening images of government bureaucratic interference in medical care. In countries with socialized health insurance, health and mental health professionals and patients often have more clinical freedom. This is in sharp contrast to the U.S., where private health insurance bureaucrats attempt to direct/interfere with care .

Manufactured confusion and fear of socialism by the health insurance industry and their political spokesmen impede the public’s ability to differentiate and thereby reduce support for Medicare for All . This allows the private health industry to successfully maintain control of the U.S. health care system for its own profitable purposes.

SEE “PLAYING THE ACE OF FEAR CARD” IN MMT SECTION BELOW: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A.

PREJUDICE AGAINST GOVERNMENT: Opposition to Medicare for All is also based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in the mid-1960s. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.

Unfortunately many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly showed how our economic system failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services. No greater disconnect exists between the public good and private interests than in the U.S. system of for-profit health insurance. Using dark money, Big Insurance and Big Pharma are very powerful private interests that have shaped public policy in national health insurance and public health for the past 40 years.

U.S. SUPREME COURT: Strong support for the U.S.Supreme Court, ‘Citizens United’ decision, by unaccountable/unregulated large Big Insurance and Big Pharma corporations and ultra-wealthy individuals/families. is based on their Machiavellian understanding of the purpose of dark money in politics: to use dark money to change political outcomes to favor themselves, the 001% oligarchs and becomes a threat to democracy because its source is not made public. Dark money is corruption that erodes confidence and trust in local, state and national government and in both major political parties. It’s used to throw referendums and elections from which can come many of today’s social, economic, public health, mental health and environmental problems. Dark money is used to hide conflicts of interests and further enhance self promotion with bogus scientific controversies, fake news and fake grassroots campaigns.

REDUCE GOVERNMENT CAPACITY TO RESPOND: To reduce governments capacity to respond to public health problems/environmental crises such as Covid-19, single-payer national health insurance and other social services, these companies fund right-wing think tanks to attack public health/social policy. By presenting government as a threat to freedom, the distinguished writer for The Guardian(U.K.),George Monbiot, described how right wing groups and big business create a narrative by reframing responsible government as the “nanny state”, the “health police” and “elf ‘n’ safety zealots”. They dismiss scientific findings and predictions as “unfounded fears”, “risk aversion” and “scaremongering”. Public protections are recast as “red tape”, “interference” and “state control”.

Although some have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. The only thing that exceeds government inefficiency is the private health insurance industry itself. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject myths about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.

TRADITIONAL MEDICARE THREATENED BY NEW PRIVATE PROFITEERS: Private profit “Medicare Advantage” present new threat to Traditional Medicare.

WHAT IS MEDICARE ADVANTAGE? Medicare Advantage is a managed care program offering private health insurance plans as options to replace traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used ,such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The deceptively innocent hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Disadvantage”is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

Dismantling Medicare with Medicare Advantage: Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

Denying Treatment: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

Deceiving Patients and Taxpayers: Reports from journalists, researchers, and government agencies have shown that health insurance companies like UnitedHealth and Cigna overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens tax dollars for conditions they aren’t even treating.

Bottom Line: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

Terminate Medicare Advantage: Physicians for a National Health Program (PNHP), concludes tnat the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

MODERN MONETARY THEORY- MMT AND MEDICARE FOR ALL:

The US healthcare system is notorious for its high costs and below par outcomes. We already spend 18 percent of GDP on healthcare, and that is projected to reach 20 percent soon. This is approximately twice as much as our peers, other rich, developed, capitalist countries with no discernably better health outcomes (and even worse on a number of measures). Our excessive spending when compared to that of our peers can be attributed to the use of for-profit private insurance to pay for healthcare, higher pharmaceutical and provider costs, and higher administrative costs. Study after study has confirmed that prices and administrative costs in the US are out of line with those in the rest of the developed world, and especially compared to countries that have some type of a single-payer.

The Ace of Fear Card: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. Economists at the Levy Institute of Economics of Bard College alert us how opponents of M4A typically warn of the high financial costs, and hence of prospective dangerously high government deficits. From the perspective of Modern Money Theory (MMT) however, these fear mongering arguments are beside the point and are a myth. A sovereign government’s finances are not like the budgeting by households and firms; the government uses the monetary system to mobilize the nation’s real resources and to move some of them to pursuit of public purposes, such as social welfare programs, public health, public health insurances, Medicare for All, etc. Whatever the financial costs, we already have a financial system that can handle them.

Distinguished Professor of Economics L. Randall Wray, Levy Economic Institute of Bard College and Yeva Nersisyan, Associate Professor of Economics at Franklin and Marshall College, Lancaster, PA, maintain that :“a sovereign government like the USA is not financially constrained; it spends by fiat, i.e., printing money, and/or through creating electronic computer entries in bank accounts and can neither run out of them nor save them for the future. What should constrain the spending of a sovereign government is the nation’s available real resources. Excessive spending, therefore, creates problems not in terms of higher government deficits and debt, but in terms of true inflation. Similarly, taxes are used not to finance government spending, but to withdraw demand from the economy, creating space for government spending to move resources to the public sector without causing inflation”.

Professor Wray notes that“the adoption of a single-payer system (replacing for-profit private insurers) would significantly reduce the resources devoted to our unusual way of paying for healthcare. It would eliminate the private insurance sector’s participation, reduce employers’ costs of administering healthcare plans, reduce the costs incurred by doctors and hospitals due to billing insurers as well as pursuing patients for uncovered costs, lower the costs of appealing denials, and cut costs associated with patients avoiding early treatment of diseases (because of the actual or expected out-of-pocket costs) that become chronic and expensive maladies. If M4A could control prices and lower administrative costs, we could spend significantly less on healthcare than we do currently, while expanding coverage to everyone. All else equal, if we were able to reduce our spending on healthcare to the level of our peers, we would be creating deflationary pressures, not inflation”.

Nersisyan and Wray estimate that “in the short term M4A could save about 3.7 percent of GDP while providing healthcare to the whole population. Even if we lowered healthcare spending by 3.7 percent of GDP, we would still be spending more on healthcare than all of our peers. “We believe our estimates are just the savings possible in the short term. In the long term, increased use of healthcare could reduce spending on chronic diseases. With universal access, cost controls, and elimination of a highly inefficient private insurance system, the single-payer system could shrink US spending on healthcare by much more, bringing us in line with other rich countries at about 10 percent of GDP.”

