Is Quality Public Healthcare Possible in the US?

People in the US pay billions towards the health insurance industry, yet many in the healthcare field believe that this industry does little to ensure quality care to patients. While US healthcare spending is by far the highest of any country in the world, the country has the lowest life expectancy among other nations with a similar GDP.

In recent weeks, the rage against the for-profit healthcare industry in the United States has intensified. The reality faced by many in the US, of avoiding seeking medical care in an emergency for fear of costs, or having health insurance claims repeatedly denied despite paying thousands to private insurers, has become too much to bear.

Take the example of UnitedHealthcare (UHC), the most profitable health insurance company in the US. UHC has built its enormous profits off of denying health insurance coverage to patients at an increasing rate. Following the assassination of UnitedHealthcare CEO Brian Thompson, a major topic of discussion became the prior authorization denials that had skyrocketed under his tenure, leading to enormous profits for the company. 

These nationwide debates have reignited the popularity of a publicly funded, single-payer health insurance system that takes the profit motive out of healthcare. Leading the charge for this new system are physicians and medical workers themselves, seeking to unite the movement for single-payer healthcare with many other social movements. “Historically, major health reforms haven’t come as isolated events from other progress on social issues,” said Dr. David Himmelstein in an interview with Peoples Dispatch. Himmelstein is one of the co-founders of Physicians for a National Health Program alongside fellow physician Dr. Steffie Woolhandler. PNHP unites physicians, health professionals, and medical students to fight for a single-payer health insurance system in the United States. Himmelstein and Woolhandler founded the organization in 1987.

Under the current for-profit system, “what you run into from day one [as a doctor] is that the insurance companies are the ones that are telling you what you can and can’t do for your patients,” said Dr. Margaret Flowers, who also has been a part of PNHP and an activist for a public, single-payer health insurance system for many years. In 2009, she was arrested at a Senate Roundtable on Health Insurance after speaking out on behalf of a single-payer healthcare option. “Every year, dollars that could be spent on providing care are going directly to the health insurance companies.” 

Towards single-payer healthcare

“Health insurance corporations are a big business in the United States. When you look at which corporations are bringing in the most profits every year, the health insurance corporations are way up there,” said Dr. Margaret Flowers in an interview with Peoples Dispatch. “They’re just parasites that steal billions of dollars, trillions really, from our health care system. Every year, dollars that could be spent on providing care are going directly to the health insurance companies.” 

In 2022, UHC made USD 20 billion in profit. Other health insurance giants also raked in billions that year, with the health insurance industry making a total of over USD 41 billion in profits that year. 

Dr. Flowers is a healthcare reform activist who was a practicing pediatrician for 17 years, but left her medical practice out of frustration with a deep desire to fight against the health insurance corporations in order to advocate for a better healthcare system. “As soon as I got out of my training, I thought, great, I’ve gotten this good training. I’m ready to go out and take care of my patients. And what you run into from day one is that the insurance companies are the ones that are telling you what you can and can’t do for your patients.”

The frustration among physicians and healthcare workers at the health insurance industry is a common sentiment. Organizations such as Physicians for a National Health Program, of which Dr. Flowers has been a part of, has united medical workers to advocate for a universal, single-payer healthcare system in the United States. Single-payer, public healthcare policy, commonly referred to as “Medicare for all”, is popular among the vast majority of people in the US. According to a Gallup poll from early in November, 62% of people in the US are in favor of the government ensuring that everyone in the country has access to healthcare.  

Under a single-payer, government-run healthcare system, the entire health insurance industry would become obsolete. The single-payer model proposes that all healthcare costs would be paid for by the government, the single public authority, not a private authority or a mix of both. Advocates like Dr. Flowers and PNHP want such a public system to be nationwide, not up to the discretion of individual states. The system would also be comprehensive, meaning that it would cover all aspects of health care, including mental, dental, vision, and reproductive care, which usually are separated under the current for-profit health insurance model. 

“We want a system that gets the private entities out of our health care system,” Dr. Flowers articulated. Alongside fellow single-payer activists, Dr. Flowers is advocating for a system in which “all of the facilities would be publicly owned, and the physicians and other health professionals would be working for the government.”

A deadly status quo

While single-payer healthcare advocates fight to take the profit motive out of healthcare, the health insurance industry is vehemently opposing these efforts. According to Dr. Steffie Woolhandler, who alongside Dr. David Himmelstein founded PNHP in 1987, if  healthcare was provided “on a publicly funded non profit basis to everyone, the health insurance industry would go out of business.”

According to Dr. Woolhandler, health insurance industry leaders have been quoted as saying, “We’re opposed to single-payer national health insurance. It’s a life-or-death struggle for us.” 

In an interview with Peoples Dispatch, Dr. Woolhandler articulates that the opposition of the health insurance industry “along with opposition from other forces like the pharmaceutical industry, is there’s a reason we do not have the kind of nonprofit national health insurance that many other nations now have.”

Dr. Flowers claims that people in the US struggle to access quality healthcare under the current for-profit system, which forces working people to incur enormous costs, especially in emergency situations. “When you get sick in the United States or you have a serious accident, you don’t know what the costs are going to be,” Dr. Flowers describes. 

