This commentary is by Lee Russ, a retired legal editor, who was the lead editor / author of both the third edition of Couch on Insurance and the medical advisor to lawyers.
Everyone in Vermont has heard horrifying stories about healthcare. But each of those stories focuses on a small part of the problem. Combining those little pieces like a jigsaw puzzle makes you sleep less at night.
Vermont is in short supply of doctors and nurses and will get worse. Many hospitals are bleeding badly. We have been waiting for the consultation of many patients, especially specialists, for a very long time. More than one-third of Vermonter has health insurance and cannot afford to pay deductions or out-of-pocket expenses, so hesitate to use it.
Premiums for commercial health insurance are high and rising. If you are insured through work, your share of premiums is rising, as are deductions and out-of-pocket costs. If you work but are not insured through your job or your hired family, you are probably in Medicaid.
Town and school budgets are bloated by the ever-increasing costs of health insurance for the people who work there. Property tax and school tax will increase accordingly. Your income tax reflects the need to fund the increasing Medicaid rolls.
The price you pay for everything includes some form of medical expenses.
If you are old enough to participate in Medicare, you still pay a lot of money. For me, this is well over $ 3,000 a year in Medicare premiums and deductions, Medicare policy premiums that cover amounts that Medicare does not cover, and prescription drug plan costs.
The federal government is rapidly transferring Medicare to commercial interests (intermediaries) through both the Medicare Advantage option and the new “Direct Contracting Agent” program.
Medicare Advantage is becoming more and more popular. This is because private insurers often have lower premiums, which they make up for by limiting your care, overcharging Medicare and bleeding the Medicare Trust Fund.
The same can be done with a direct contract entity program, because adding an intermediary requires more costs, less care, or both. It must be done.
Here in Vermont, it takes several years for a medical “reform” called the “full payer model” to distribute health insurance payments to doctors using “accountable medical institutions”. If it sounds like a complex intermediary, then yes.
This effort has so far absorbed millions of dollars in taxes while not producing real cost savings. People still have to pay premiums, deductions and out-of-pocket payments, and the full payer model does not provide compensation to anyone.
Vermont continues to work on this reform, but it is reported that the popularity of accountable care organizations is declining overall.
Please note that the University of Vermont Medical Center, which operates our accountable care organization, has recently partnered with the commercial insurance company MVP to sell the Medicare Advantage Policy.
The UVM Medical Center continues to expand its reach and the number of independent physician consultations continues to decline. Insurers and other people with a commercial interest in keeping this Byzantine system working overtime instead “simply” to scare people from the possible fears of a “single payer” healthcare system. We are heading for a “one provider” system.
Private equity companies have tripled their investment in health care in recent years and are now reported to own more than a quarter of the hospitals in the United States. Ambulance services owned by private equity companies have already been shown to charge higher prices and simply discontinue unprofitable services.
Over 900 companies sell health insurance in the United States, offering thousands of different types of insurance. Hordes of additional health insurance programs are offered by the federal and state governments. This complexity and fragmentation was purely managed by 10 in 2019, while only one of the 17 healthcare professionals was a doctor and the other 6 took care of patients as nurses, assistants, etc. That’s the main reason why it worked.
In 2020, US health care costs will exceed $ 4 trillion, accounting for less than 20% of total GDP. In 2019, Vermont alone spent $ 6.5 billion. Isn’t it strange that more than 1.4 million Americans traveled to other countries for medical care in 2017?
Every aspect of our current healthcare system is failing. It is clear to me that this failure is the result of corruption of the basic purpose of medical care, which is to make it available to those in need. The purpose of our current system seems to be primarily to protect and perpetuate the system for the benefit of those who benefit from it.
This is an emergency. If we don’t have the courage to work on it, we all pay the price. If you timidly poke the edge of a fiery fire, the fire will not go out. The most effective solution is a publicly funded single payer plan.
