Health care in the United States continues to be defined by multiple system failures, despite the promised improvements of the Affordable Care Act. Driven by corporate profiteering at the expense of the sick and suffering, the system despite its vast resources just doesnāt work very well. This isnāt just hyperbole. As a 2018 HarvardĀ studyĀ concluded, the U.S. health system spends almost twice as much on medical care than other high-income nations, but offers less access to care and poorer outcomes.
Ā
Then again, if youāre a privileged health industry āleader,ā everything is just fine. According toĀ Business Insider, the nationās largest U.S. health insurer, UnitedHealthGroup, which also runs clinics and other health programs, paid its CEO $18,107,356 last year. The CEO of Molina Healthcare received compensation worth $15,219,770.Ā Anthem, seller of Blue Cross Blue Shield insurance, paid its CEO $14,184,276 in compensation. And so it goes.
Ā
If any wealthy health care CEO actually had a conscience, they might forgo their bloated salaries to make a statement on behalf of health care equity and justice for the millions who canāt afford the costs of care. Or maybe they could pour millions of their dollars into the GoFundMe accounts of Americaās most desperate families, raising funds for their ill or injured relatives?
Ā
A demonstrative statement along these lines might at least show they believe their own corporate marketing hype about serving the needs of their ācustomers.ā Could they get by on a more modest low six-figure salary? Unfortunately, under the present system itās unlikely weāll ever know. The outsized wealth of health industry executives is made possible by the costly premiums, copays, co-insurance, and high deductibles Americans are forced to pay for their overly complex, inferior insurance products.Ā
Ā
Challenge to Industry Status Quo
If there is a counterweight to this dismal reality, itās to be found in the widespread public support for a single-payer, or Medicare for All, health system. In fact, a 2018 Reuters poll foundĀ 70 percentĀ of Americans support a government-sponsored Medicare for All system. According to theĀ Kaiser Family FoundationĀ (KFF), support for single-payer has been slowly growing for nearly two decades. While poll results will varyāKFF reports a majority 56 percent of the public now in support of such proposalsāsingle-payer has remained consistently popular with most Americans.
Ā
Thereās also traction for Medicare for All in Congress. With several public health plan reform bills now before Congress, the most far-reaching are the comprehensive single-payer bills sponsored by Sen. Bernie Sanders (I- VT) and Rep. Pramila Jayapal (D-WA). The latterās House bill now has 108 co-sponsors. Itās testament to single-payerās gathering momentum that theĀ vested profiteers of the health care status quo are now organizing to discredit Medicare for All. As theĀ New York TimesĀ and otherĀ mediaĀ reported earlier this year, industry groups such as the Federation of American Hospitals, Americaās Health Insurance Plans, Pharmaceutical Research and Manufacturers of America and other lobbyists are partnering to wage a public campaign against any single-payer legislative initiatives.
Ā
Enter the Partnership for Americaās Health Care Future. Under the leadership of executive director,Ā Lauren Crawford Shaver,Ā a former advisor to Hillary Clintonās 2016 presidential campaign, the groupās disinformation campaign seeks to frighten the public that theyāll be paying more under Medicare for All than they already are. In return they offer bland reassurances that most Americans already have affordable health care, and that whatever problems exist are nothing a few tweaks to the existing for-profit system canāt fix.
Ā
Itās hard to take such propaganda seriously. As groups likeĀ Physicians for a National Health ProgramĀ (PNHP) have long argued, eliminating all individual premiums, copays, and coinsurance under a single-payer system will drastically improve access and affordability for the overwhelming majority of Americans. Indeed, a recentĀ RAND studyĀ in New York state found single-payer legislation would dramatically lower health costs for most people, with only individuals earning above $134,000 (or a family of four earning $276,000) paying more than current costs.