“Some will object that the savings largely accrue to the private sector, while the government will face additional costs. While it is true that the distribution of spending between the private and public sectors would change”, economist Wray assures us that. “there is nothing about government spending that necessarily makes it more inflationary than private spending. If private spending on healthcare costs falls by more than the increased government spending, the movement to single payer will be deflationary, not inflationary. Only a net increase in demand for resources would be inflationary.”

CONCLUSIONS:
The common good of our nation is ignored because the U.S. subscribes to a private business model for health insurance that defines insurers as commercial entities. Private health insurers maximize profits by limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money. Under this business model of health insurance, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored. Excluding many in the middle class, the poor, the aged, the disabled and the mentally ill is sound business practice policy since it maximizes profit.

Today we still have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians and other health/mental health professionals because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. For example, statistics show that nearly 41% of adults (or nearly 100 million) are forced to get a medical loan to cover their health-care debt because they don’t have enough savings, and nearly 12% of them owe more than $10,000. Also, these data don’t take into account such forms of debt like credit cards or installments offered. When millions lost their jobs due to Covid-19, the dangers of connecting health insurance to employment also became painfully clear. Health insurance must not be tied to employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as a single-payer, health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Wall Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing full health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The USA is a country where health insurance for medical and mental health care 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 one of the the greatest health systems in the world, but only for those who can afford it. We must support the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation.

Let’s never forget that universal Medicare for All is a solid investment, not an expense, in and for 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 59 year 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 all 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/crowd. Professor of Economics L. Randall Wray notes that the US healthcare system still has significant gaps in coverage—all while facing the highest healthcare bill in the world. Dr. Wray convincingly argues that the underlying challenge for a system based on private, for-profit insurance is that basic healthcare is not an insurable expense. He concludes that It is time to abandon the current, overly complex and expensive payments system and reconsider single payer for all. Social Security and Medicare provide a model for reform.

Today, the very best way forward is, without ambivalence, avoidance behavior or any further delay, to immediately implement 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 long overdue reform.

President Harry S. Truman once said,”There is nothing new in the world except the history you do not know”. Attempts to transfer ownership and control of economic programs/services/financial resources from the government into private, greedy hands have existed in many societies for thousands of years. Father Lactantius, c.250-c.326, an early Christian author and advisor to the Roman Emperor Constantine I, wrote in “ The Divine Institute”, a timely piece about Roman society that well applies to 21st century USA society:

In order to enslave the many, the greedy began to appropriate and accumulate the necessities of life and keep them tightly closed up so that they might keep these bounties for themselves. They did this not for humanity’s sake which was not in them at all but to rake up all things and products of their greed and avarice. In the name of justice, they made unfair and unjust laws to sanction their thefts and avarice against the power of the multitude. In this way they ruled as much by authority as by strength of arms and overt evil.

LINKS: Full text U.S.House of Representatives – H.R. 3421

Full text U.S. Senate – S. 1655

In a recent 5-4 decision, the U.S.Supreme Court rejected Purdue Pharma’s controversial bankruptcy settlement that protected the billionaire Sackler family from further liability for the opioid epidemic in the USA. The Harrington v. Purdue Pharma SCOTUS case blocks a ruling by a federal bankruptcy court in New York that was first rejected by a district court but later appealed before the US Department of Justice finally challenged it before the Supreme Court.

The original deal allowed Purdue, the Sackler owned pharmaceutical company behind the prescription opioid OxyContin, to restructure and protect Sackler billionaires without requiring them to declare personal bankruptcy. From the huge fortune they made from OxyContin the Sacklers agreed to contribute $6bn to the settlement from the vast fortune they made from OxyContin plus relinquish ownership in Purdue Pharma.

In a bankruptcy filing, a New York Times article,”The Sacklers Could Get Away With It,” reported, “debts are forgiven — “discharged,” in legal terms — after debtors commit the full value of all of their assets (with the exception of certain types of property, like a primary home) to pay their creditors. That is not, however, what the Sacklers want, and indeed the members of the family have not filed for bankruptcy themselves. What they proposed instead is to be shielded from all OxyContin lawsuits, protecting their tremendous personal wealth from victims’ claims against them. What’s more, a full liability release would provide the Sacklers with more immunity than they could ever obtain in a personal bankruptcy filing, which would not protect them from legal action for fraud, willful and malicious personal injury, or from punitive damages”.

CNBC Video: “Supreme Court blocks Purdue Pharma bankruptcy settlement”

By using the bankruptcy agreement, Purdue/Sackler wanted to resolve lawsuits, including those filed by state and local governments, alleging that Purdue Pharma caused a crisis killing half a million Americans when it asserted that OxyContin was non-addictive while it promoted massive over-prescribing via pill mills. Elizabeth Prelogar, U.S. solicitor general, argued that “the release of the Sacklers from future liability is not authorized by the bankruptcy code and constitutes an abuse of the bankruptcy system.”

PARAGONS OF GOOD WORKS

With charitable foundations on both sides of the Atlantic, the Sacklers, who are based in New York, have donated millions to the arts and sponsored faculty at Yale and many other universities. In each case, the family’s name is displayed prominently as the benefactor. Forbes listed the collective estimated worth of the 20 core family members at $14bn in 2015, partly derived from $35bn in sales revenue from OxyContin between 1995 and 2015. The name Sackler is displayed in the forecourt at the Victoria and Albert Museum in London and was noted in the Sackler Gallery at the Serpentine in 2013. The ancient Egyptian Temple of Dendur has a Sackler Wing in the Metropolitan Museum in New York. The Sackler Centre for Arts Education at the Guggenheim and many other arts institutions around the world have galleries or wings named after the Sackler family.

But few know 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.

PROFIT, PLUNDER, DEATH

The untimely overdosing death of famous singer Tom Petty can be traced to the Sackler family and Purdue Pharma according to many addiction specialists.The family of Tom Petty said that the singer’s death was caused by an accidental overdose with a cocktail of prescription drugs and pain pills, including oxycodone and fentanyl. Although prescriptions for opioids fell in response to the crisis, Americans didn’t shake the habit or seek rehab; they turned to heroin instead. Four out of five people in the US who try heroin today started with prescription painkillers, according to the American Society of Addiction Medicine. Alarmingly, street heroin started being secretly cut with the dangerous synthetic opioid fentanyl.

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. Legal experts, the NYT writes, conclude that “allowing the bankruptcy court to impose a global OxyContin settlement may at first appear to be an efficient way to resolve litigation that could drag on for years, the Sacklers will benefit from this expediency at the expense of victims. At stake is whether there will ever be a fair assessment of responsibility for America’s deadly prescription drug epidemic. Protection from all OxyContin liability for the Sackler family would be an end-run around the reckoning that justice requires”.

