Article written 10 yrs ago!!!
This article was written 10 yrs ago.......funny how the more things change the more they stay the same:
The Great Health Care Deception
Ten Years Later
Author’s note: This article was published in the June, 1992 issue of Broker World. Little has changed in the ten years that have elapsed. Some players have changed and some new health care entitlement programs have been granted to selected consumers, but the real issue is not being debated. That issue is about how we are governed, not about how health care should be financed and delivered.
Proponents for change on all sides of the health care controversy continue to use inaccurate data, misinformation, lies, ambiguities and other techniques to push their special interests. Make no mistake about it, our way of life, our very freedoms, our very life itself depends on the outcome of the health care battle.
. The road from democracy has taken us over two hundred years to travel and our journey is nearing its end. Our government is a deception away from socialism and no one has addressed that change.
The health care debate parameters have never been set and it is providing fertile ground for sowing seeds of misconception, confusion, ambiguity, and misunderstanding.
At stake is not” only the way health care is financed and provided—the powers between state and federal governments will be redrawn. More importantly, it will measure the financial impact socialism will continue to place on the fabric of a market driven economy. On an individual level, the “rags to riches” American dream could turn into a nightmare for millions of Americans. The stakes are high. No wonder, so are the “spoils of war.” Health care can be an $800 billion “pork barrel” for politicians or an $800 billion market-driven economic freight train.
Is the plight of 31 to 37 million uninsured Americans really the cause for this much national attention? Surely America has had 13 percent or more uninsured citizens since the Massachusetts Health Insurance Company of Boston was organized in 1847 to issue insurance coverage for medical care. In the forties, less than 10 percent of the US population was covered with health insurance. Even in 1966, when Congress initiated the Medicare and Medicaid programs, the uninsured population was well over 13 percent.
Are we then to believe that as of 1991 or after that our health care system has failed? Just at a time when more Americans than ever in the history of our country are covered? At a time when Americans enjoy the absolute best in medical care and technology? At a time when the United States leads the world in medical research and development? At a time when we have the most medical equipment available of any country in the world? At a time when access to the best care in the world is readily available to all citizens—rich and poor alike—even those without insurance or the ability to pay? At a time when people throughout the world come to the United States to receive the care they can’t get anywhere else, even in countries with national health care? If you listen to the media and special interest groups and some influential politicians, you can be convinced that our health care system is a failure. After enduring this onslaught of “bad press,” I am convinced the health care debate has triggered one of the greatest deceptions ever perpetuated on the American taxpayer. This is the subject of this article.
What started as a call to “insure” those 31 to 37 million uninsured Americans has now grown into a demand for a totally new health care delivery system for all 250 million US citizens. Has anyone questioned how subtly this change was made? And why? This campaign is not about health care at all. In a March 1992 meeting with David Nexon, Senator Ted Kennedy’s top man on the Senate Health and Human Services Committee, and his chief health advisor, I realized that health care was the means to an end and not the end itself. Mr. Nexon related to me and two others the simple fact that health care is a basic human right and has to be provided by the government. He also said that between then and the November 1992 presidential election would be the closest and best opportunity ever to install a universal health care program in the United States. End of story! So health care is not the issue. The issue is whether the government has a responsibility to provide it. Now I understand.
The big question is: does an individual have a responsibility to society or does society have a responsibility to its individual citizens? Which exists first—society or the individual? In the absence of a society, how are the individual’s needs satisfied? In the absence of the individual, how does society exist?
What this boils down to is opposing ideologies. One ideology wants to provide health care to all Americans by improving the market-based, private/public financing mechanism for delivering health care. They say the principles of free enterprise have built the country into the world’s greatest economic power. They say America has the best quality and technology, owing to market-based financing of care. The other wants government to provide health care to all Americans by eliminating the private sector and market-based financing. They say people can’t handle their own affairs as well as the government can handle it for them. They say private enterprise is a failure. It really is that simple.
Deception One. On November 8, 1991, HIAA issued a press release indicating that, based on preliminary findings of a poii, Senator Harris Wofford’s stunning victory in Pennsylvania was not due to his call for a national insurance plan. Only 14 percent of Pennsylvania constituents voted for him because of his “call to adopt a national insurance plan,” according to the HIAA poll. To assure against any appearance of bias, HIAA commissioned two pollsters: Democratic pollster Ed Lazarus of Mellman and Republican pollster Bill Mclnturff of Public Opinion Strategies. All issues other than health care garnered him a higher percentage of voters. Yet the media blasted the air waves with the message that the Pennsylvania election was a mandate for a national health care plan, misleading millions of Americans from coast to coast.
