John Geyman on Step by Step Reform Versus Medicare for All

Even the most ardent supporters of Medicare for All in Congress, including Senator Bernie Sanders and Congresswoman Pramila Jayapal, are retreating into President Biden’s step by step approach to addressing the ravages inflicted on the American people by the increasingly powerful medical industrial complex.

John Geyman

Sanders wants to drop the Medicare age to 60, expand it to include dental, hearing and vision and cap all out of pocket expenses at $2,000.

Those who support the Sanders approach, like Michael Lightly, admit that “an age-based expansion would leave over one hundred million residents of the United States at the mercy of employer-provided health benefits.”

“But unfortunately, Medicare for All isn’t yet winnable,” Lighty says. “Expansion is.”

John Geyman is the author of the just released America’s Mighty Medical Industrial Complex.

In it, he pushes back against the step by step approach.

“I end the book with a quote by doctors Phil Caper and Peter Arno,” Geyman told Corporate Crime Reporter in an interview last month. “They have been around health policy circles for about 40 years. They know the ropes. Phil Caper was working inside the beltway many years ago.”

“The real struggle for a universal single payer system in the U. S. is not technical or economic but almost entirely political,” Caper and Arno write. “Retaining anything resembling the status quo is the least disruptive, and therefore politically easier route. Unfortunately, it is also the least effective route to attack the underlying pathology of the American health care system – corporatism run amok. Adopting the easiest route will do little more than kick the can down the road and will require repeatedly revisiting the deficiencies in our health care system until we get it right.”

Geyman says that – “as usual, any time that Medicare for All is raised, the insurance industry, big pharma, hospitals, propose these step by step approaches.” 

“In previous drives for reform, there were about five lobbyists inside the beltway for every legislator. It’s a battle royale. It’s about money and profits. It is a medical industrial complex in full form.”

What is the medical industrial complex?

“Dwight Eisenhower in his farewell address to the country back in 1961 warned us about the military industrial complex. Then in 1970, Barbara and John Ehrenreich warned us about the medical industrial complex. They wrote an important book – American Health Empire – Power Profits and Politics.” 

“Their warnings are right on. It has developed incrementally. A corporatized for profit and now largely investor owned complex that runs much of our healthcare system and ends up adverse to patients. Prices and costs are what the traffic will bear. Access goes down. Quality of care goes down. We have more and more people unable to afford care.”

“On page 39 of my book is a chart comparing investor owned care versus not for profit care. And it just goes right down the list.”

“For investor owned care we have hospitals with higher costs, fewer nurses, and higher death rates than not for profit care.”

“We have emergency medical services with higher prices, worse care with slower response times.”

“Nursing homes are often in corporate chains, have lower staffing levels, worse quality of care and higher death rates.” 

“Mental health centers have restrictive barriers and limits to care, such as premature discharge without adequate outpatient care.” 

“Dialysis centers have mortality rates 19 to 24 percent higher and 53 percent less likely to be put on a transplant waiting list.” 

“Assisted living facilities show many critical incidents of physical, emotional, or sexual abuse of patients.” 

“Home health agencies have higher costs, lower quality of care.” 

“Even hospice care has been privatized, with missed visits and neglect of patients dying at home. They recruit patients and then neglect them.”

“This is all well documented. It goes right down the list.”

You contrast what you call an amoral medical industrial complex with a moral medical community. Could there be a moral medical industrial complex? Could you have these giant medical centers with chains of hospitals that were committed to public health?

“I don’t think so in our culture. We have had since 1970 for the medical industrial complex to demonstrate if that were possible. And clearly it is not. If we look at experience and behavior and our culture, I would say no.”

You portray the medical industrial complex as riven by corporate crime and fraud. Is there any indication that a single payer system would be less susceptible to being ripped off than the fragmented system we have now?

“It’s a challenge for the government to do it right. The Medicare for All legislation in the House will bring negotiated prices for drugs. It will bring negotiated prices for medical devices. All that can be done and should be done. Traditional Medicare is much more efficiently run and managed than private insurance. HR 1976 would bring universal coverage for all medically necessary care including areas that have not been well covered, such as mental health care, long term care, dental, hearing and vision. This would be for all residents of the country.”

“Most health professionals, if they want to, can remain in private practice. It’s not a socialized system. This legislation would share risks of accidents and illnesses among all 330 million Americans. It would establish an office of health equity to monitor and eliminate health disparities and promote primary care. It would do all of these things. Is that impossible to do? No. It has to be done.”

President Biden is concerned about taking away employer sponsored insurance from the 150 million or so Americans who have it. 

“Here is what Dr. Atul Gawande said. He wrote a book called Being Mortal: Medicine and What Matters in the End. He chops right through to the problem of employer sponsored insurance.

“The central error of our system has been attaching our health care to where we work,” Gawande writes. “A company sponsored insurance plan for a family adds an average of fifteen thousand dollars to the annual cost of employing a worker – effectively levying a fifty-per-cent tax on a fifteen dollar an hour position. We’re all but paying employers to outsource or automate people’s jobs. The result is to make both work and health care less secure and more fragmented – and to deepen our inequalities.” 

“I just saw a report yesterday from the Kaiser Family Foundation. They surveyed top executives from almost 90 percent of large employers. They are saying that the cost of providing health benefits to their employers will become unsustainable in the next five to ten years. The system is falling apart. The pressure will build.”

How many people will die every year from lack of health insurance or under insurance?

“A Yale study has just found that 68,000 people a year would not die under Medicare for All that would have in our current non system.”

[For the complete q/a format Interview with John Geyman, see 35 Corporate Crime Reporter 19 (12), Monday May 10, 2021, print edition only.]

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