Medicare for all is what U.S. needs

By Jack Bernard
The Citizen (Fayetteville, Ga.), Feb. 16, 2016

I enjoyed reading Dr. Scherz’s (opinion column, 1-10-16), which was well written. As a retired senior level healthcare exec and former GOP elected official, I understand his frustration with the downside of Obamacare (the ACA). I hear much the same from my two sons, who are practicing physicians.

But, I am not in agreement with Scherz’s suggested solution, i.e., going back to the time before we had primary care insurance and having individuals fend for themselves, negotiating direct agreements with each of their doctors. The paperwork, research, skill and time required on both sides would be immense.

And, there it is a certainty that the consumer would pay more due to paucity of easily obtainable comparative data and lack of any leverage when dealing with providers. In other words, Medicare can get better rates than an individual because many providers cannot afford to lose the government’s business, accounting for over half of all U.S. healthcare expenditures.

Along the lines of the Scherz approach, a conservative friend mentioned to me the other day that he agreed with Gov. Mike Huckabee on healthcare. The problem with Americans is that we do not know the cost of healthcare services, so we want everything.

True, there are problems with our insurance system, some of which were identified by Dr. Scherz. Health insurance certainly does insulate the patient from costs. That is what all insurance is supposed to do; should we eliminate all types of insurance? Plus, we are already less insulated than other nations (see study cited below).

One alternative is to have no health insurance for anyone, an impractical suggestion advocated by the then-head of the Georgia Medical Association in response to one of my earlier Atlanta Journal-Constitution editorials. Dr. Scherz seems to suggest something similar for primary physician care, although he does not mention the hospital side where much of the cost, and possibly waste, resides.

Another alternative often suggested by conservatives is to have deductibles so high (one physician I know suggested $10,000) that most patients pay just about everything out of pocket. Does anyone other than the 1 percent really think that is an optimum solution? Unfortunately, due to inaction by Congress, the private insurance system seems headed that way now.

Huckabee, Scherz and others are subtly building on the healthcare establishment’s historical position: “We have the best health care in the world.” The real problem is patients and their reliance on insurance to insulate them from costs. So why change anything on the financing end through government programs like Obamacare (the Affordable Care Act, ACA)?

But, how do other nations view our system? The Journal of the Royal Society of Medicine (the UK’s AMA) did a comparative study in 2011 of 19 countries and found: “In cost-effective terms, i.e., economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates.”

Our own National Institute of Health (NIH) issued a study (1-9-13) which detailed many problems with our lifestyle, but it also criticized our access problems, stating that 50 million residents had no health insurance. Regarding access, all nations studied did better than the U.S., except Turkey, Chile and Mexico. (Note: Despite its problems, the ACA has made a significant dent in this figure via Medicaid expansion and the healthcare exchanges.)

Specifically, NIH criticized the private-public-provider-payer morass that constitutes American health care delivery and financing, stating that U.S. patients do not receive the care that they need and sometimes receive care that they do not need. It further indicated that “Americans do not experience optimal quality when they do receive health care” due to the “fragmented” nature of our system, creating “inefficiencies and coordination” problems that other nations do not have.

The report also referred to a Commonwealth Fund study which found that Americans were more uncertain than others that their treatments would be adequate if they were seriously ill.

And, NIH found that Americans already had higher deductibles, copayments and out of pocket expenses versus other nations, with 40 percent of those under 65 with insurance reporting access problems due to cost.

As opposed to what many on the right say, the study found that our citizens were more likely than other countries to experience delays when seeing a physician for serious ailments. The study also reported that other studies have shown hospital readmission rates to be higher here, an indicator of lower quality care.

All told, it is a damning indictment of how we get health services in the United States … the result of our excessively expensive but deeply flawed system.

What can we do about the situation? First, stop buying false arguments about the only problem being the patient. We have identifiable access, cost and quality issues.

The website of Physicians for a National Health Program (PNHP) outlines another solution, used by many of the nations who are clearly ahead of us: true national health insurance covering everyone.

With Medicare as the sole payer, not only can costs be controlled and universal access guaranteed, but we can institute national quality measures as well.

Will this grand plan happen tomorrow? No, it will take time. But, if we push our legislators to logically look at facts and science, versus the histrionics of TV entertainers and politician skeptics, that day will come.

Jack Bernard resides in Peachtree City, Ga. His former chairman of a county commission (Jasper County) and chair of the Republican Party there. He is also a a retired healthcare executive and the former director of Health Planning for the state of Georgia. His website is http://universalhealthreform.wordpress.com/.
 
http://thecitizen.com/letters-editor/medicare-all-what-us-needs