By Carol Paris, M.D.
USA Today, September 1, 2017
The Senate’s chaotic attempts to dismantle the Affordable Care Act prove that Republicans who campaigned for years against the ACA never had a plan to replace it. In the meantime, Americans’ support for a comprehensive national health plan grows even stronger.
As a physician and longtime advocate for Medicare for all, I’m ready for an honest, bipartisan dialogue about the shortcomings of the ACA.
However, in the last few weeks, I’ve read proposals to “fix” the ACA by funneling even more money to private insurers, or to lower premiums by stripping out patient protections. I’ve seen plans to let patients buy into Medicaid or Medicare, or to establish a public option to compete with private plans.
But unlike a comprehensive single-payer program, these “band-aid” proposals are merely tweaks disguised as solutions. They are sold as easy, politically achievable, and best of all, NOT disruptive.
What exactly are we afraid of disrupting? Under Medicare for all, the only people worse off would be insurance and pharmaceutical company executives like Mark Bertolini of Aetna, who made $41 million last year, or John Martin of Gilead Sciences who took home nearly $900 million. Crowdfunding sites like GoFundMe would have to rethink a business model fueled by desperate families facing catastrophic illness and bankruptcy.
Under Medicare for all, doctors would continue to care for their patients, but would have to decide how to spend the extra nine hours they used to waste each week on administrative tasks like billing. Patients could visit the doctors and hospitals they like, but the average family would have to plan how to spend the countless hours they wasted haggling with private insurers and negotiating medical debt. Businesses would have to decide what to do with the time they spent shopping for small group policies and sweating over outrageous annual cost increases. The millions of Americans tied to jobs they don’t like would be free to move on, or to start the business of their dreams.
Instead of grading a health proposal on how “not disruptive” it is, use the standards set by President Trump: Does it cover everyone? Does it improve care? Does it lower costs, both for patients and the federal government? For incremental plans like increased subsidies, buy-ins and the public option, the answer is no.
The fatal flaw in these plans is their reliance on the profit-driven insurance industry to finance care. “Fixing” the ACA means dumping more cash into the pockets of private insurers, that, despite record profits and billions in subsidies, regularly threaten to abandon the marketplace, treating patients like hostages and leaving millions more uninsured. The public option would do little for those squeezed by the skyrocketing costs of employer plans, and has no power to eliminate the waste inherent in a fractured, multi-payer system.
The only bill that meets all three of Trump’s standards is H.R. 676, the Expanded and Improved Medicare for All Act. But we have to get it right. My colleagues at Physicians for a National Health Program have studied health systems around the globe, measured costs and outcomes and answered tough questions about provider payments, cost containment and even job retraining for insurance workers.
In our Physicians’ Proposal for Single-Payer Health Care Reform, we conclude that a slight increase in government spending would be offset by massive administrative and personal savings under Medicare for all. The U.S. spends more than $3 trillion per year on health care, and the vast majority is already financed by your tax dollars. The money is there. We’re just not spending it on actual care.
Crying “It’s too hard!” is not a solution. Fear-mongers have compared our health care system to a barge — too big and heavy to turn around. If health care is a barge, it’s time to lose the dead weight of private insurers with their layers of administrative waste and profit, and start moving in the right direction: Medicare for all.
Dr. Carol Paris, president of Physicians for a National Health Program, is a retired psychiatrist who worked for more than 25 years in private practice, community mental health, prison psychiatry and academia. Follow her on Twitter: @CarolParis7