Our neighbor Canada recently showed the US how healthcare policy should be approached, when Liberal Prime Minister Justin Trudeau announced a cooperative political alliance with an opposition party, the New Democrats (NDP), led by Jagmeet Singh, an arrangement that will tentatively last until the next parliamentary elections in 2025. Trudeau’s Liberals, forced to form an ad hoc minority government last fall, will henceforth be senior partners in what’s tantamount to a stable majority coalition, with the social-democratic NDP given no cabinet positions, but an equal say in policy decisions, among them issues related to healthcare.
High on the agenda for the new center-left partnership will be broadening Canada’s existing universal single-payer Medicare system, which has operated successfully since 1968 albeit with certain gaps in coverage. Foremost among the systemic holes Trudeau has committed Liberals to filling are NDP demands for national dental and prescription-drug programs. Details have yet to be fully worked out, but dental care, an NDP priority, will include a family income limit on eligibility ($90,000 Can.), unlike the rest of Canadian Medicare. However, those families with annual incomes under $70,000 will have the added benefit of no required co-pays.
As outlined, the dental program, a policy plank in the NDP’s left-leaning election platforms for 2019 and 2021, would be gradually phased in between 2023 and 2025, starting with children under age 12; it would eventually cover 6.5 million Canadians currently lacking dental insurance, including numerous low-income seniors now forced to seek dental care from hospital emergency rooms.
Another addition to Canada’s social safety net agreed to by its two co-governing parties will be so-called national-pharmacare legislation establishing universal, publicly financed drug coverage, an innovation first proposed by Trudeau’s Liberal government in 2019, but never implemented; it will now be front and center. Canada Pharmacare, as the plan will be called, is expected to be enacted in some form by 2023.
The new Canadian model will certainly be simpler, more comprehensive and more consumer-friendly than America’s limited Part D Medicare drug benefit, an unnecessarily complex add-on by Bush Republicans in 2003 that, like the Affordable Care Act, forces recipients to deal with private health-insurance companies, choose annually among a maze of competing plans with widely varying costs and options, and pay inflated premiums and fees. Greater efficiency will be built into Canada Pharmacare by Canadian Medicare’s ability to negotiate lower prices for bulk purchase of prescription drugs, something American Medicare for seniors, hostage to the drug industry, still cannot do. Above all, everyone will be covered as a right of citizenship, and not just those of retirement age.
While Canada is forthrightly working to meet its public health needs, this country is turning away. The late Build Back Better Act (RIP) contained no dental coverage at all, and its paltry proposal to reduce drug costs (mainly by targeting insulin makers) was an empty shell compared to what’s envisioned north of the border. In fact, some Neanderthal elements in US politics actually favor a regression in health policy. Florida’s Republican Sen. Rick Scott, for instance, once entangled in Medicare fraud as a shifty hospital-chain CEO, seriously proposes sunsetting the entire federal program in five years, part of his bizarre 11-point economic plan to “rescue America.”
Other US healthcare initiatives currently swirling about are less flat-out crazy, but equally destructive in various ways. An example is the lawsuit by two pillars of the nation’s for-profit medical establishment, the American Medical Association (AMA) and the American Hospital Association (AHA); they’ve teamed up to block aspects of a recently enacted federal ban on surprise medical billing resulting from a failure to honor patient coverage for “out-of-network” health services not recognized by one or another provider.
This travesty exposes the harm arising from constrictive health networks imposed on victimized policyholders unfamiliar with multiple billing procedures. To oversimplify, doctors, hospitals and insurers are fighting, and confused patients are caught in the middle — a rather typical product of our overly competitive healthcare system.
Another instance of dysfunction is the practice, revealed by New York Times investigators last year, of US hospitals bypassing patient insurers, including the Medicare and Medicaid programs, to bill patients directly using state lien laws; the aim is to collect higher amounts of money. Numerous hospital chains across the country have been implicated in this scam, producing multiple lawsuits.
Still another example of American free-market medicine gone awry is the sudden increase lately of doctors, medical specialists and hospitals suing insurance companies over the insurers’ practice of forcing independent physician groups out of their coverage networks, so that patients will have to use in-house specialists and insurer-affiliated clinics instead, thereby boosting company profits. Giant UnitedHealthcare, embroiled in ongoing lawsuits in two states (Colorado and Texas), is a major offender.
Also in bad aroma is insurer Anthem Blue Cross Blue Shield, presently facing accusations by hospitals and medical associations in four states (Maine, Georgia, Virginia and Indiana) for underpayments or late payments and improper denials of coverage, leaving patients with unjustified out-of-pocket expenses. One hospital, Portland, Maine’s Maine Medical Center, cites three years of delinquent Anthem reimbursements totaling $70 million.
The sad thing about the impaired operation of the US healthcare system is that no one vested interest is entirely at fault. All of the inappropriately named “stakeholders” (insurers, doctors, hospitals, drug companies, medical-device marketers) are avidly milking the system for their individual benefit. They were given legitimacy by being accorded prominent roles in shaping the last several healthcare “reforms” — Clinton’s Medicare Plus Choice program (1997), Bush’s Medicare Modernization Act (2003), and Obama’s Affordable Care Act (2010).
The self-serving stakeholders (a designation that curiously fails to include consumers), each seeking to leverage public healthcare for private profit, were permitted unlimited lobbying access and often allowed to literally write the rules. The end result is a system out of control, an octopus-like medical-industrial complex spreading its financial tentacles far and wide.
The system’s mothers’ milk is unrestricted mass advertising, such as the proliferating drug commercials (banned in Canada, but allowed here) that saturate American TV screens and whose ultimate cost is borne by the consumers themselves. This distorted behavioral pattern, broadly applied, of converting healthcare into nothing more than a business opportunity has, according to Forbes magazine, created no fewer than 33 US healthcare billionaires.
Look north; there’s a better way.
Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He holds a doctorate in American history and is the author of two prizewinning books.
From The Progressive Populist, June 1, 2022
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