Healthcare and Capitalism ��The State of American Healthcare and How We Can Change It

A CPUSA Presentation

Disclaimer

Useful Terms

• Health Insurance Premium – The amount that policyholders pay for health coverage.¹
• Health Insurance Deductible - The amount you pay for covered health care services before your insurance plan starts to pay.¹
• Medicare – An American health insurance program for U.S. citizens and certain non-citizens aged 65 or older²
• Medicaid – An American health insurance program that covers U.S. citizens and certain non-citizens with limited income²
• Single-Payer Health Insurance – A healthcare system in which one entity (a single payer, usually the government) collects all healthcare fees and pays for all healthcare costs. Depending on the country, care is then delivered by private or public facilities.³ Single-Payer as a term does not refer to coverage status.⁴
• Universal Healthcare – All people regardless of status have coverage within a certain jurisdiction (say, a state or a country).⁴

1. https://www.healthinsurance.org/glossary/health-insurance-premium/
2. https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC5481251/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6775924/#:~:text=Whether%20a%20health%20care%20system,it%20single%20or%20multiple%20payer.

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Useful Terms

• Affordable Care Act (ACA) – A comprehensive health reform signed into law in 2010 by the President Barack Obama. Key points include¹:
• Requiring U.S. Citizens and Legal residents to have qualifying health coverage at risk of a tax penalty
• Requiring employers with over 50 full-time employees to offer health insurance coverage
• Expanding Medicaid to all non-Medicare eligible individuals under age 65
• Dictating an essential benefits package that all health plans must cover at a minimum
• Prohibiting individual and group health plans from placing lifetime limits on the dollar value of coverage

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• Medicare for All – A single-payer healthcare payment plan (notably fronted by Senator Bernie Sanders and Representative Pramila Jayapal) that would act as a replacement for all private health insurance, as well as the current Medicare program.
• It would entail comprehensive benefits financed by taxes (no premiums), a lifetime enrollment, and would be accepted by all state-licensed certified providers who meet eligible standards, though not all Medicare for All proposals share the same benefits.²

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1. https://www.kff.org/affordable-care-act/fact-sheet/summary-of-the-affordable-care-act/
2. https://www.healthline.com/health/what-medicare-for-all-would-look-like-in-america#2

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Part 1: ���The State of American Healthcare

The State of American Healthcare Payment

• Private Insurance is the dominant form of healthcare coverage in the United States
• Of Americans with health insurance, (92%), 65.4% are insured by private health insurance companies (Anthem, Kaiser Permanente, etc.) and 36.3 are insured by public health insurance (Medi-Cal, Medicare, etc.)¹

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• Workers’ contributions and family premiums to employer-provided health insurance plans have grown at a rate 3 times that of workers’ earnings, far outpacing expected price hikes caused by inflation²

1. United States Census Bureau
2. “Why does the cost of employer-sponsored coverage keep rising?”
3. Profitability of Health Insurance Companies

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1. “Why does the cost of employer-sponsored coverage keep rising?”

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1. https://www.ncbi.nlm.nih.gov/books/NBK571929/

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Not Just the Insurance Companies

• While insurance company stock prices have doubled since 2014, profits for health insurance companies have been consistently lower than those for nonprofit and for-profit hospitals¹

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1. “Why does the cost of employer-sponsored coverage keep rising?”

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Profits Over People:�Hospital Mergers and Private Insurance

• Large hospital organizations (such as UnitedHealth Group) are routinely buying up smaller hospitals to consolidate services¹
• Due to lack of competition, these hospital networks can charge exorbitantly for patient care
• Large hospital systems can accept or deny insurance providers as they see fit, restricting patient access to care². Certain hospital systems are owned by the same company that provides insurance or provide their own health insurance (Ford Health System in Detroit)
• Hospital mergers have resulted in:
• Higher insurance premiums and lower wages for healthcare professionals.³
• Worse care for patients due to the avoidance of lower-cost procedures and efficiency quotas for physicians⁴

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1. “Big corporations are quietly taking over your medical practice.”
2. “Some hospital networks also become insurers”
3. “Environmental Scan on Consolidation Trends and Impacts in Health Care Markets”
4. “The Impact of Vertical Integration on Physician Behavior and Healthcare Delivery: Evidence from Gastroenterology Practices”

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“Sleeping with the Enemy”:�Organizations and Industry

• Many American healthcare organizations have deep ties to industry, leading to blatant conflicts of interest in research and health guidelines¹
• NIH (National Institute of Health) lists Pepsi and Coca Cola as corporate sponsors
• AAP (American Academy of Pediatrics) partners with Nestle
• In a survey of the department chairs at Harvard Medical School by Eric Campbell in 2007, 2/3rds of the department chairs had a direct personal tie to industry

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1. “Becoming Employees: The Deprofessionalization and Emerging Social-Class Position of Health Professional” by Matthew Anderson

Divorcing the healthcare system from the profit motive is required for a healthier patient population.

