By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
Annals of Internal Medicine, April 2, 2019
The leading option for health reform in the United States would leave 36.2 million persons uninsured in 2027 while costs would balloon to nearly $6 trillion. That option is called the status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life expectancy, the widening mortality gap between the rich and the poor, and rising deductibles and drug prices. Even insured persons fear medical bills, commercial pressures permeate examination rooms, and physicians are burning out.
In response to these health policy failures, many Democrats now advocate single-payer, Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump administration seeks to turbocharge market forces through deregulation and funneling more government funds through private insurers. Here, we highlight the probable effects of these proposals on how many persons would be covered, the comprehensiveness of coverage, and national health expenditures (Table available at link).
(THE FULL ARTICLE CAN BE ACCESSED FOR FREE AT THE LINK BELOW.)
In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and persistent problems with access and quality triggered a roiling debate over single-payer plans. As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative, 1 of several proposals promising broadened coverage on terms friendlier to private insurers. Kennedy derided these proposals by stating, āIt calms down the flame, but it really doesn’t meet the need.ā President Nixon’s pro market HMO strategyāa close analogue of the modern-day accountable care strategyāultimately won out, although his proposals for coverage mandates, insurance exchanges, and premium subsidies for low-income persons did not reach fruition until passage of the ACA.
Five years into the ACA era, there is consensus that the health care status quo spawned by Nixon’s vision is unsustainable. President Trump would veer further down the market path. Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-for-All proponents aspire to decouple care from commerce.
Comment:
By Don McCanne, M.D.
Annals of Internal Medicine and its publisher, American College of Physicians, are providing free access to this article. The Table provides an excellent summary of the characteristics of Medicare for All (Single Payer), Medicare for America, Medicare Public Option, Medicaid Public Option, and Trump Administration White Paper and Budget Proposal (and is much easier to read if it is printed out).
The link should be shared with anyone who cares about the future of health care in America. The status quo is unsustainable, so there will be changes. Out of the quagmire there is the opportunity for comprehensive, affordable, equitable health care for everyone, providing that we select the single payer Medicare for All model.
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