Last month, the House Oversight Committee had the first hearings on Medicare for All in the 117th Congress, sponsored by Rep. Carolyn Maloney (D-New York) and Rep. Cori Bush (D-Missouri). The hearings included testimony from patients, patient advocates, and healthcare experts. The conversation detailed the ways in which our system is broken — and why we cannot fix it without government power and commitment.
In one particularly poignant exchange, Rep. Katie Porter of California engaged an expert witness on the bloated overhead of our current insurance system: “I support patients over paperwork,” she concluded.
Quickly after the hearings, Sen. Bernie Sanders announced another hearing in the Senate Budget Committee in May. “The function of a rational healthcare system is to provide healthcare to all in a cost-effective way — not to allow private insurance companies and private drug companies to make obscene levels of profit,” he said.
After a healthcare-intensive presidential primary, which concluded in the election of not-a-fan-of-M4A Joe Biden, progressives in the House and Senate are finally rebuilding momentum for Medicare for All. It can’t come soon enough. Not only did the pandemic demonstrate how broken our healthcare system is, but it made it worse. And many of the trends it set in motion may be difficult to reverse.
Opponents of reform — any kind of reform — try to peg the system’s dysfunction as a matter of inevitable circumstance. They use words like “unforeseeable,” “unpredictable,” and “tragic” to absolve themselves of any complicity in events they could have helped prevent. And while Medicare for All would not have stopped a new coronavirus from emerging across the world, it certainly could have helped prevent the unnecessary mayhem it created here.
The pandemic has claimed nearly a million lives. To appreciate what that means, it’d be like a 9/11 attack every day… for almost an entire year. And it’s not just the lives — it’s the holes those lives leave in the homes and hearts of millions more. It’s also the livelihoods that have been upended and destroyed, flipped upside down as jobs and savings and opportunities were lost.
Even for those of us who made out with our lives and livelihoods intact, consider the pain we’ve endured in forms big and small. Weddings rescheduled, celebrations missed, milestones unmarked.
No one could have predicted this particular pandemic, caused by this particular virus. But that some virus would cause some pandemic? That was all but certain. Yet we were unprepared. Our public health system had been infarcted from the inside — the victim of a gradual ischemia that decimated it slowly. Our network of clinics and hospitals, designed to forge profit from illness. “Just-in-time” supply chains designed to prevent every ounce of waste meant that frontline workers were left without that personal protective equipment they needed to protect themselves and their patients.
Let’s zoom in on the nurses who’ve cared for millions of Americans, valiantly putting their duty ahead of their own wellbeing. For decades, nurses have been underpaid and underappreciated by a healthcare system that has tried to stifle their pay and raise their patient burdens at every turn — squeezing out every last dime of their productivity.
As cases surged early in the pandemic, hospitals struggled to accommodate, turning to travel nurses to address their shortages. Travel nurses routinely earn substantially more than their hospital-employed counterparts. At the height of New York City’s surge, a travel nurse could earn $100,000 for a 13-week contract. And yet that created the awkward circumstance wherein a travel nurse could be paid many times as much as a hospital nurse right beside them.
As COVID spread across the country, this incentivized more nurses to join the ranks of the travelers, earning more in less time than counterparts who’d been serving in communities for decades. A “death spiral” soon set in — understaffing leading to more reliance on travel nurses, which raises their pay, and creates more incentive for nurses to leave their hospital jobs and travel, thus accentuating shortages, and so on.
Nursing shortages are just one facet of a lattice network of healthcare delivery upended by the pandemic. Consider the fact that 22 rural hospitals shut down during 2020 and 2021 — in the middle of the worst pandemic in recorded history while hospitals struggled to deal with their patient loads. They added to dozens that had closed in the decade prior.
Why? Because rural communities lack the density or the wealth to sustain hospitals in a for-profit healthcare system. It doesn’t help when your patients forgo care because they have to drive too far or are uninsured — or reimburse at half the rate of private insurance because they’re on Medicaid.
Meanwhile, hospitals across the country are consolidating, as I’ve written about in these pages. That consolidation means that patients are facing fewer choices for where they can get their care.
One of the principal drivers of consolidation has been the rise of for-profit healthcare chains, like HCA Healthcare, the nation’s largest hospital chain. A recent report by the Service Employees International Union analyzed admission rates among Medicare patients across HCA hospitals and found that HCA’s rates were substantially higher than average — and how HCA hospitals charged nearly double as much as the average hospital.
Many of these mammoth healthcare systems have realized that they can squeeze even more profit out of their communities. Many are acquiring or building health insurance plans. The upshot is that they’ll be able to force regional employers into their plans because they dominate so much of their local markets.
Indeed, the new documentary InHospitable details the ways that the “non-profit” University of Pittsburgh Medical Center leveraged mergers and acquisitions to become the most dominant provider in western Pennsylvania, and then attempted to sever ties with one of western Pennsylvania’s largest insurers, effectively shutting off healthcare access to thousands who are insured.
Nursing shortages, rural hospitals shutting down, for-profit hospitals over-admitting and overcharging patients, hospital-insurance collusion: all of these are systematic issues at the heart of our healthcare system. They emerge because of the unique obsession with profits at the heart of every aspect of American healthcare.
And they’re extremely hard to reverse. Building new hospitals once they’ve shut down is an immense undertaking. So is forcing hospitals to break up after they’ve consolidated.
All of this is why a conversation about “universal health coverage” simply isn’t big enough to encapsulate the scale and scope of what’s broken. With these hearings, congressional progressives are reminding us of that.
Originally published April 5 in The Incision. Get more at abdulelsayed.substack.com.
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