By Jonathan Mizrahi, M.D.
St. Louis Post-Dispatch, Feb. 15, 2017
I hope many people were able to watch the debate that CNN hosted last week between U.S. Sens. Bernie Sanders and Ted Cruz. They spent over an hour fielding questions from spectators and moderators about the present and future of health care in the United States. Sen. Cruz provided a couple misleading answers and suggestions that I believe are worth clarifying.
First, he stated that his primary goal in repealing the Affordable Care Act was to remove government from the equation so that health care would be back in the hands of patients and their physicians. As appealing as he makes it sound, removing government-funded insurance would hardly make a dent in the amount of autonomy patients and their physicians have over their health care.
This is the case because nearly two-thirds of Americans have private insurance. The ever-present middlemen, these insurance companies very much dictate what medications you will have covered, which physicians and specialists you will be able to see and which exams and lab tests will be paid for. Removing government from the equation will not change this.
Second, Sen. Cruz used impressive-sounding statistics to make the case that the health care system in the U.S. is the best in the world. He quoted the higher number of mammograms and MRI scans that are performed in the U.S. compared to other developed countries.
While larger numbers surely do sound exciting, the number of MRIs physicians order for their patients in the U.S. is far too high. These are not true markers of health care performance, and instead are emblematic of the waste in our system. Do not get me wrong, MRIs are an invaluable tool in the arsenal of a physician, but they are too often ordered because our system of payment does not yet place a premium on cost-effectiveness.
This has caused the U.S. to spend more money per capita on health care than any other country in the world, while being ranked 11th out of 11 in overall health care among countries studied by the nonpartisan Commonwealth Fund, largely due to our poor rankings in access, equity and efficiency.
It is important to note that the U.S. indeed delivers effective and innovative health care. However, too often, only the wealthiest citizens with the most expensive insurance are able to benefit from it. There are still about 28 million uninsured Americans who are unable to access the best tests and treatments that physicians have to offer.
The Affordable Care Act has brought the number of uninsured down by 20 million, a significant number to be sure, but one that still has room for improvement. This is why building on the present law is needed, but calls to completely repeal it represent a callous and dangerous approach to those who have benefited most.
I point these two above examples out from the CNN special, but there were many other important takeaways from listening to these two senators debate. There is a fundamental difference in the approaches of Sens. Sanders and Cruz to U.S. health care. Sen. Sanders emphatically views the delivery of health care as an American right, while Sen. Cruz stated he views access to health care (i.e. through less expensive options by way of increased competition) as an American right. This distinction is not trivial.
A particular organization with a sensible solution that I would like to highlight is Physicians for a National Health Program. With chapters across the country, including one here in Missouri, PNHP is a group of physicians that advocate for consideration of moving toward a single-payer system, similar to Medicare-for-all. Benefits of such a system include removing private insurers from the marketplace, helping to drive down costs, and allowing the national insurance program to negotiate drug prices with pharmaceutical companies, helping to curb the often-astronomical prices that patients must pay for brand-name therapies. This proposal is similar to the system that Canada has in place, and is essentially the same as what Sen. Sanders has been advocating for throughout his career. Reasonable people can disagree about the advantages and disadvantages of such a system, which takes me back to the debate.
While Sen. Sanders’ argument for universal health care will guarantee that no American is uninsured, Sen. Cruz’s plan will leave the number of Americans uninsured up to the marketplace. Whether the latter seems desirable or fair in the richest nation in the history of the world is the question we must ask ourselves.