A recent study found that even those with private health insurance “spend $646 out-of-pocket, on average, for an emergency department visit.” This is compounded on the high costs that private insurance policy holders incur from their deductibles and premiums. This is because the health insurance industry “shifts a lot of the cost of care off on to the patient through money that you have to pay up front,” Dr. Flowers describes. 

“You may have to pay a certain amount of money, it’s called a co-pay, in order to see a health professional. So you have to pay right away when you’re going to get service. And then on top of that, insurance plans have what are called deductibles. So the insurance company won’t actually cover the care until you’ve incurred enough costs to meet your deductible. And these are typically 5,000-6,000 dollars a year. So people are paying maybe 10,000, 12,000, or more a year in health insurance premiums. And then another 5,000, 6,000, or more thousand dollars out of pocket before the health insurance actually covers them.”

As a result, working people in the United States feel forced to “stay home if they’re starting to feel like they’re having a heart attack instead of going to the hospital quickly, because they’re worried about the cost and they think, well, maybe I’ll just see if this will pass,” Dr. Flowers said.

According to Dr. Woolhandler, the enormous healthcare spending is due partly to the astronomical overhead costs of maintaining a for-profit healthcare system. “The total cost of administering the US health care system, if you include what the health insurance companies take, is overhead,” Dr. Woolhandler explained. “What the hospitals spend with the complicated paperwork we have to submit to insurance companies, and when doctor’s offices submit complex paperwork related to billing.” 

These administrative costs amount to around 30% of the nation’s total healthcare spending. Canada, a nation with a publicly-funded single-payer healthcare system, only spends around 17% on administrative costs. 

“So the share of spending that just goes for paperwork and transactions in the US is double the share in a place like Canada,” Dr. Woolhandler articulates. “The fact that it takes twice as much as a share of spending to administer the US health care system versus Canada, is really an indictment of how inefficient it is to run a profit-oriented health care system.”

“That means we’re wasting about $900 billion each year on useless administration, which is really two things,” said Dr. David Himmelstein to Peoples Dispatch. “One is the cost of extracting profits. And so and the second is the cost of enforcing inequality.”

“If you’re going to have lots of different health insurance plans, each one wants to make sure that it’s not paying for anything it doesn’t have to, and that no one gets health care they don’t have a right to. That’s really the cost to say we’re going to fight over every nickel and dime.” 

According to Dr. Himmelstein, this means that doctors have to spend “an enormous amount of time and money on the administrative hassles, because you basically have to get insurance companies permission to care for people.”

This is also the experience of Dr. Flowers, before she left her pediatric practice. “I had to fight with insurance companies constantly to get the care that I needed for my patients,” Dr. Flowers told Peoples Dispatch. 

“The moment that really struck me was when my office manager would tell me that if I had a patient and they had more than one complaint, I could only see them for one complaint and they would have to schedule another appointment for the second complaint,” Dr. Flowers described. “And I said, this is crazy. We’re asking parents to take time off work. We’re asking them to take the kids out of school to worry about this condition.”

Dr. Flowers also claimed that “the insurance companies will retaliate against you if you speak out for a national healthcare system,” and that she knew fellow doctors “who had lost their practices over speaking out or advocating for this issue.”

Fighting for a better system

Given the dissatisfaction with the health insurance industry, activists for a public healthcare system now see a renewed opportunity. 

“It’s really been interesting to see, after the death of the UnitedHealthcare CEO, Brian Thompson, the response of people in the United States,” Dr. Flowers said. She points to progressive legislation that has been introduced by progressive members of Congress, including the legislation for Medicare for All sponsored by progressives such as Bernie Sanders. 

“We need to push harder on members of Congress to make those changes,” Dr. Flowers said. “But during the health reform process, we didn’t just focus on members of Congress. We also focused on the health insurance corporations themselves.” 

“It’s really important that social movements not tie themselves to a political party, especially the Democratic Party,” said Dr. Flowers “The Republicans are pretty out front and just say, no, we don’t support [single-payer healthcare]. We’re not going to do it. A lot of Democrats will run saying that they support it, but then they get into office and they don’t do anything about it. They’re obedient to the party. So we really have to be independent of political party.”

For Dr. Woolhandler, fighting for single-payer healthcare is about mobilizing working people as well as healthcare workers. Dr. Himmelstein describes that, “historically, major health reforms haven’t come as isolated events from other progress on social issues.” 

According to him, “In the US, the progress in the 1960s on [public insurance systems] Medicare and Medicaid when they were first enacted, so Medicare for the elderly, Medicaid for the poor, was part of the upsurge of the Civil Rights Movement and the demands for attention to the needs of the poor and other groups.”

“In other countries, similarly, when they instituted national health insurance, it’s generally been part of a broader political mobilization, not just an isolated demand for health care,” Dr. Himmelstein continued. “So we need a broad political movement, not just one that pays attention to health care.”

Dr. Flowers also sees the importance of bringing together many movements together in a united front to fight for a public nationwide healthcare system. “We see workers in Jackson, Mississippi, who, this is part of their platform, pushing for universal health care. We see it in the climate movement,” Dr. Flowers said. “I’ve been interviewing folks who work on climate, and they tie climate to health care as well, as well as the anti-war movement and the anti-imperialist movement.”