���Part 2: �����Vietnam and China

Vietnam

• Universal Health Coverage – 89.3% of Vietnamese people have health insurance (almost as high as the US’s 92%) as of 2021, up from 63% in 2010¹
• Community-based services (immunizations, hygiene, nutrition) provided at low or no cost
• Coverage plan is the same for all citizens
• Rapid growth in medical product development, including vaccines¹
• Challenges include expansion of medical care to rural areas and some high out-of-pocket costs for certain procedures, but increased government funding towards healthcare programs is alleviating these concerns
• Vietnam has one of the highest scores (73 out of 80 in 2018) in the WHO’s UHC index on coverage of essential health services²

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1. “Vietnam’s Evolving Healthcare System: Notable Successes and Significant Challenges”
2. “Advancing universal health coverage in China and Vietnam: lessons for other countries”

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Vietnam (cont.)

1. https://data.who.int/countries/704
2. https://data.who.int/countries/840
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC9643243/

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2020

2020

China

• Universal Healthcare Coverage
• Largest population coverage in history (96% of 1.4 billion as of 2023)¹
• Insurance Group Categories²
• Insurance care is divided into different public agencies based on patient population (urban and rural)
• Service coverage is stilted based on how much funding each agency receives
• Strong government incentive for population coverage
• Population coverage is a performance indicator for local governments²

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1. Achievements and Challenges of the Healthcare System in China
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC7690086/

China

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1. USC Annenburg US-China Institute (Data Pullsed from Johns Hopkins and Organization for Economic Co-operation and Development

China (cont.)

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https://data.who.int/countries/156

https://data.who.int/countries/840

���Part 3: ���Is change possible?�

Instituting Healthcare Change in Switzerland

• Until 1994, Switzerland had a healthcare system based entirely on profit-oriented, private health companies
• Companies had complete freedom to charge premiums based on risk groups determined by the companies themselves¹
• Essentially no services or coverage mandates
• Now, all Swiss insurance companies must offer basic services to all Swiss citizens

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What happened?

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1. “Explaining Policy Stability and Change in Swiss Health Care Reforms” by Björn Uhlmann and Dietmar Braun

Escaping Private Insurance: Switzerland’s Story

Soaring costs caused by the Swiss Free Market Healthcare system instigate attempts at Healthcare Reforms

1964

1972

Alternatives to the current Swiss system are proposed:

1. Comprehensive mandatory health insurance
2. Private option with some mandatory inpatient payments
3. Status quo upheld

1974

Voters uphold the status quo

1. “Explaining Policy Stability and Change in Swiss Health Care Reforms” by Björn Uhlmann and Dietmar Braun

Escaping Private Insurance: Switzerland’s Story

Panel of Healthcare Experts assembled to address viability of another Swiss Healthcare landscape due to unacceptable prices

1987

1992

The Swiss Healthcare Minister (a member of the liberal CVP, or Christian Democratic Party) proposed a healthcare reform law that was a compromise between the Socialist Party’s Universal Mandatory Coverage and Private options proposed by bourgeois parties

1994

A coalition between the SP and the CVP allowed a 51.8 percent majority in favor of the proposed healthcare reform law

1. “Explaining Policy Stability and Change in Swiss Health Care Reforms” by Björn Uhlmann and Dietmar Braun

How do we fight back against private insurance companies and for a single-payer, universal coverage system?

Forming Coalitions

• Labor United for Universal Healthcare
• Backed by a coalition of Unions, including LA Fed and the National Union of Healthcare Workers
• Works with physician groups such as Physicians for a National Health Program
• Provides information for voters on local healthcare measures and bills such as the Healthy California Program, SB 562

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https://laborforhealthcare.org/about/

��Concluding Thoughts

• What does equity look like in a healthcare payment system? If someone needs an expensive procedure, who should pay for it?

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• Coverage does not necessarily mean quality; what metrics should be considered for an equitable standard of care? Who should decide these metrics?

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• Paying for healthcare is just one component of the overall healthcare landscape. How do we take medical research out of the hands of big business? How do we produce more primary care practitioners?

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