By Sean Lehmann, D.P.M.
Nevada Appeal, Jan. 20, 2016
The Affordable Care Act (ACA or Obamacare) has most certainly had some successes. There are many who didn’t have health coverage that do now and many others who can now get coverage that were previously denied due to pre-existing conditions.
With that said, still others have seen increases in their premiums, deductibles and co-pays. It has become more and more obvious the ACA is not a long term solution for our health care system. Unfortunately, neither party has championed a viable alternative. The majority of Democrats vow to protect the ACA, while the Republicans repeatedly attempt to “repeal Obamacare” which isn’t a plan at all.
I began practice as a sole practitioner nearly 16 years ago. One of my first workplaces was the Fallon Tribal Clinic. The family practice doctor at that clinic told me it was a “grave mistake” when we decided as a country that health care would be treated as a for-profit commodity. During the years I have learned he was definitely right. I have had the unique perspective of being on the front lines of health care as both a provider and consumer.
In our current system, private for profit insurance companies are middlemen and as such, drive up the cost of health care. There are only two ways in which an insurance company can increase profits for its shareholders: raising premiums and denying care. This is a serious conflict of interest, yet we have allowed it to happen.
During 2014 alone, the CEO of United Health Care made $66.1 million. Not to be outdone, the CEO of Gilead Pharmaceuticals made $192.8 million in the same year. As a nation we spend 17 percent of our GDP on health care, while the next closest country, Norway, spends only 9.3 percent. The vast majority of nations spend less than 10 percent of their GDP on health care and still provide universal coverage for their citizens. We spend significantly more on health care than any other nation on earth, yet more than 50 percent of personal bankruptcies are due to medical bills or illness.
How do we fix this? The overhead for private for profit health insurance companies is nearly 20 percent, yet the overhead with Medicare is only 1.3 percent. Eliminating the middleman would account for an immediate 18 percent reduction in our healthcare costs. As Americans well know, we also pay infinitely more for prescription drugs than the rest of the world. In fact, we’re the only country that allows pharmaceutical companies to charge whatever they want. By negotiating these prices, we could realize large savings.
Personally, I pay nearly $6,000 a year to insure my family. We also have a $10,400 deductible. This means I pay $16,000 per year before my family and I get any health care coverage. I have heard horror stories from patients of mine who pay even more, some significantly more.
What about Medicare? The program that covers seniors isn’t perfect, but the costs to patients are infinitely lower. The monthly premium is $104.90 and the deductible is $166. This means seniors will pay just more than $1,400 yearly before Medicare begins to cover them. My father was self-employed and paid enormous premiums to a private insurer before he turned age 65. He was relieved when he was finally able to enroll in Medicare, just like many others were when they became eligible. So why not extend Medicare to everyone? There’s a bill to do just that, HR 676, “expanded and improved Medicare for all”.
So how do we pay for it? There is already a payroll tax for Medicare. This payroll tax would be increased slightly, but the increase would pale in comparison to what we’re already paying for health care. Remember, I’m already paying $16,000 per year. Others are paying even more. Employers would see huge savings over what they are contributing to private for profit plans. A recent study by the University of Massachusetts showed there would be an annual savings of $592 billion. No other plan can achieve this magnitude of savings on health care.
It’s clear Medicare for all could be positive for many patients, but what about physicians? Physicians for a National Health Program (PNHP) is a National organization of more than 20,000 physicians and other health care providers that endorse this plan. In my own practice, it would be welcome change. Instead of dealing with hundreds of insurance companies and literally thousands of plans, I would only have to deal with one. Talk about making things easier! The countless hours spent credentialing, negotiating, and appealing with all these different plans would be reduced significantly. The extra time I would have available could be spent where it should be: patient care. Moreover, with everyone on Medicare, there would be no networks and patient access would be increased substantially.
There’s no perfect solution to our health care dilemma. However, I would propose Medicare for all is a viable and workable alternative. A recent poll by the Kaiser Family Foundation shows 58 percent of Americans agree. We have recently organized a Nevada Chapter of PNHP and invite all those who support this initiative to join us. Please visit www.pnhp.org for more information.
Dr. Sean L. Lehmann is a practicing podiatrist in Carson City. He also has a master’s degree in health care administration and is chair of the Nevada Chapter of Physicians for a National Health Program.