Just like all Big Pharma corporations, Sackler/Purdue pharma are dedicated to the bottom line of maximization of profit; everything else is of insignificant value compared to this. Their large and aggressive marketing campaign to sell the supposedly ‘safe’ pain drug OxyContin appears to have disregarded all boundaries and turned this dangerous drug into immense profit for themselves. There are always among us those self-serving and toxic individual and corporate predators who regard democracy/government regulation/community as an obstacle to their greed and avarice. The opioid epidemic is now burgeoning in the U.S. with millions of ruined lives, individuals, families. The Sacklers want to retreat back into their money and vast profiteering, and let other people clean up and pay for the overall and inevitable long-term suffering, death and destruction they allegedly created.

The SCOTUS decision recognizes plaintiff’s due process rights and the ability of plaintiffs to sue the Sacklers. The Sacklers, they argued, should not be rewarded for their contribution because they “created the need for that money” by taking it out of the company in the first place, setting up the situation where they would be protected from lawsuits “by piggybacking on the bankruptcy of their company.” In agreement with. SCOTUS, U.S. Attorney General Merrick B. Garland said in a statement, “The bankruptcy court did not have the authority to deprive victims of the opioid crisis of their right to sue the Sackler family.”

1). Medicare Advantage (MA), the privately-administered version of Traditional Medicare (TM), is causing significant harm to America’s patients, providers, and health

2). Political support for the private health insurance industry and Medicare Advantage exists because our government permits private health insurance companies to exact large profit from its citizens as Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches.

3). High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

4). The recent JAMA IM article, “Less Care at Higher Cost — The Medicare Advantage Paradox,” details how private insurers have exploited loopholes in Medicare’s complex payment rules for decades to extract overpayments.

5). The federal government pays insurance companies a lump sum for each patient its Medicare Advantage plans sign up, with the amount of the lump sum based on enrollees’ “risk scores,” which the government calculates from diagnosis codes that the plans submit. The risk scores are meant to predict how much care enrollees will need.

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6). Research has repeatedly shown that the private plans game the system by cherry-picking the healthiest seniors to enroll, and then exaggerating how sick they are by so-called “upcoding,” i.e. padding enrollees’ medical charts with long lists of diagnosis codes that do not require specific treatment, jacking-up the risk score and hence the government’s lump-sum payment to the plan.

7). According to the JAMA IM article, privatized Medicare plans often refuse to cover providers that high-cost patients need, such as specialized cancer hospitals, mental health professionals and psychiatrists; restrict access to drugs and treatments; and pressure patients and doctors to curtail expensive care.

8). As a result, the privatized plans spend, on average, 9% less on medical services (including the extra benefits they promise) than traditional Medicare spends for comparable patients.

9).“Medicare Advantage plans have, in effect, stolen hundreds of billions from taxpayers,” says David Himmelstein, a study co-author who is a Distinguished Professor at CUNY’s Hunter College, a lecturer at Harvard Medical School, and a Research Associate at Public Citizen. “And the private plans’ schemes also raise seniors’ Part B Medicare premiums. Even seniors who don’t choose to enroll in Medicare Advantage are subsidizing the private plans’ profits.”

10). Medicare was created to serve the people, and MA betrays that promise. We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and put an end to these egregious harms.

By never mentioning the potentially deadly side effects of Medicare Advantage plans, insurers’ pitchmen—like ‘Broadway Joe’ Namath, Danny Glover and others—mislead everyone about what Medicare Advantage enrollees are really getting into . Leaving out important (Medicare Advantage) details we better know about before we sign on the dotted line is a recipe for disaster.

WHAT IS MEDICARE ADVANTAGE ?

Medicare Advantage is a program offering private health insurance industry plans as options to replace public traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending, and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used, such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Dis-Advantage” is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

HOW MEDICARE ADVANTAGE PLANS DIFFER FROM TRADITIONAL MEDICARE:

* They are owned and operated by for-profit, private insurance corporations;
* Unlike traditional Medicare, Medicare Advantage plans often refuse to pay for treatments and medications physicians prescribe;
* Unlike traditional Medicare, many physicians, other healthcare professionals, and hospitals will be off-limits to patients because Medicare Advantage companies create their own proprietary and often skimpy, managed care type “networks” of healthcare providers;
* If patients go out of network, they could be on the hook for thousands of dollars out of their own pocket; and
* They likely will have to pay extra—often a lot extra—for some of those extra benefits.

OVERCHARGING BY MEDICARE ADVANTAGE PLANS:

A). To put the sheer magnitude of overcharging in MA in perspective, a CBO analysis of a 2019 bill proposing to add dental, hearing, and vision benefits to Medicare and Medicaid estimated that in the most expensive year of its implementation, these benefits would cost a combined $84 billion.

B). Even by minimum estimates, private insurers receive more than enough surplus money to provide critically needed benefits to all Medicare and Medicaid beneficiaries.

C). Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment.

D). While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve “improved Medicare for All.”

ARE YOU CONSIDERING ENROLLMENT IN A MEDICARE ADVANTAGE PLAN?
! C A V E A T E M P T O R – B U Y E R. B E W A R E !

1). DON’T DO IT ! Stay with (or return) to traditional Medicare and buy a supplemental Medigap policy, because unfortunately, traditional Medicare has some big holes in it.

2). The trouble with Medicare Advantage plans is they look good while you’re healthy. But when you get sick, odds are high they will deny you.

3). Beware of another important factor: The door will have been slammed behind you if you have been in Medicare Advantage for more than six months and then decide you want to return /re-enroll in traditional Medicare.

4). With the exception of four states in this country, if you’re in Medicare Advantage for more than six months and decide you want to go back, and then buy a supplemental coverage, the insurance companies that sell you supplemental coverage can turn you down for supplemental coverage..

5) If they don’t like the look of your pre-existing conditions, they can also charge you a lot more money.

6). You need to make this decision in the next six months enrollment timeframe if you are still fairly new to MA.

7) The basic recommendation to everyone is: don’t even think about enrolling in Medicare Advantage in the first place!

DON’T ALLOW PRIVATE HEALTH INSURANCE INDUSTRY TO DISMANTLE TRADITIONAL MEDICARE: REJECT MA !