Deception Two. On February 6, 1992, ABC’s Nightline aired “Emergency! Health Care in America.” The show, and I mean show, originated from the University of Chicago and started at 10:30 pm CST. It consumed over two hours, almost entirely devoted to those unfortunate cases designed to illicit the proper emotional appeal and responses from the television audience. Occasionally, Ted Koppel allowed a “balanced” response. Finally, at the end of the program, Ken Prazak, after a two hour wait, was allowed to speak, but only after putting Mr. Koppel on the defensive during a commercial break. He ran up to the stage and yelled, “What about the free market, Ted? What about small business?” Ted allowed him to speak following the break.
“I’m self employed, I’m one of the uninsured, and I don’t want universal health care. If you want to see an example in action, look at any VA Hospital. That’s universal health care—government provided and universally hated,” Mr. Prazak stated. He went on to point out he didn’t want to pay for other’s drug abuse, alcoholism, and in vitro fertilization.
Several members of the Illinois Association of Health Underwriters were on hand too. Edward Zurek, a member of the Illinois AHU Legislative Council, was able to get in and was promised an opportunity to speak. I recall phoning Mr. Zurek the day of the broadcast. He was excited about the program and the prospects of presenting the NAHU strategy for health care in America to millions of television viewers. His opportunity never came. But he did observe. He spoke to me the day after the program. His report: the program was rigged, a set up. They had no intention of putting on a rational debate, exposing diverse opinions. Mr. Zurek overheard one ABC supervisor saying to his crew that only people with preapproved comments would be allowed to speak. Instead, Nightline pandered to the emotions of the audience. How else can you explain the names of the “spontaneous” audience speakers appearing on the television screen before they spoke?
Deception Three. Access to care is being called a ”national disgrace.” Just about everyone getting press is talking about access to health care as if it doesn’t exist and in the alternative, access will drive costs of care downward if all Americans are covered.
Even the uninsured can get the care they need by “accessing” hospital emergency rooms. Every one has access to care. Any hospital that receives federal funds must accept indigent patients. So really we don’t have anyone out of the loop. The 13 percent uninsured are the lucky ones in some respects. Their care is free to them because it is paid by the insured population. According to a leading British economist, the average uninsured American has better access to health care through hospitals that accept federal funds than do the residents of England under their so-called “free access to all” health care system. The only right the citizens of countries with national health care have is the right to wait in line for care. This doesn’t even insure them a place, either. For example, being fourth in line to receive a heart bypass doesn’t guarantee that you’ll be the fourth person to receive this lifesaving surgery.
Granted, care given in hospital emergency settings is more expensive. But more expensive than what? If the cost shifting tab is $17.1 billion, as reported by BNA, Daily Report for Executives, December 20, 1991, and released by the National Association of Manufacturers, how much of this is attributable to the uninsured? Cost shifting occurs when providers shift the shortfalls in reimbursements from uninsureds, Medicare, and Medicaid recipients to the private payers—those who are insured.
Let’s review. The uninsured medical tab is paid by those insured—approximately 77 percent (Medicare! Medicaid not counted) of the people in the USA. Let’s calculate how this risk is spread:
250 million Americans x 77 percent = 192,500,000 people That’s a rather large pool! So the $17.1 billion cost shifting tab divided by 192.5 million equals about $89.00 a person, per year.
The proposals I have seen approach $100 billion dollars or more to insure the uninsured. Remember, $17.1 billion includes Medicare and Medicaid patients. Let’s use the total dollars anyway to be more than fair. So we are being asked to insure those 31 to 37 million uninsured at $100 billion divided by the 192.5 million, who will pay the cost? That equals approximately $520.00 per person, per year. It seems like there is some profit factored into these proposals. Let’s assume these people were given access to “free” care and they did seek preventive care rather than wait until the condition was acute. Can we be sure those costs combined with the “long run” costs will be lower? When things are perceived as “free,” over-utilization occurs and this drives costs up.
Deception Four. The media, some politicians, and regulators have been telling Americans that Canada’s national health plan provides access to all and does so far cheaper than our US system. Is this true?
Canada doesn’t have one national health plan. It has ten different plans, one for each province. Second, while all provincial plans provide “access” to all, this doesn’t mean care when needed. In Canada, of the 25 million citizens, the waiting list for surgery is 250,000 people.
According to the National Center for Policy Analysis, a Dallas-based research institute, Canada’s real health spending per capita is virtually the same as our own. IHIIAA just announced a report indicating Canada, the United Kingdom, and France, all countries with taxpayer-funded, government managed national health insurance, had greater increases in per capita health care spending between 1970 and 1989 than the United States.
If access to all means care when needed and Canada is spending the same or more per capita than we are, then why does Canada have waiting lists for needed surgeries? Why does Canada have less medical equipment than the US? There are more MRI scanners in Washington state with a population of approximately 4.6 million residents, than in all of Canada. At least one province doesn’t even have an MRI. Those residents have to travel to another province. Is this “access”?