Ā
Even if higher income taxes were associated with Medicare for All, Americans would be still be getting more for their health care dollar. But the assumption that tax increases on working-class Americans would be necessary can be challenged. After all, this is the country with the richest rich people and the richest corporations in the world. Certainly new taxes on the 1 percent and corporate wealth alone could ensure ordinary Americans donāt pay more for better health care. If not, thereās always the $718 billion in Pentagon military budget waiting to fund something actually useful like health care.Ā
Ā
More Services, Better Healthcare
It is also important not to forget a key word in the Medicare for All proposalsāImproved. The campaign for single-payer is an opportunity not only to improve access to affordable care, but also enhance the quality of care available to every person.
Ā
This is recognized in the Sanders and Jayapal bills, which promote extending coverage for a full range of reproductive care services, including abortion services, as well as vision, dental, and prescription drug benefits. With the renewed assault on womenās reproductive rights in Alabama and other states, imposing de facto bans on abortion under so-called āheartbeatā laws, itās especially vital now that the Medicare for All movement clearly stand in defense of abortion as a legitimate medical procedure.
Ā
As a May 16 PNHP twitter statement declared, āWe need to urgently reverse course andĀ expandĀ access to reproductive health care, including abortion. That means guaranteed coverage, access to providers in all communities, andĀ zeroĀ cost sharing.ā
Ā
Likewise, to safeguard quality and patient safety, the Sanders bill would alsoĀ mandateĀ limits on nurse-patient ratios and staffing levels for physicians and other providers, based on input from the National Nurses United union and others.Ā Notably, the Sanders bill also designatesĀ the Department of Health and Human Services (HHS) to determine which ācomplementary and integrativeā medical services are included in the new public system.
Ā
This is important. NearlyĀ 40 percentĀ of U.S. adults use some form of complementary or integrative care. While some of what falls under this category includes products or services better categorized as self-care outside of a professional health care setting, medical treatment by licensed professionals for acupuncture, chiropractic, naturopathic care, and related services deserve to be included in the single-payer roster of covered benefits.
Ā
In fact, there is a credible evidence base for inclusion of many complementary and integrated care services. In 2017, an AustralianĀ studyĀ found evidence for acupunctureās effectiveness for 122 treatments comprising 14 clinical areas. Another meta-analysis of 39 clinical trials involving over 20,827 patients published in theĀ Journal of PainĀ (May 2018) found acupuncture to be an effective chronic pain treatment. As an American Academy of Family Physicians (AAFP)Ā reportĀ noted, the benefits of acupuncture were found to persist over time and were not explainable simply as a consequence of the placebo effect.
Ā
With an ongoing opioid public health crisis, the use of effective non-pharmacologic treatment options such as acupuncture and other interventions has acquired a new urgency.Ā According to theĀ Centers for Disease ControlĀ (CDC), more than 700,000 people died from a drug overdose from 1999 to 2017. In 2017, about 68 percent of the more than 70,000 drug overdose deaths involved an opioid. The number of overdose deaths in 2017 involving opioids (including both legal and illegal) was six times higher than in 1999.
Ā
These figures describe a mounting public health crisis, one withĀ roots in the corrosive influence of Big Pharma on medicine. āThe human toll of opioid overprescription now represents one of the largest iatrogenic epidemics in history,ā write Scott Poldosky, MD, and colleagues inĀ The New England Journal of MedicineĀ (NEJM). It is a āstory of unconscionable corporate (and individual) profit at the expense of the publicās health.ā
Ā
According to theĀ U.S. Government Accountability OfficeĀ (GAO), pharmaceutical and biotechnology sales revenue increased from $534 billion to $775 billion between 2006 and 2015. Notably,Ā GAO also reports 67 percent of drug companies increased their annual profit margins during these years, with the 25 largest companies reporting an annual average profit margin somewhere in the 15 to 20 percent range. To put this in perspective, GAO notes the average annual profit margin globally for the 500 largest non-drug companies varies between 4 and 9 percent.
Ā
More than ever, health care providers need alternatives to opioids, both safer pharmacologic and non-pharmacologic treatment options. Notably, the Joint Commission, the accrediting body for many healthcare organizations, nowĀ requiresĀ accredited hospital organizations to provide such non-pharmacological treatment options such as acupuncture to meet pain management standards.