DISMANTLING MEDICARE WITH MEDICARE ADVANTAGE: Over 50% of Medicare beneficiaries have signed up and now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

DENYING TREATMENT: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

DECEIVING PATIENTS AND TAXPAYERS: Reports from journalists, researchers, and government agencies have shown that health insurance companies like United Health and Cigna overcharge Medicare by giving patients exaggerated,upcoded or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens’ tax dollars for conditions they aren’t even treating.

Image by Arvi Pandey from Pixabay

BOTTOM LINE: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: Their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

TERMINATE MEDICARE ADVANTAGE: Physicians for a National Health Program (PNHP), concludes that the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

BIG INSURANCE MOTIVATED BY PROFIT:

Highly respected healthcare reform advocate, Wendall Potter, reports on the alarming scope of profiteering by Medicare Advantage plans:

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.

TURNING PUBLIC MONEY INTO A BONANZA OF PRIVATE RICHES:

for the”BigInsurance/BigPharma/Congressional Complex”

Political support for private health insurance industry and Medicare Advantage exists because our government permits private health insurance companies to exact large profit from its citizens as Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want. It’s no wonder so many beholden members of Congress want to protect the interests of their donors, Big Insurance and Big Pharma, industries that spent $371 million on lobbying in 2017.

The website/blog The Lever reported that The Better Medicare Alliance, an advocacy group for Medicare Advantage plans, spent $570,000 lobbying Congress in the first quarter of this year, nearly double the $330,000 spent in the prior quarter. All told, the four major publicly traded health insurance companies that operate Medicare Advantage plans, as well as the insurance lobby America’s Health Insurance Plans, spent nearly $19 million on federal lobbying in the first quarter of 2023, a 66% increase from the prior quarter, according to a Lever analysis of data from OpenSecrets.

The USA is a country where health insurance for medical and mental healthcare is a function of socioeconomic status. Everyone knows that this inhumane system should have been corrected long ago. We must immediately end our moral crime of having one of the greatest health system in the world, but only for those who can afford it. We must support the common principles that healthcare is a human right, must be free from corporate profit, and must be achieved through national legislation.

Let’s never forget that universal Medicare for All is a solid investment in, not a cost for, all citizens of our country by simply promoting a social service for universal access to affordable healthcare insurance for all. Aren’t we a society that cares enough to see that everyone receive the healthcare 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 like Medicare Advantage. Insist on real health insurance reform essential for individuals and families.

Contact your legislators asking them to oppose and end Medicare Advantage plans immediately. Most importantly, ask them to strongly 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.

“In just a few weeks”, says Potter, “we’re once again going to be bombarded with ads featuring healthy and happy-looking seniors playing tennis and telling us how wonderful their Medicare Advantage plan is and how much of a no-brainer it is to shun traditional Medicare and opt instead for a plan operated by a big corporation like Humana and Cigna. We’ll hear insurers’ shills tell us about the extra benefits we’ll get, like discounts on gym memberships, $900. for groceries and some coverage for dental, vision and hearing. They’re short on details of course, and we never hear that coverage for those extra things can be pretty meager”.

Potter adds that ‘We also never hear about the potentially deadly side effects of Medicare Advantage plans. Make sure that insurers’ pitchmen–like Broadway Joe Namath–are more forthcoming about what we’ll be getting ourselves into if we do as he suggests. Why should he be allowed to leave out important (Medicare Advantage) details we better know about before we sign on the dotted line?”

HOW MEDICARE ADVANTAGE PLANS DIFFER FROM TRADITIONAL MEDICARE:

* They are owned and operated by for-profit, private insurance corporations.
* Unlike traditional Medicare, Medicare Advantage plans often refuse to pay for treatments and medications physicians prescribe.
* Unlike traditional Medicare, many physicians, other health care professionals and hospitals will be off-limits to patients because Medicare Advantage companies create their own proprietary and often skimpy “networks” of health care providers.
* If patients go out of network, they could be on the hook for thousands of dollars out of their own pocket.
* And likely will have to pay extra–often a lot extra–for some of those extra benefits.

PRIVATE HEALTH INSURANCE INDUSTRY DOMINATES:

The for- profit, private insurance industry thoroughly dominates our national health insurance system and defines the basic concept and purpose of health insurance . The U.S. private business model of health insurance defines insurers as commercial entities, and 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 .

POLITICAL SUPPORT FOR PRIVATE HEALTH INSURANCE INDUSTRY:

Because our government permits private health insurance companies to exact large profit from its cItizens, Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want. It’s no wonder so many beholden members of Congress want to protect the interests of their donors, Big Insurance and Big Pharma, industries that spent $371 million on lobbying in 2017.

The website/blog “The Lever”, reported that “The Better Medicare Alliance, an advocacy group for Medicare Advantage plans, spent $570,000 lobbying Congress in the first quarter of this year, nearly double the $330,000 spent in the prior quarter. All told, the four major publicly traded health insurance companies that operate Medicare Advantage plans, as well as the insurance lobby America’s Health Insurance Plans, spent nearly $19 million on federal lobbying in the first quarter of 2023, a 66 percent increase from the prior quarter, according to a Lever analysis of data from OpenSecrets”.

U.S. political and oligarch support for privatization of health insurance is grounded in the philosophy espoused by University of Chicago economist, the late 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”.

In contrast, classical economist Michael Hudson notes that 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”.

BIG INSURANCE PROFITEERING STATISTICS- Wendall Potter reports on recent profiteering by Medicare Advantage plans:

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.

VOTERS DON’T MATTER:

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”.

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”.

TRADITIONAL MEDICARE THREATENED BY NEW PRIVATE PROFITEERS: Private profit “MEDICARE ADVANTAGE” and “REACH” plans present new threats to Traditional Medicare.

1). WHAT IS MEDICARE ADVANTAGE? Medicare Advantage is a program offering private health insurance plans as options to replace traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used ,such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Disadvantage”is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

DISMANTLING MEDICARE WITH MEDICARE ADVANTAGE: Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

DENYING TREATMENT: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

DECEIVING PATIENTS AND TAXPAYERS: Reports from journalists, researchers, and government agencies have shown that health insurance companies like UnitedHealth and Cigna overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens tax dollars for conditions they aren’t even treating.

BOTTOM LINE: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

TERMINATE MEDICARE ADVANTAGE: Physicians for a National Health Program (PNHP), concludes tnat the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

2). WHAT IS A ‘DIRECT CONTRACTING ENTITY’ (DCE) AND ‘REACH’? This program hands traditional Medicare to Wall Street by inserting a profit-seeking middlemen in Traditional Medicare to “manage” care for seniors and people with disabilities, allowing companies to keep up to 40% of what they don’t spend on care as overhead and profit. Beneficiaries are assigned. without their knowledge or consent. automatically to a ‘Direct Contracting Entity’ if their primary care physician has joined a DCE. The only way for beneficiaries to opt out is to find a different primary care physician.

