By Jack Bernard
The Citizen (Fayetteville, Ga.), Oct. 4, 2016
Megan McArdle, a well-known national writer for Bloomberg View, has put forth herself as an impartial expert on our healthcare system. However, I have found this piece (9-7-16, Citizen and 8-31-16, Bloomberg View) and other McArdle columns lacking in balance and solutions, not that what she says is necessarily wrong about the current situation.
For example, what she does not say is that the most recent data show that the ACA, Obamacare, has drastically reduced the number of uninsured. According to the National Center for Health Statistics, in the first quarter of 2016 there were “21.3 million fewer persons than in 2010” who were uninsured. That is quite an accomplishment, even though it still leaves 12% of our adult population uninsured, a bit less than 30 million people.
On the other hand, most of what she says about the ACA is true. It is a highly political “Rube Goldberg” rigged mess. Problems such as adverse selection, driving up costs for insurers who will then be forced to leave the market or raise rates, were entirely predictable. Years ago, my letters that were published in the Washington Post and USA Today indicated that virtually all of this would occur.
However, her analysis is incomplete. Although she briefly alludes to certain ACA provisions as halfhearted watered down versions of what works in Europe, she does not say is that the basic coverage and cost problems in the USA are due to our fragmented private insurance system.
It was and is this same system, via corporate lobbyists, that throws money at politicians so that nothing (including access, quality or cost) gets in the way of the corporate profit motive. It was corporate money and clout that pushed the ACA through Congress. Remember who funded the ads.
As she says, it’s the “political calculation,” and it is both parties who are guilty … aided and abetted by the relatively recent naive (read the decision to see how SCOTUS believes money has little effect on our politics) and disastrous Supreme Court decision known as Citizens United. How a supposedly conservative court can encourage the buying of our politicians is just beyond me.
But, my biggest problem with McArdle is that she appears to have no suggestions to clean up the malfunctioning system long term. A recent McArdle single payer (Medicare expansion) piece in Bloomberg purposefully misunderstands and excuses away the basic problem, our irrational healthcare financing and delivery system. In fact, the aim of that entire article seems to be to blindly accept the mess that we currently have because, in her words, “the politics is impossible” and there is a problem with “constitutionality,” whatever that means to her.
Further, she makes the incorrect assumption that single payer advocates believe that Medicare expansion will “magically transport us to the land of cheap health care.” I have been involved with single payer for many years and I know of no advocate who has said it will be easy. In fact, that very difficulty is the reason that both Obama and Trump have said that they could not support single payer, although both have made positive statements about it.
Let’s start with what McArdle gets right in her Bloomberg column. The U.S. spends a lot more per capita than any other country on healthcare, per her chart in that piece, and a lot of public dollars on a variety of government healthcare programs. And, our system does not deliver better results, an inconvenient fact which she ignores but that many healthcare experts know to be true.
We spend much more of our GDP on healthcare than other developed nations. When I became Director of Health Planning for the state of Georgia in the mid-1970s, we spent about 8 percent of GDP. We are now at about 18 percent … and still growing. What this means to the taxpayer is that we cannot make investments in other long-term priority areas, like education or alternate energy models, that are vital for the future of the nation.
With our current fragmented system, key players (providers, insurers, big pharmaceuticals) hold all the winning cards. That can only be changed if there is one payer, Medicare, with enough clout to force change. McArdle ignores this fact and others, incorrectly stating that private insurers (20 percent admin/marketing overhead) are just as efficient as Medicare (3 percent).
McArdle’s unstated conclusion in that piece and this current one as well is to just acknowledge that change is too hard to accomplish. So, let’s just complain and do little.
That position is a cop out and one that hurts this nation economically … and morally. What we need are leaders willing to look at the facts, fight the entrenched special interests and pass Medicare for All.
Jack Bernard resides in Peachtree City, Ga.