The NCPA also stated in its report, “Twenty Myths About National Health Insurance,” that “not only do citizens have no enforceable right to any particular medical service, they don’t even have a right to a place in line when health care is rationed.”
Last, Canada’s costs do not include the government’s cost to administer the ten plans. Canada also imports much of the USA’s medical technology, foregoing these research and development costs.
Not only do Americans enjoy better medical care, we, in most cases, receive care on demand along with a choice of providers. Is it wrong to pay more, if you get more? Are we really paying more for the same services, or are we getting more? The truth is, we get more for our money’s worth, not less, as millions of Americans are being led to believe.
Deception Five. President Bush’s proposal for health care in America has drawn a mixed reception in the media. Those who understand it, think it attacks most of the problems. Everyone can probably find some “special interest” disagreement. Those who oppose it appear to misunderstand the problems, or have not read the proposal adequately, or could possibly just be too close-minded to see another solution. Yet they seem to get the lion’s share of our press. Herein lies the problem! The media seems too quick to allow a preponderance of the ambiguous and the sophistic the opportunity to speak, therefore spreading
misinformation to untold millions of our clients. Rarely does the truth reach the same people to correct this unfortunate damage.
On Wednesday, March 25, 1992, in the USA Today, a leading politician said of President Bush’s proposal, “according to the Congressional budget office, more than 70 percent of the uninsured have incomes above the poverty line. No such protection appears available to them in the President’s plan.” Yet page 30 of “The President’s Comprehensive Health Reform Program,” indicates 29 million uninsured would become covered when the plan is fully phased in. (70 percent of the 37 million uninsured totals 25.9 million.) So the plan actually will cover about 80 percent. If you use the figure 33 million uninsured, the plan becomes even more significant.
In the same article this US Senator is quoted as saying, “When he talks about it costing more than $100 billion over five years, he avoids putting any numbers on how you pay for it.” He adds that “Bush’s plan also fails to address the problems of families above the poverty line.” Throughout the President’s plan, references are made on how and how much savings will occur. Chapter 5 explains how reforms in the Medicare and Medicaid programs alone will fund the $20 billion a year price tag for his plan. Again, page 30 of the plan indicates “a total of 95 million individuals would benefit from the health insurance tax credit and deduction.” Of these, 57 million middle income Americans would benefit.
Can you imagine what this misinformation campaign is doing to consumers or more accurately your clients?
Deception Six. Many sources and experts are saying that “millions more Americans have such limited insurance coverage that they face serious financial hardship, even bankruptcy, if they are unlucky enough to have a disease like AIDS, Alzheimer’s, or muscular dystrophy.” (Health Decisions, a highly visible health care advocacy group.)
When the media disseminates unchallenged information, the public usually assumes it is fact. Therefore,
exaggerations are hard to dispute by the uninformed reporter even before they are released. Yet, the impact on the consumer is even harder to determine and change after the fact.
Let’s examine the following statement, in particular, and limited insurance in general. “Sixty-two percent of the total population are covered primarily through private health insurance. Most of these are covered through employment,” according to the President’s plan. The uninsured equal 11.6 percent, so they are not counted as having limited insurance; 10.4 percent are covered by Medicaid, so we can rule them out; 6.6 percent are self insured, so they can’t be counted either, and .3 percent are covered by Medicare, so this group is ruled out as well. So the “limited insurance” population must be among the 153 million covered by private health insurance. According to data compiled by HIAA, in 1984, “over 98 percent of the employees surveyed had some out-of-pocket limit, the most common being $1,000 and $2,000.” In a 1986 HIAA survey, “90 percent of the surveyed employees had maximum benefits of $1 million or more.”
Two percent of 153 million people with private insurance is about three million. The average out-of-pocket limit was $1,000 and $2,000; the disease was AIDS, muscular dystrophy and alzheimer’s. Most alzheimer’s patients are over 65 and covered by Medicare. AIDS patients receive government assistance and unpaid costs are passed along to private payors via cost shifting. I’m not sure how many people with “limited insurance” have an MD. I’m no actuary but this isn’t millions facing bankruptcy.
What I am sure of is this: if someone who has the ability to pay for the cost of care and who does not have insurance can pay from personal finances. Now these few may face a financial hardship and even bankruptcy. In fact, some Americans are being advised to file for bankruptcy to keep them from paying health care costs. Is this right? The NCPA states that most Americans are over-insured. According to their study entitled “Controlling Health Care Costs With Medical Savings Accounts,” Americans only spend 24 cents out of every dollar spent on health care. Ninety-five percent of all hospital bills and 80 percent of doctor’s charges are paid by private and third party payors.
Just about everyone will experience a financial hardship at some point in time. What makes a health care financial hardship any different than any other? Most financial hardships are not protected against by the government. Why health care? Why not food? We eat a lot more often than we get sick, and food is essential for life. Is this next?