Ā
Holistic Care Model
If the United States eventually adopts a single-payer health system, expanding coverage for essential health services will underscore the need for a more encompassing or holistic model of care. This is a point made by Margaret Chan, MD, former director-general of the World Health Organization (WHO) in her 2016Ā keynote addressĀ at the International Conference on the Modernization of Traditional Chinese Medicine.
Ā
As Dr. Chan observes, as health systems expand essential medical services, not only do expectations for care rise, but also necessary costs. āFaced with this dilemma, and most especially the costs of treating lifestyle-related chronic diseases, many experts see a need to shift the model for health service delivery away from a strictly biomedical model, focused on individual diseases, towards a more holistic approach,ā says Dr. Chan. āThis is an approach that stresses prevention as well as cure, offers integrated services that address the multiple determinants of health, and asks people to take more responsibility for their own health.ā
Ā
As such, acupuncture and herbal medicine can play a positive role within the larger health system, suggests Dr. Chan. There are variants of such practice already existing in some modern health systems, such as in Japan where herbal prescriptions (āKampo medicineā) areĀ integratedĀ into physician practice under the national health insurance system.
Ā
Further, in our modern society where not only stress, but traumatic stress is common, therapies that address theĀ psychophysiology of illness can more fully serve the well-being of communities. This includes not only different types of psychotherapy, but mindfulness practices, yoga, acupuncture and related bodywork therapies. Interestingly, Bessel van der Kolk, MD, psychiatrist and author ofĀ The Body Keeps the Score: Brain, Mind, and Body in the Healing of TraumaĀ (Penguin Books, 2015) recounts how in the wake of the 9/11 terror attacks in 2001, he participated in expert panels in New York City organized by the National Institutes of Health and other organizations to recommend treatments for people traumatized by the attacks on the World Trade Center.
Ā
After much discussion, the experts only recommended psychoanalysis and cognitive behavioral therapy. As it turned out, few New Yorkers took advantage of these publicly sponsored services. Later, Dr. van der Kolk toldĀ The New York Times, data gathered on mental health care for more than 10,000 survivors of 9//11 found acupuncture the most popular service used to overcome the effects of the experience, followed by yoga, massage, and EMDR therapy (a form of psychotherapy).
Ā
This anecdote speaks to the need for more integrative approaches to health care, in response to the pervasive psycho-social burdens and traumas modern society imposes on individuals. Certainly health care justice starts with accessible and affordable care. But health care also means elevatingĀ the human touch in medicine, normalizing connection and compassion as markers of a health system that truly serves every individual in need. Health care is social solidarity at the most direct level.
Ā
In this sense, humane medicine involves more than parsing results from randomized controlled trials to establish what is āscientific medicineā and thus legitimate practice. After all, medicine is an applied science, an evolving body of knowledge that draws upon multiple sources of research, clinical observation and judgment, and patient input to find effective paths to healing and well-being.
Ā
Now, in an age where cruelty reigns in politics, where the hardened, vision of the far right threatens violence all over the globe, where racism and misogyny, poverty and exploitation rearĀ up like a monstrous hydra of inhumanity, the vision of a just, humane health care system might appear to be little more than a wistful dream. It is not. In fact, the struggle for health care justice in the United States is inseparable from the larger political and social challenges involved in defeating the slide into barbarism that now confronts humanity.
Ā
From Big Pharma to the insurance industry, medical devices manufacturers, investor-owned hospital systems and more, corporate capitalism distorts medicine from what should be a humane mission into just another profit stream. To defeat corporate health care and its profiteers is possible, but it will take more than passively placing our hopes in Congressional Democrats, many of whom are afflicted with the tendency to embrace progressive demands like single-payer only when such demands have little chance of implementation.Ā
Ā
The widespread popular support for Medicare for All represents a potentially unstoppable popular movement. But if we want a just, equitable public health care system, the people have to speak out, rally and get politically organized. If we want to truly liberate medicine from the profiteers, a mass grassroots organizing campaign is the path to change what needs to change.Ā
ZNetwork is funded solely through the generosity of its readers.
Donate