“Before I discuss a treatment plan with my patients I check their chart to see what insurance they have,” said Toni Ramirez, a family practice physician speaking at a forum called “Getting to Health Care for All”, at the Windsor Democratic Club meeting on February 27.
“I never withhold information”, she emphasized, “but I am forced to shape my discussion around what patients have access to or can afford.”
Also speaking was Terry Winter, a retired nurse. Getting to Health Care for All is a project of Health Professionals for Equality and Community Empowerment (HPEACE) and North Bay Jobs with Justice.
Health care in the United States is paid for by a mix of private for-profit insurance and government-funded insurance. Most private insurance is tied to employment.
With little regulation, medical providers can and do charge wildly different amounts for the same treatment or procedure, depending on the type of insurance or specific policy a patient has. Access to health care is rationed by an individual’s ability to pay.
Although the US spends nearly twice as much per capita on healthcare as do other developed countries, US residents are actually less likely to see a doctor when they are sick.
“This is incredibly stressful for primary care physicians,” Ramirez said. “We are trying to provide our patients with the treatment they need, while working in a system that values profit over health.”
Although more people became insured under the Affordable Health Care Act, primarily through the expansion of Medicaid, up to 40 million remain without insurance. And even those with insurance may not be able to afford care.
Without regulation, premiums, co-pays, and deductibles have skyrocketed, forcing people to switch to very-high deductible policies. If they get sick they may be as badly off as if they had no insurance at all. 600,000 personal bankruptcies a year are due to medical costs. Most of these people had insurance.
The United States is the only major country in the world that does not have some form of government-mandated, tax-supported, universal health care, either directly government-run, or a single-payer system where the government is the insurer.
Medicare for All is a proposed single-payer system. Health care remains private. People can keep their doctors. The government pays the bills. Medicare for All covers vision, hearing, dental, mental health and long-term care, services not currently covered under Medicare.
Public Option, or Medicare for All Who Want It, simply adds Medicare or Medicaid to existing insurance options. It does little to address underlying problems.
Medicare for All would cost about $3 trillion per year. The government already spends roughly $2 trillion on health care. To pay for the rest, two presidential candidates, Bernie Sanders and Elizabeth Warren, propose some form of wealth tax. Sanders also proposes a 7.5% payroll tax on employers, excluding the first $2 million of payroll, and a 4% tax on individual income over $29,000. Warren’s “employer health care contribution,” would be 98% of what companies currently pay for health insurance.
Healthcare currently costs about $3.8 trillion per year. Under either proposal almost everyone would pay less than they do now for far better care. Even those who pay more would benefit from living in a healthier, more equitable society.
“Our current system is over-priced, under-performing, inequitable and unsustainable,” Ramirez concluded. “We simply need the political will to change it.”