Vermont Standard
By Kurt Staudter

Back when I was in college, I wrote an exhaustive paper on the Vermont experience moving towards a single-payer universal coverage healthcare system. At the time when the Vermont Democrats had the Senate, the House and our smiling governor looked into the camera and told us that the struggle was over and that we’d lead the nation in reforming healthcare. We all know the end of that story: Governor Shumlin wasn’t up for leading the state to single payer. Since then, politicians under the golden dome have been content with just going with the flow. Legislation that would fix lots of our healthcare problems is stuck languishing on the wall in the healthcare committees. Unlike the wonderful book by John F. Kennedy, “Profiles in Courage,” up in Montpelier we see the Democrats and profiles in cowardliness.

In my research, I had access to the national labor archive maintained by the AFL-CIO, and some of the most amazing insights I gleaned from that collection were eye-opening. First was the fight for a single-payer healthcare system dated back to the Truman administration just after WWII as the European countries all went for national plans. Do you think we waited long enough yet? However, even back then the powerful medical industrial complex (HIC) put an end to the effort here. In cahoots with the providers were the unions, and they fought the effort because good health insurance was their top selling point to new members while organizing.

Going through the records into the 1960s I discovered that the efforts to create Medicare and Medicaid were pushed by the HIC. The insurance companies and providers weren’t stupid: Poor people can’t pay for health insurance (Medicaid) and old people need too much care (Medicare.) With those two populations out of the mix, the health insurance companies and large providers were now free to profit from the sick and dying. For the most part unregulated, they went wild charging us more for care that was declining in quality.

Right now healthcare related spending in the country is pushing 20% of the gross domestic product (GDP.) That’s one of every five dollars spent in the U.S. economy is spent on healthcare. We easily spend twice what others spend around the world and, measured by some metrics like infant mortality, the U.S. has worse outcomes than some third-world countries.

OK, we all know what the problems are, it’s too expensive, it’s poor quality and it doesn’t cover everyone. However, if you’re an investor and shareholder you’re doing just fine, and that’s the real problem. For way too long, people have been making lots of money on the sick in this country. Back in 2018, we spent $3.6 trillion, and between 10 and 25 cents on the dollar are going for administration and profit. Do the math: There’s hundreds of billions in profits to be had, and we’re going to have to rip it out of the cold dead hands of the HIC. Why would they give it up willingly and besides, don’t they already get the best legislation money can buy?

As other states try to reform healthcare around the country, we’re seeing no difference in the result. Powerful special interests stop it dead in their tracks. Just like with Obamacare,or the No Insurance  Company Left Behind  Act, unless the for-profit actors are not given a seat at the table nothing will change.

Not satisfied with their share of the pie, now they want a slice of the Medicaid action with Accountable Care Organizations (ACO). The irony here is that the Vermont ACO, OneCare, is nothing more than a middleman that siphons millions while providing no care, and according to the State Auditor Doug Hoffer, no accountability. What’s worse is now the ACO is owned by the largest hospital in the state. What could possibly go wrong?

As I write this, one of the ceaseless Medicare Advantage commercials plays on the TV in the other room. Started by the Trump administration and continued by Biden, we now have a middleman that gets paid by Medicare and then pays our providers. Now here’s the kicker: Anything left over is free to the Direct Contracting Authority (DCA) to keep as profit. As you might expect, the insurance companies have moved in to fill the role of DCA and are up to their old tricks of denying payment as their knee-jerk response to any and all claims.

It has been said by some that the ultimate goal of the ACOs and DCAs is to privatize our public sector health plans. Moreover, you’d think that now that the Dems are in control that these Trump era initiatives would end up in the dustbin of history. Not so. Biden and his Health and Human Services agency have been full-steam ahead towards more profiteering, more suffering and more transfers of wealth from hard working men and women to the corporations. If lawmakers put as much effort into fixing Medicare as they do in screwing it up, then we’d have the best healthcare in the world. Instead, the richest nation on the planet is just a healthcare embarrassment.