Our health care payment system needs a complete overhaul

COMMENTARY

When the CEO of United Health Care was gunned down on a city street, it is unclear whether anyone expected the massive outburst of hatred for the health insurance industry. The memes are amazingly creative, the stories are bringing tears to my eyes, and the rage at these terrible businesses is only growing.

So what is private health insurance, how did these companies become the life or death decision makers?

The Great Depression followed a period that might be similar to the moment we are slogging through right now - the Gilded Age, from the 1870s to the early 20th century. Like now, the hallmarks were a huge and growing chasm between the wealthy and the poor, a very corrupt system, and fast technological growth. This was also the time when medical care was evolving from "medical schools" that accepted men who could pay, but gave them no hands on experience. They hung out a sign, and dispensed patent medicines, often with opium or actual poisons in them. Europe was far ahead in medical training, teaching about the body using a real cadaver, and other methods that actually attempted to show how you can help a sick person, methods that were sailing across the Atlantic by the early 20th century. The first real medical school opened in 1893 at Johns Hopkins University, thus opening the door to an actual health care system, and they were the first to admit women. While health care was far, far less expensive, complex and dominant in the economy, in 1911 the first employer sponsored disability insurance was offered, but it was mainly wage replacement for injured breadwinners. An aside - I had a kind great uncle who sold this very insurance to "help the working man." That disability insurance evolved into private health insurance in the first half of the 20th century. Blue Cross was introduced as a hospital insurance program. Given what we are facing in out-of-control health costs, this will sound hard to believe, but Franklin Roosevelt did not include universal health care with Social Security because it allegedly was not demanded - not by congress, interest groups, or citizens. We now know that even as early as the 1940s, the American Medical Association staged a campaign pushing private heath insurance as a symbol of freedom! And that universal health care was branded as socialism.

In the McCarthy era, the movement toward private health insurance being employer based was completed. In the late 1940s and early 1950s, the red scare cleaned out the socialist leadership in unions, the very people who would have fought for national health care. The era of business unions was upon us, and your job was your only ticket to health insurance. Millions of people have been stuck in jobs they hated because they needed the insurance for themselves or a family member. The fact that health insurance was unaffordable to many led to the 1965 creation of Medicare and Medicaid, serving the elderly, the disabled, and the very poor. The next major development in health insurance was Obamacare, a totally privatized, but more affordable, much more for some, program. Millions of us campaigned for a public option, at least, but we were denied.

It appears that the American Medical Association opposed universal health care from the earliest days, but many doctors now hate the health insurance industry - they hate the fact that their professional opinions and work are being undermined by business.

The CEO of United Health Care was all in on the AI program that denied 32 percent of doctors' treatment prescriptions for their patients. In a 2023 story about Cigna, Propublica found internal documents that claims are denied without even opening the file! "We literally click and submit," said one doctor. The stories of denial are heartbreaking: children denied life saving care for congenital conditions, patients being denied mobility because a motorized wheelchair is out of the insurance company's willingness to pay, an insured family hit with $100,000 bill because a child was medivac'ed to a different hospital, and in the emergency, nobody told them that a flight is not covered.

As we read and hear all the time, every industrialized country in the world has some form of universal coverage, although as fascism rears its ugly head in countries around the world, many of the national health care programs are being intentionally undermined by their governments - Canada, France and Great Britain come to mind. But as of yet, the US is the big winner in medical bankruptcies, people forced to live or die without any care at all, and highly paid health care executives.

At this time, American health care's payment system needs a complete overhaul in the opposite way Trump, Musk and their other superrich buddies will be steering the ship. Trump is still using the amazingly stupid phrase "we have the concept of a plan" for killing the Affordable Care Act and replacing it with a private plan that will essentially kick off more than half the population, since the big change will be an end to the demand that pre-existing conditions do not raise premiums - and we have a very unhealthy population. The Trump boys also plan to kill any government oversight process to appeal the denials.

So it is possible that, once Trump and the techbros get their hands on the health industry, only the wealthy and the comfortably middle class will have any health coverage, unless cash strapped states stand up. Project 2025 is brutal. And does anyone believe the trumpers will fund health clinics for those denied care? Obamacare is the only reason millions of Americans have the sorry and limited care they have, but when that goes, there is a void. It may be that Trump will offer you the same care that he offers victims of mass shootings ... "thoughts and prayers." But no health care.

Nancy Braus is a long-time Vermont activist who writes from Guilford. The opinions expressed by columnists and oped writers do not necessarily reflect the views of Vermont News & Media.