By Philip Caper, M.D.
Bangor (Maine) Daily News, April 17, 2019
I agree with Sen. Angus King’s frustration, expressed in his March 31 BDN OpEd, with the seemingly endless debate about how best to provide access to health care to all Americans. I have known King for more than 40 years, dating back to the time we were both on the staff of the U.S. Senate. In general, I agree with King’s politics, and admire his skills as a politician. But in the case of the debate about health care, I disagree with his analysis.
In his OpEd, King decries the Groundhog Day nature of our national health care debate, yet advocates putting yet another patch on the Affordable Care Act rather than replacing it with something better.
He writes, “The ACA isn’t perfect, but it’s made people’s lives better, and that’s worth building on by making simple fixes around the edges rather than tearing it apart or repealing it entirely.” His sentiment is a noble one. But, as Albert Einstein once put it, “The definition of insanity is doing the same thing over and over again and expecting different results.” There have been many attempts to patch up our insurance-and-market-based system. All have failed.
In Maine, Dirigo Healthcare is a prime example. It was launched in 2003 by then-Gov. John Baldacci but never achieved its coverage goals and was allowed to sunset in 2014 by Baldacci’s successor, Gov. Paul Le Page — with hardly a whimper from the public.
In Massachusetts, Romneycare achieved better coverage than did Dirigo, but it has failed to reign in out-of-control health care costs. As a result single-payer health care bills have once again been introduced in the Massachusetts Legislature.
Patching our fundamentally flawed insurance-based system will not solve our health care problems. The problem is not one of designing better insurance, because insurance itself is the problem.
Medical underwriting, the fundamental business of commercial insurance, is all about finding ways to discriminate against sick people or those who are likely to become sick, in order to increase shareholders’ profits. Do we really want a health care financing system that discriminates against sick people? We need to create a system better than insurance.
The ACA lacks adequate cost controls when we’re already spending too much and getting poor results for our money. Furthermore, patches to the ACA will do nothing to fix the extreme fragmentation of our current health care system. That would only contribute to the ongoing confusion and polarization about health care reform that have created our current political gridlock.
Improved Medicare for all would introduce sorely lacking budgets into every level of the system, going a long way toward controlling out-of-control health care costs. And a gradual transition to a new and better system can limit the disruption that is inevitable with any change of this magnitude.
King is a very smart and thoughtful politician with a sophisticated understanding of the complexities of American health care. But on this issue he’s a bit too cautious. He has yet to endorse improved Medicare for all, the one solution that would put an end to his Groundhog Day.
Winston Churchill once said, “Americans will always do the right thing, once they’ve exhausted all alternatives.” Now is the time.
Dr. Philip Caper is an internist and founding board member of Maine AllCare.