PROFITS OVER PATIENT CARE : Profits are put ahead of patient care by virtually any type of company to be a Direct Contracting/REACH middleman, including commercial insurance companies, private equity investment firms, and other Wall Street profiteers. DCE’s expand profiteering to all of Medicare. Direct Contracting companies have already enrolled 1.8 million beneficiaries, with plans to take over all of Traditional Medicare in the next decade.

TERMINATE DCE’S and REACH: It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive insurance business model, and the DCE/REACH program should be terminated.

FREE OURSELVES FROM PROFITEERS:

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Wall Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing full health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. We must support the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation.

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.

Contact your legislators asking them to oppose and end Medicare Advantage, DCE’s and REACH plans . Most importantly, ask them to strongly 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.

Medicare was a momentous act because it provided new 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 administrative costs above 15 percent.

Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national, single-payer 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/profiteers   and their champions in the White House and Congress.

MEDICARE STRONGLY OPPOSED BY PRIVATE INSURANCE INDUSTRY:

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 .

Because our government permits private health insurance companies to exact large profit from its citizens, Wall Street banks and investors who back Big Insurance turn public money into private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

TACTICS AND STRATEGY OF PRIVATE INSURANCE INDUSTRY:

To protect and enhance high profits by opposing improved Medicare for All 2023, the private health insurance industry has mounted a huge campaign using myths, scare and fear tactics ever since ‘Obamacare’, the Affordable Care Act (ACA), was enacted in March, 2010. The U.S. health insurance industry lobbied Congress hard at that time to enact a requirement that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

FEAR: The expedient health insurance industry seeks to protect high profits using scare/fear tactics against new and improved Medicare for All 2023 legislation. One tactic deliberately confuses the public by not honestly telling individuals what would change if their private insurance is replaced by the new Medicare for All health insurance program. Lack of specificity and avoidance behavior promotes confusion, misunderstanding and great fear because it conflates loss of private health insurance with loss of their own physicians, other health professionals and hospitals. The for-profit health insurance industry knows full well that people are most interested in keeping their own doctors and that the new Medicare for All 2023 does not interfere with that. By conflating private health insurance with the direct provision of medical treatment itself, many patients are mislead into thinking they could lose all their health professionals. Fortunately, once folks understand that losing their expensive, for-profit private insurance plans is the only thing that will change, support for Medicare for All sharply increases. The huge profits of Big Insurance and Big Pharma are threatened once folks become aware of this tactic.

Another effective industry scare tactic is to stoke public fear and confusion by conflating the “socialized medicine” label with single-payer, “socialized (public) health insurance”. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. The U.S. Veterans Administration is an example. In contrast, most European countries, Canada, Australia and Japan have ‘socialized health insurance’, not ‘socialized medicine’.

SOCIALIZED MEDICINE: The term “socialized medicine” is often used by the private insurance industry and politicians to manufacture frightening images of government bureaucratic interference in medical care. In countries with socialized health insurance, health and mental health professionals and patients often have more clinical freedom. This is in sharp contrast to the U.S., where private health insurance bureaucrats attempt to direct/interfere with care.

Manufactured confusion and fear of socialism by the health insurance industry and their political spokesmen impede the public’s ability to differentiate and thereby reduce support for Medicare for All . This allows the private health industry to successfully maintain control of the U.S. health care system for its own profitable purposes.
 

SEE “PLAYING THE ACE OF FEAR CARD” IN MMT SECTION BELOW: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2023 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. 

PREJUDICE AGAINST GOVERNMENT: Opposition to Medicare for All is also based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in the mid-1960s. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.

Unfortunately many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly showed how our economic system failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services. No greater disconnect exists between the public good and private interests than in the U.S. system of for-profit health insurance. Using dark money, Big Insurance and Big Pharma are very powerful private interests that have shaped public policy in national health insurance and public health for the past 40 years.

U.S. SUPREME COURT: Strong support for the U.S.Supreme Court, ‘Citizens United’ decision, by unaccountable/unregulated large big insurance and big pharma corporations and ultra-wealthy individuals/families. is based on their Machiavellian understanding of the purpose of dark money in politics: to use dark money to change political outcomes to favor themselves, the 001% oligarchs and becomes a threat to democracy because its source is not made public. Dark money is corruption that erodes confidence and trust in local, state and national government and in both major political parties. It’s used to throw referendums and elections from which can come many of today’s social, economic, public health, mental health and environmental problems. Dark money is used to hide conflicts of interests and further enhance self promotion with bogus scientific controversies, fake news and fake grassroots campaigns.

REDUCE GOVERNMENT CAPACITY TO RESPOND: To reduce governments capacity to respond to public health problems/environmental crises such as Covid-19, single-payer national health insurance and other social services, these companies fund right-wing think tanks to attack public health/social policy. By presenting government as a threat to freedom, the distinguished writer for The Guardian(U.K.),George Monbiot, described how right wing groups and big business create a narrative by reframing responsible government as the “nanny state”, the “health police” and “elf ‘n’ safety zealots”. They dismiss scientific findings and predictions as “unfounded fears”, “risk aversion” and “scaremongering”. Public protections are recast as “red tape”, “interference” and “state control”.

Although some have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. The only thing that exceeds government inefficiency is the private health insurance industry itself. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject myths about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.

TRADITIONAL MEDICARE THREATENED BY NEW PRIVATE PROFITEERS: Private profit “Medicare Advantage” and “REACH” plans present new threats to Traditional Medicare.

WHAT IS MEDICARE ADVANTAGE?   Medicare Advantage is a program offering private health insurance plans as options to replace traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used ,such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare. 

In reality, “Medicare Disadvantage”is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

Dismantling Medicare with Medicare Advantage:  Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

Denying Treatment:  Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

Deceiving Patients and Taxpayers: Reports from journalists, researchers, and government agencies have shown that health insurance companies like UnitedHealth and Cigna overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens tax dollars for conditions they aren’t even treating.

