Medical debt pushes more than half a million people in the U.S. into bankruptcy each year.
More than a third of healthcare expenses go not to actual medical care, but to administrative costs.
But despite the well-known state of the U.S. healthcare system and a current political climate in which the fight for Medicare for All has been relatively "quiet," as one advocate said, Dr. Deborah Richter believes the Gathering showed a resurgence in the movement for a government-funded healthcare system is on its way.
Growing bipartisan anger over a lack of transparency about healthcare prices, private insurers' denial of claims, and the huge profits raked in by insurance companies while an estimated 98 million American adults skip or delay medical appointments to avoid an unaffordable bill are all pushing people to demand change, according to Richter, who gave a presentation about efforts to bring government-funded healthcare to Vermont.
"Walter Cronkite once said that the U.S. healthcare system is neither healthy nor caring, nor a system," said Richter in the talk, which like the rest of the three-day conference was livestreamed. "And decades later, it's still true. But I think that's the bad news. The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
The system that costs Americans twice the amount which people in other wealthy countries pay for healthcare is spending money not on caring for people, but on administration, said Richter, showing a chart that compared Duke University Hospital Medical Center, a facility with 957 beds and 1,600 billing clerks, with a Canadian hospital with 1,200 beds and just seven billing clerks.
Since 1970, she said, the U.S. has seen more than a 4,000% increase in the number of healthcare administrators, while the number of doctors has risen just 200%.
The discrepancy has helped lead to a system in which insurers are increasingly denying claims to maximize their own profits.
"The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
"I'm hearing from people who were pretty much Republicans and more conservative in their views complaining about Medicare, complaining about the fact that Medicare doesn't cover things," Richter told Common Dreams after her talk, pointing particularly to Medicare Advantage, which is billed as an alternative to traditional Medicare that provides greater benefits, but whose participating private insurers frequently deny claims and overcharge the government, costing taxpayers $140 billion annually.
Richter, a primary care physician who chairs Vermont Health Care for All, said she frequently hears from patients "about having to jump through all kinds of hoops in order to get a procedure or a prescription or whatever. And you're hearing that from pretty much everybody now... Those are all the kindling that we need to get this movement ignited again."
"It's the silver lining to having things just crumbling before your eyes," she added.
In Vermont and across the country, the crumbling healthcare system is one in which primary care doctors are leaving their profession in droves—fed up with the bureaucracy put in place by for-profit insurance companies that force them to get approval to provide certain services.
With insurers placing more value on surgeries and other procedures than on the preventative healthcare management provided by primary care doctors, physicians are spending their days "having to deal with prior authorizations and having to deal with paperwork to justify that you deserve to be paid for the services you render," said Richter. "When you're seeing 16 to 20 patients a day, and each one of those has its own enormous bureaucracy, you can imagine how you end up taking your computer home to do your charts. Medical students are not blind to this and are not choosing [primary care], and that's become a catastrophe."
At a panel discussion on healthcare for senior citizens and the hospital system, Medicare for All advocate Wendell Potter recalled that while he was working in the for-profit health insurance industry, an executive told him the greatest threat to the business was the possibility that employers—who pay for insurance plans for roughly half of insured Americans—would begin to see that the industry does little to ensure people get the healthcare for which they pay an average of $477 per month in premiums.
"Someone asked [the executive], 'What keeps you up at night?' And he said disintermediation," said Potter, who worked in communications for health insurance giants Humana and Cigna before leaving the industry to advocate for Medicare for All. "He said that employers in particular would begin to wake up and question the value proposition of big insurance companies as the middleman. But they as middleman take more and more and more of the dollars that we spend on healthcare."
Another panel focused on price transparency in healthcare, a cause which Sanders (I-Vt.) has championed along with Medicare for All to reduce patients' costs within the current system.
Along with Sen. Mike Braun (R-Ind.) earlier this year, Sanders introduced the Healthcare Prices Revealed and Information to Consumers Explained (PRICE) Transparency Act 2.0 (S. 3548), which would require all negotiated rates and cash prices between healthcare plans and providers to be accessible to patients.
Healthcare price transparency has officially been the law of the land since 2021, explained Cynthia Fisher, founder and chair of Patient Rights Advocate, at the Gathering. But many hospitals refused to comply with the price transparency rule finalized by the Centers for Medicare and Medicaid Services under the Trump administration—even suing to block the rule and appealing when they lost the case.
More than three years later, Fisher's organization still sees medical bills "beyond the negotiated rates that are in place now today," she told Common Dreams. Only 35% of hospitals post all of their pricing data for patients to see online, she said, and "the insurance industry has made the files very difficult for anybody to read and parse through."
Under the for-profit healthcare system, Fisher said, patients become victims of the equivalent of "extortion" as they are forced to arrange medical procedures without knowing how much they'll cost out of pocket or how much another hospital might charge for the same care.
"Every time we get care we have to pay by first signing a blank check," said Fisher. "We're signing away our rights to know those prices upfront... And we're signing away our rights to say... that we are responsible to pay whatever they choose to charge us."
Fisher told the story of one patient in Colorado who was provided only with an estimate of the cost before she got a hysterectomy, with her insurer telling her she was likely to pay a $500 copay and the procedure would cost an estimated $5,000 total.
"What happened in reality was the insurance company denied the claim and the doctor charged $9,000 out-of-network and the hospital had a lien on her home," said Fisher, "because she couldn't pay the $74,000 bill."
"Everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
Patient Rights Advocate helped the patient find the hospital pricing file and found that the procedure "was indeed closer to $5,000. And indeed it should have been covered," Fisher explained. "It took us, with her, about four or five months to get that lien off of her house. But [transparent] prices empowered her, they saved her, they protected her, and it's happening across the country."
The group has started a project called Power to the Patients, partnering with famous musicians as well as artists to make sure Americans know they have the right to know how much their healthcare will cost ahead of time.
Artist Shepherd Ferry designed a mural for the group that has now been painted by local artists in nearly 50 cities across the U.S., including Seattle, Los Angeles, and New York.
With 54% of American adults delaying medical care to avoid the cost, said Kevin Morra, co-founder of Power to the Patients, millions of people across the country have come to believe that "healthcare is not for them."
"They can't afford it. They don't want to be in a critical moment where they decide, 'Do I pay my rent or do I pay this medical bill?'" Morra said at the Gathering. "People are making a decision, a deliberate decision to not seek medical care, to not take these nondiscretionary procedures. And when nondiscretionary becomes discretionary, we all have a real infrastructural issue in this country."
During the question and answer session at the panel on healthcare for senior citizens, healthcare providers and patients alike raised their hands and shared personal stories about the "demoralizing" nature of fighting to have medications and procedures covered by insurance companies, with doctors "stripped of [their] professionalism" and patients forced to prove to companies that they're required to cover certain services.
Potter agreed with Richter that Medicare for All advocates are "regrouping," particularly around the issues of improving traditional Medicare by including dental and vision coverage and protecting the program "from creeping, almost galloping, privatization by big insurance companies" through Medicare Advantage.
"More and more people are waking up to realize, we do not want private insurance companies to be in control of our healthcare system," said Potter. "Private companies have grown massively over the last several years and they control so much of their access to care."
From the audience, Ellen Oxfeld of Vermont Health Care for All rallied other attendees of the Gathering.
"The left gets very splintered," said Oxfeld. "And I think Medicare for All is one issue that can unify all of us. I know it's not happening tomorrow, but... everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
"We can get there, is what I'm going to say," she added.
