By Jack Bernard
The Springfield (Mo.) News-Leader, Aug. 21, 2013
While hospitals in Missouri are having their reimbursement cut under the Affordable Care Act (Obamacare), “red’’ leaning states are still trying to figure out whether or not to fully implement the law.
As pointed out in “What’s next? Information about the Affordable Care Act is in short supply in Missouri” in the News-Leader Aug. 11, Missouri has been among the most vehement in its opposition to implementation, going so far as legally prohibiting state employees from assisting.
Hospitals that treat the poor in disproportionate numbers are having their Medicare reimbursements cut under the ACA. Before the Supreme Court made Medicaid expansion voluntary, the law assumed that under the ACA these hospitals would see a decrease in medically indigent patients who would instead be covered by Medicaid.
In the short term, we Republicans need to wake up and support implementation of Obamacare in so far as it expands coverage of insurance to our low-income citizens at little cost to the state. The first three years of the expansion would be paid for 100 percent by the feds. After that, there would be a gradual tapering down to 90 percent federal support.
Expanding Medicaid also makes economic sense. Adding coverage for a more people means more economic activity in the health sector. This equates to thousands of jobs being created, both directly and indirectly. With unemployment still high, there is a need for more jobs in Missouri.
Besides, if Missouri does not take the federal money, it will be used in the “blue” states in the Northeast and the West Coast. So, take the money and push for more effective reform.
Which leads us to “where should the GOP go from here long term regarding national health financing reform?” The answer, to paraphrase “Star Trek,” is in a bold new direction where no Republican has gone before.
And, what would be bolder than having my party propose Medicare for all?
Medicare for all would find wide acceptance with the all important independent swing voters who make up an increasing portion of the electorate and decide national elections. It would also be a hard position for elderly tea party activists to attack. In 2009, they carried nonsensical signs saying “keep the government out of my Medicare.” Tea party or not, seniors like me love the program.
A group of progressive doctors known as Physicians for a National Health Program have a website, www.pnhp.org, devoted to explaining how universal Medicare would operate and how it could be funded.
On this site, you can also find references to numerous studies showing conclusively that our current system is clearly not cost-effective. The United States is currently spending more tax money per capita on health care than any other developed nation. We are just not getting as much for our excessive public expenditures.
It is time for us to face the facts. We do not have the best health care system in the world. Our expenses are out of control and our outcomes are much worse than nations with a single payer system, like Canada.
If we really want to change America for the better while turning around electoral losses in Congress and the presidency, we Republicans should propose something that can actually get the votes needed for passage. That something is Medicare for all.
Jack Bernard is a retired senior level health care executive who worked with Missouri hospitals and health systems on planning and cost-containment issues. He is a former chairman of the Republican Party and the County Commission in Jasper County, Georgia, an Atlanta suburb.