Deception Seven. How many times have you heard the phrase, “Health care costs are out of control?” This is a misnomer. Health care costs are being controlled. Who’s doing the controlling? The federal government directly and the medical community indirectly. How? Through the Medicare and Medicaid programs.
By creating a floor for prices, no provider will charge less than the floor price. An analogy would be to use a retail store as an example. If the government sets the floor price of a gallon of milk as $1.99 and reimburses $1.99, the retailer will never lower his price below $1.99. In effect, the government sets the negotiated charges based on inflation, lobbying, technology, etc. Why should providers charge less than the government is willing to pay? Market pressures are not allowed to exert themselves in the health care arena. Health care is devoid of competition in pricing, therefore, there is no check on costs. Market forces must be introduced so that consumers can drive the cost of care. What is at stake is who will control costs in the future. Will it be the consumers, the government, or the medical community?
The blame for high health care costs must be squarely shouldered by the politicians for designing the legislation and tax codes to permit annual double digit cost increases over the last 25 years. It’s time for them to face economic reality. It’s time for the truth to be told to the American people. Only when the voter demands change, will Congress have the integrity and intestinal fortitude to act.
Deception Eight. Another often used argument deals with the huge profits insurance companies are making by charging “outlandish” premiums. Hardly ever have I seen this challenged. I used to think that insurance companies merely added their costs of paying claims to administrative expenses and bingo, the premium was determined. I really thought insurance companies passed the high cost of medical treatment along to their insureds. I didn’t realize, until I saw these reports in the papers and magazines that insurance companies have “gouged” the American people by artificially inflating premiums. Premiums were only limited by the companies’ conscience. Less conscience, more premium. Now, I am led to believe that if insurance companies didn’t make these huge profits, they could lower premiums by 20 to 50 percent or more and still make money, too. In this way, health care costs will go down accordingly. Is the consumer buying this logic?
Just a few days ago, I received a call from an angry client. Angry because she had just received a 20 percent rate increase on her major medical plan. She was going to write her Congressman, Senators and Insurance Commissioner. “There is no way the insurance company should be allowed to go up this much on my policy. It’s ridiculous! I can’t afford this, and they know I can’t. They know I can’t pay this. They know I don’t work and have a fixed income. They want me to drop it. It’s just not fair,” she said (among other things).
I focused her attention on health care costs and convinced her insurance companies just passed them on to her. By the time we finished, she was still going to write. This time, however, she was going to criticize the proper culprits. How many consumers do blame the insurance companies? How many clients don’t call and give you the opportunity to educate them? How many feel justified in their anger towards company rate increases, in the absence of convincing proof that it is misplaced?
I have listed only a few deceptive practices being perpetuated on American consumers. The same people we refer to as clients. I am positive you have seen, heard, or read even more distortions and misinformation.
What are you doing about it?
What is your insurance company doing about it?
What can be done?
If you see a wrong, correct it. Prepare yourself with as many facts as you can. If necessary, build a reservoir of health care related information and catalog it for quicker reference. When you see or read something that smacks of misconception, falsehood, misinformation, etc. prepare your response and release it! The sooner the better. This assures good “damage control.”
Encourage the companies you represent to engage in this practice, as well. Most will tell you that they rely on organizations like the HIAA, ACLI, ALIC, etc. to handle these things. Maybe they aren’t getting the message. The proponents of national health care are very prolific. We need to be, but aren’t. Your response should be, “if they were doing their jobs, wouldn’t I see it?” Just maybe companies don’t understand the problem or have underestimated it.
A few challenges in response to multiple attacks will be ineffective. We must challenge each and every occurrence.
Audrey Snead was once quoted as saying, “some folks never exaggerate, they just remember big.” Every seed of misinformation sown yields fruit for our adversaries. Every ambiguity not corrected lingers as truth to those who hear it. We must recognize this simple truth and, therefore, commit to the re-education of our clients. Why is this necessary? All of our efforts must center around the concept of educating the consumer, arming them with the truth and asking them to determine their health care future based on the knowledge of facts and logic rather than on the knowledge of half-truths, falsehoods, and emotion. We may have all the answers to the health care puzzle, but if we don’t tell someone, no one will know.
During World War II, the Allies used a little known information gathering technique to determine troop movements and other vital information to help them win the war. They read German newspapers. Obviously, troop movements and other sensitive information was not in the newspapers, but what the Allies did successfully was “read between the lines.” Things not said, how things were said, etc., did give some military secrets away. Many experts “read between the lines” to monitor, to capitalize on opportunities, and to determine what will happen in the United States.
Are you reading between the lines? Can you guess what is going on in America? Unless America hears the other side of the story—and often, socialized medicine is a deception away.
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