Bottom Line: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

Terminate Medicare Advantage:  Physicians for a National Health Program (PNHP), concludes tnat the Center for Medicare Services (CMS) should terminate the Medicare Advantage program.  It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

WHAT IS A ‘DIRECT CONTRACTING ENTITY’ AND ‘REACH’?  This program hands traditional Medicare to Wall Street by inserting a profit-seeking middlemen in Traditional Medicare to “manage” care for seniors and people with disabilities, allowing companies to keep up to 40% of what they don’t spend on care as overhead and profit. Beneficiaries are assigned. without their knowledge or consent. automatically to a ‘Direct Contracting Entity’ if their primary care physician has joined a DCE. The only way for beneficiaries to opt out is to find a different primary care physician.

Profits Over Patient Care : Profits are put ahead of patient care by virtually any type of company to be a Direct Contracting/REACH middleman, including commercial insurance companies, private equity investment firms, and other Wall Street profiteers. DCE’s expand profiteering to all of Medicare.  Direct Contracting companies have already enrolled 1.8 million beneficiaries, with plans to take over all of Traditional Medicare in the next decade.

Terminate DCE’S and REACH:  It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive insurance business model, and the DCE/REACH program should be terminated.

MODERN MONETARY THEORY- MMT – SUPPORTS  MEDICARE FOR ALL

The US healthcare system is notorious for its high costs and below par outcomes. We already spend 18 percent of GDP on healthcare, and that is projected to reach 20 percent soon. This is approximately twice as much as our peers, other rich, developed, capitalist countries with no discernably better health outcomes (and even worse on a number of measures). Our excessive spending when compared to that of our peers can be attributed to the use of for-profit private insurance to pay for healthcare, higher pharmaceutical and provider costs, and higher administrative costs. Study after study has confirmed that prices and administrative costs in the US are out of line with those in the rest of the developed world, and especially compared to countries that have some type of a single-payer.

The ‘Ace  of  Fear’ Card:  Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2023 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. Economists at the Levy Institute of Economics of Bard College alert us how opponents of M4A typically warn of the high financial costs, and hence of prospective dangerously high government deficits. From the perspective of Modern Money Theory (MMT) however, these fear mongering arguments are beside the point and are a myth. A sovereign government’s finances are not like the budgeting by households and firms; the government uses the monetary system to mobilize the nation’s real resources and to move some of them to pursuit of public purposes, such as social welfare programs, public health, public health insurances etc. Whatever the financial costs, we already have a financial system that can handle them.

Professor of Economics L. Randall Wray, Levy Economic Institute of Bard College and Yeva Nersisyan,  Associate Professor of Economics at Franklin and Marshall College, Lancaster, PA, maintain that :“a sovereign government like the USA is not financially constrained; it spends by fiat, i.e., printing money, and/or through electronic computer entries in bank accounts and can neither run out of them nor save them for the future. What should constrain the spending of a sovereign government is the nation’s available real resources. Excessive spending, therefore, creates problems not in terms of higher government deficits and debt, but in terms of true inflation. Similarly, taxes are used not to finance government spending, but to withdraw demand from the economy, creating space for government spending to move resources to the public sector without causing inflation”.
  

“The adoption of a single-payer system (replacing for-profit private insurers) would significantly reduce the resources devoted to our unusual way of paying for healthcare. It would eliminate the private insurance sector’s participation, reduce employers’ costs of administering healthcare plans, reduce the costs incurred by doctors and hospitals due to billing insurers as well as pursuing patients for uncovered costs, lower the costs of appealing denials, and cut costs associated with patients avoiding early treatment of diseases (because of the actual or expected out-of-pocket costs) that become chronic and expensive maladies. If M4A could control prices and lower administrative costs, we could spend significantly less on healthcare than we do currently, while expanding coverage to everyone. All else equal, if we were able to reduce our spending on healthcare to the level of our peers, we would be creating deflationary pressures, not inflation”.

Nersisyan and Wray estimate that “in the short term M4A could save about 3.7 percent of GDP while providing healthcare to the whole population. Even if we lowered healthcare spending by 3.7 percent of GDP, we would still be spending more on healthcare than all of our peers. “We believe our estimates are just the savings possible in the short term. In the long term, increased use of healthcare could reduce spending on chronic diseases. With universal access, cost controls, and elimination of a highly inefficient private insurance system, the single-payer system could shrink US spending on healthcare by much more, bringing us in line with other rich countries at about 10 percent of GDP.”

“Some will object that the savings largely accrue to the private sector, while the government will face additional costs. While it is true that the distribution of spending between the private and public sectors would change, there is nothing about government spending that necessarily makes it more inflationary than private spending. If private spending on healthcare costs falls by more than the increased government spending, the movement to single payer will be deflationary, not inflationary. Only a net increase in demand for resources would be inflationary.”

Common good ignored: The U.S. subscribes to a private business model for health insurance that defines insurers as commercial entities. Private health insurers also maximize profits by limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money. Under this business model of health insurance, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored. Excluding many in the middle class, the poor, the aged, the disabled and the mentally ill is sound business practice policy since it maximizes profit.

Today we still have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians and other health professionals because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. For example, statistics show that nearly 41% of adults (or nearly 100 million) are forced to get a medical loan to cover their health-care debt because they don’t have enough savings, and nearly 12% of them owe more than $10,000. Also, these data don’t take into account such forms of debt like credit cards or installments offered. When millions lost their jobs due to Covid-19, the dangers of connecting health insurance to employment also became painfully clear. Health insurance must not be tied to employment.

Conclusions: Almost none of these problems would exist if the government, instead of the private insurers, served us as the health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Wall Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing full health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The USA is a country where health insurance for medical and mental health care 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. We must support the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation. 

 Let’s never forget that universal Medicare for All is a solid investment, not an expense, in and for 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 58 year 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/crowd.  Professor of Economics L. Randall Wray notes that the US healthcare system still has significant gaps in coverage—all while facing the highest healthcare bill in the world. Wray argues that the underlying challenge for a system based on private, for-profit insurance is that basic healthcare is not an insurable expense. He concludes that It is time to abandon the current, overly complex and expensive payments system and reconsider single payer for all. Social Security and Medicare provide a model for reform.

Today, the very best way forward is, using MMT as a guiding light, without ambivalence, avoidance behavior or any further delay, to immediately implement 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 long overdue reform.
 
LINKS: Full text   U.S.House of Representatives – H.R.  3421
 

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.

Image by Tumisu from Pixabay

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.

Reports show that states like Florida, for example, have made it almost impossible to keep up with the paperwork and remain on Medicaid. So far, over 250,000 Floridians have lost coverage. Some states aren’t interested in paying for poor people’s health care. Gov. Sarah Huckabee Sanders stated that she is increasing removal of Arkansas citizens from “government dependency”.

