By Jack Bernard
Las Cruces (N.M.) News, May 2, 2018
In 2017 op-eds, I described the mess that Congress made of health reform. They were taking a flawed program, Obamacare, and modifying it to be much worse via Trumpcare…which I believe Donald Trump still has never given up on enacting; he is just waiting until the opportunity arises.
In the meantime, he and Alex Azar, his new DHHS secretary, will do everything that they can administratively to undermine the ACA. In 2017 there were fewer people covered by insurance than in 2016 due to Trump’s policies.
Many conservative politicians state incorrectly that we have the “best” health care in the world. But, our mortality-morbidity rates are higher than other developed nations. Reports by the respected Commonwealth Fund consistently rate us last or next to last on health-care quality, access and cost criteria.
Plus, our costs are escalating, via higher premiums and deductibles. In 1980, healthcare was 9 percent of GNP. It is more than double that now, taking money that could be used for other vital areas.
So, where should we go with Medicare, Medicaid and the ACA (Obamacare)?
The GOP House of Representatives has a radical health-care agenda, devised by and expressed repeatedly by departing Speaker Ryan and Tom Price, former House member and x-secretary of DHHS. Both Price and Ryan are motivated solely by federal budget concerns versus quality or financial access.
Former Rep. Mick Mulvaney, now the head of OMB, shares this lack of concern over the impact of policy changes on real people. Mulvaney, a Tea Party darling, founded the right-wing House Freedom Caucus which advocated a shutdown of our government rather than budgetary compromise.
The Ryan-Price strategy of Medicare and Medicaid abandonment is not supported by the majority of Americans in either party, as various surveys show. It is abandonment when you privatize Medicare via vouchers, destroying senior finances, and cut funding for Medicaid via state block grants, thus denying care to our poorest citizens.
The bill that Price originally proposed as a replacement for the ACA cut financial support for millions (85 percent of Health Exchange enrollees) who are now receiving a high level of governmental assistance in order to purchase insurance. The average cost of a family’s health-care insurance policy is over $18,000 annually. How many lower-income families can afford to purchase health-care insurance with a stipend of only $3,000 as detailed in the original Price legislation?
So, if the radical privatization schemes and confusing, elusive block grants won’t work, what will?
The situation becomes clearer when we look at the health-care costs in other developed nations. At a per capita cost of over $9,000 in the USA, we run nearly three timesthe per capita cost in Italy, whose health system is rated second best in the world by WHO.
How do these other developed countries do it? The answer may surprise you: single payer (Medicare for All) or something like it (utility models) with more government involvement, not less.
Through cutting out marketing and overhead expenses, savings are achieved. Medicare has only a 2 percent overhead versus 12 percent for private insurance. And, centralized budgeting combined with leveraging of governmental purchasing power makes sure that costs are contained.
The primary impediment to Medicare for All, which has been proposed in bill form by Senator Bernie Sanders and co-sponsored by 16 senators, is clear: big business lobbying. Why?
Price escalation by Big Pharma would be severely limited under Medicare for all, as it is in other nations. Instead of spending money on health insurance corporate marketing and overhead expenses, money would go to direct patient care. Insurance and pharmaceutical companies would lose business. Their executives would not be getting those seven figure salaries. So, they buy influence.
This situation can only be corrected by you, the American taxpayer, by knowing the issues and voting.
Jack Bernard, the first director of health planning for Georgia, has been a senior executive with several national health care firms, working with New Mexico hospitals on cost containment.