HEROIC JOB CREATORS VS. DESPICABLE MOOCHERS

The ”slash and burn” social and health policies of many states eager to drop Medicaid coverage comes from the old, worn out myth about “heroic job creators vs. despicable moochers”. This toxic and misleading ideology is based on discredited supply side, trickle-down, voodoo economics that have consistently failed to deliver good jobs, or recognize that government aid and investment is often a crucial lifeline. The 2017 cruel GOP tax plan, for example, made it very difficult to make the kinds of investments that would realistically put large numbers of Americans back to work in quality, good paying, secure jobs. Much needed today is a large program of infrastructure repair and renewal, enormous national investments in public health programs and single-payer national health insurances.

AYN RAND AND COMPANY

Belief that low-income Americans do not deserve a helping hand derives from the wealthy 1% private corporate business ideology, straight out of Ayn Rand, asserting that the US is a meritocracy where only the most deserving rise to the top. If you’re sick or poor, you’re on your own, and those who are more fortunate have no obligation to help. In fact, it’s immoral to demand that they help. Alarmingly, many believe the ludicrous myth that welfare recipients receiving public benefits are “takers” rather than “makers” which is untrue for the vast majority of working-age recipients.

In 2012, GOP Presidential candidate Mitt Romney and V.P. candidate Paul D. Ryan asserted that 47 % of all Americans are “takers”; that poverty relief will turn the safety net into a “hammock”; and that food stamps turn the inner city into a “culture of dependence with legions of moochers, welfare “Cadillac” queens, anchor babies, illegal immigrants”, ad nauseam. According to these derisive geniuses, removing benefits is necessary to compel the unemployed to work even if their children suffer in the process.

Corporate big business ideology says that human society is a market, and social relations are commercial transactions with a “natural hierarchy” of winners and losers. Attempts to limit competition, change social outcomes eg, estate tax issue, mandated health insurance, etc. is treated as hostile to liberty and big business interests. Unions and collective bargaining must be crushed; tax, public protection regulations and public services must be minimized or eliminated. Inequality is okay since it’s a result of a reward for merit and generates wealth for the tiny .001%, which the false myth says trickles down to enrich everyone in the 99%. Tax and other social policies to create a more equal society are dismissed as counterproductive to the interests of the ultra wealthy.001%.

MEDICAID REVIEWED

1). Medicaid is financed jointly by the federal government and the states. Early in 2023, 93 million people were enrolled in Medicaid or the Children’s Health Insurance Program, up from 71 million before the pandemic.

2). One of Medicaid’s most important dimensions is its irreplaceable role in addressing the immediate and long-term effects of public health crises, such as Covid-19, since it is the biggest single source of health care financing for dealing with critical public health threats. As we are painfully seeing, these threats may begin with an initial, recognized period of a formally declared emergency. They then can morph into events with very long-term effects felt for years or decades after. This was the case with the World Trade Center attacks, which led to an immediate surge in health care spending, followed by years of elevated spending to address the long-term health fallout triggered by the emergency itself. Think about Zika or the opioid crisis, or COVID-19, to understand the near-term/long-term nature of public health threats.

Image by Darko Stojanovic from Pixabay

3). SNAP, formerly known as food stamps, serves 42 million Americans. At least one adult in more than half of SNAP-recipient households are working. And the average SNAP subsidy is $125 per month, or $1.40 per meal.

4). 80% of adults receiving Medicaid live in families where someone works, and more than half are working themselves and doesn’t trap people in poverty or pay people not to work. Temporary Assistance to Needy Families has required work as a condition of eligibility since Bill Clinton signed welfare reform in 1996. The earned income tax credit, a tax credit for low and moderate income workers supports only people who work.

5). Workers apply for public benefits because they need assistance to make ends meet. Although American workers are among the most productive in the world, during the last 40 years the bottom half of income earners have seen no income growth. Since 1973, worker productivity has grown almost six times faster than wages.

6). Wage stagnation interfaces with costs of housing.Most Americans are spending more than one-third of their income on housing, which is increasingly unaffordable. There are 11 million renter households paying more than half their income on housing. And there is no county in America where a minimum wage worker can afford a two-bedroom home. Still, only 1 in 4 eligible households receive any form of government housing assistance.

7). The majority of recipients of public benefits who do not work are primarily children, the disabled and the elderly, people who cannot or should not work. The safety net exists to rescue people during vulnerable periods. Most people who receive public benefits leave the programs within three years.

8). Many public benefits pay for themselves over time as every dollar in SNAP spending is estimated to generate more than $1.70 in economic activity. Medicaid benefits are associated with enhancing work opportunities. The earned income tax credit contributes to work rates, improves the health of recipient families and has long-term educational and earnings benefits for children.

MEDICAID EXPANSION NEEDED

The COVID-19 pandemic demonstrated the urgent need for expansion of the Medicaid health insurance program. In too many states, political decisions by state legislators to deny health insurance to thousands of their citizens has resulted in an almost non-existent social and health safety net. Decisions in 2016/2017 by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act resulted in an estimated 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York. The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage remained uninsured.

PRIVATIZED ADMINISTRATION/MANAGED REIMBURSEMENT/CARE IN MEDICAID

To worsen the situation, many states have over the last decade privatized administration of their Medicaid program into a managed care program administered by the private profit health insurance industry. The companies are paid by state government, and their profit depends on spending as little as possible on Medicaid patients. It’s hard to imagine any greater disconnect between public good and private profit: the interest of private health insurance companies lies not in the obvious social good of delivering quality health care to patients but in having as few as possible treated as cheaply as possible. No better example exists of a private capitalist enterprise that feeds on the misery of man.

You might think that we learned the lesson of discredited managed care in the 1990s. The term “managed care” is confusing to many, but really amounts to managed reimbursement rather than managed care. A set prospective annual payment is made by federal/state governments, as in the case of state Medicaid managed care, to cover whatever services patients will receive over the coming year. There is therefore a built-in incentive for managed care organizations to skimp on care and pocket more profits.

ACA PROMOTES MEDICAID MANAGED CARE

Unfortunately, privatized Medicaid managed care was facilitated further by the Affordable Care Act (ACA). More than one-half of Medicaid beneficiaries are now in privatized plans, which have been enacted in many states based on the unproven theory that private plans can enable access to better coordinated care and still save money.

That theory is not just unproven, it is patently wrong as the state of Florida discovered. In 2016, Medicaid ate up 45.9 percent of growth in general revenue , ballooned by approval of a 7.7 percent increase in payment to private managed care plans. Privatized programs have high administrative costs, built-in profits, and do not save money or improve care. Their route to financial success is by finding more ways to limit care and deny services.

Without evidence or disclosure by the private Medicaid plans business/profit interests, private HMOs claim they save the state millions annually. Shockingly, we let many state administrations get away with this illusion by forgetting that adding a “profiteering middleman” to manage health care delivery always adds cost, and does not lower them. The Florida and other state GOPs, for example, lobbied hard for Medicaid managed care. Using scare tactics, they claimed that more than 3 million recipients (Fla.) would receive better care and also save the state money, sternly warning the roughly $23 billion a year Medicaid bill was consuming the state budget.

WHY DO WE STILL WORSHIP AT THE ALTAR OF PRIVATIZATION IN U.S. HEALTHCARE?

John P. Geyman, M.D., former chair of the University of Washington Department of Family Medicine and one of the most published family physicians in the U.S., asks, “Why do we still worship at the altar of privatization in U.S. health care, especially for the poor and most vulnerable among us?”

Several answers stand out:

(1) there is a lot of money to be made by insurers operating health programs subsidized by state governments;

(2) exploitive privatized programs are perpetuated by well-funded “free market” think tanks, their followers in Big Business, and compliant politicians responding to industry lobbyists;

(3) regulations are inadequate to prevent gaming by insurers at patients’ expense;

(4) as a society, we still don’t seem to care when people have bad health outcomes and die because of failed health care policies.”

Wendall Potter, a New York Times bestselling author, health care and campaign finance reform advocate, and authority adds more re., privatization/profiteering:

A). 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.

B). 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.

C). 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.

D). 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.

E). 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.

F). 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.

CONCLUSION

US citizens should demand that private corporate HMOs be removed and banned from the administration of our public health insurance programs in all states. Privatization of Medicaid increases costs, without any corresponding increase in quality or access to care. Private insurers maximize profits by mainly limiting benefits or by not covering people with health problems. The greed of casual inhumanity is built in the business model and the common good of citizens is ignored. Excluding the poor, aged, disabled and mentally ill is sound business policy, since it maximizes profit. As long as insurance for health care remains so lucrative for private insurers, patients’ needs and the public interest are disregarded by health insurance profiteers.

After we expand Medicaid to meet today’s immediate challenges, tomorrow we need to insist that the federal government finance a nationwide, not-for-profit, Medicare for All system of universal, single-payer coverage, based on medical need and not ability to pay. This would resolve persistent problems of failed market policies, and would resolve what Martin Luther King, Jr. once described: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

To fix this problem, on May 17, 2023, Rep. Pramila Jayapal, Rep. Debbie Dingell, and Sen. Bernie Sanders and more than 120 other colleagues re-introduced the Medicare for All Act in the U.S. House and Senate. These landmark pieces of legislation would finally establish a single-payer national health program in the United States. These long-overdue bills are most welcomed and Congress is urged to move quickly to guarantee universal coverage, comprehensive benefits, and zero out-of-pocket costs for all U.S. residents.

The nuts and bolts of the new Medicare for All Act-2023 calls for citizens to be guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care. Each of these bills provides all residents of the United States and its territories with a nationally consistent comprehensive benefit design, eliminates nearly all copays and deductibles, is funded through an equitable tax model, protects current benefits and services for veterans and Native Americans while also including them in Medicare for All, and dedicates expanded resources towards improving equity and justice in health care/health insurance.

EVERYBODY IN, NOBODY OUT !

The new legislation 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 the new act 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, in- cluding 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 indi- viduals with functional limitations, or low-income in- dividuals (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.)

CO-PAYMENTS / DEDUCTIBLES ENDED

Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2023 covering 100 percent.

All residents are guaranteed access to quality health care while achieving significant overall savings compared to our existing Medicare system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians and other health/mental health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.

HEALTH CARE ESTABLISHED AS A BASIC HUMAN RIGHT

Good health care is established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees. Health insurance is based on residence, not employment.

With M4A, citizens are guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care.

FINANCING M4A SYSTEM:

We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.

More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households — one study says 95 percent —would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.

M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. The USA is a country where health insurance for medical and mental health care 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.

WHY BIG INSURANCE OPPOSES MEDICARE FOR ALL: ! PROFITS – PROFITS – PROFITS !

I. Highlights from Wendall Potter, Feb 27,2023,” BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets”
Analysis of the 2022 financial statements of UnitedHealth Group, CVS/Aetna, Cigna, Elevance, Humana, Centene, and Molina

1. Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans they call Medicare Advantage.

2. The for-profits now control more than 80% of the national PBM market and more than 70% of the Medicare Advantage market.

3. 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.

II. Facts and figures to keep in mind as Big Insurance thrives (W. Potter)

1. 27.5 million people remain uninsured in the United States.

2. Up to 14 million more will lose their Medicaid coverage once the pandemic emergency period ends later this year.

3. 100 million of us – almost one of every three people in this country – now have medical debt.

4. In 2023, U.S. families can be on the hook for up to $18,200 in out-of-pocket requirements before their coverage kicks in, up 43% since 2014 when it was $12,700.

5. The Affordable Care Act allows the out-of-pocket maximum to increase annually – 43% since the maximum limit went into effect in 2014.

6.44% of people in the United States who purchased coverage through the individual market and (ACA) marketplaces were underinsured or functionally uninsured.

7. 46% of those surveyed said they had skipped or delayed care because of the cost.

8. 42% said they had problems paying medical bills or were paying off medical debt.

9. Half (49%) said they would be unable to pay an unexpected medical bill within 30 days, including 68% of adults with low income, 69% of Black adults, and 63% of Latino/Hispanic adults.

10. In 2021, about $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That’s not surprising when you realize that in the United States, even people with insurance all too often feel they have no choice but to beg for money from strangers to get the care they or a loved one needs.

11. 62% of bankruptcies are related to medical costs.

12. Even as we spend about $4.5 trillion on health care a year, Americans are now dying younger than people in other wealthy countries.

13. Life expectancy in the United States actually decreased by 2.8 years between 2014 and 2021, erasing all gains since 1996, according to the Centers for Disease Control and Prevention.

As these numbers show, the real boogeymen opposing M4A are the wealth addicted private health insurance and pharmaceutical industries who have the most to lose if their huge profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of their insurance and Big Pharma donors — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma and Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House and Senate Bills, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.

Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, the one percenters have elevated self-interest even further above life itself for the ninety-nine percent.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.

A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. By making health insurance available to all age groups, we can have the assurance that this life-saving health insurance program will continue.