By Tom Gates, M.D.
Lancaster (Pa.) Online, June 1, 2015
I was astonished to read U.S. Rep. Joe Pitts’ criticism that Obamacare does not do enough to cover the uninsured, leaving 30 million without coverage, and that it “achieves too little at too high a cost.” Astonished, because for the last five years Pitts and his congressional colleagues have to all appearances been concerned not with covering the uninsured, but rolling back the modest progress we have made.
Since I graduated from medical school 35 years ago, the number of uninsured in this country has risen inexorably year after year, more than doubling over the course of my career. The number of uninsured peaked at around 50 million in 2010, with a modest decrease of about 2 million from 2011 to 2013 as the initial provisions of the Affordable Care Act took effect.
Then in 2014, when Medicaid expansion and the new insurance exchanges kicked in, the number of uninsured fell by 15 million — far and away the biggest decrease in uninsured since Medicare was passed. The ACA has performed better than predicted, at a lower cost than projected, and, contrary to congressional critics like Pitts that it would be a “job killer,” its full implementation in 2014 coincided with the biggest net gain in employment in 15 years.
Pitts says that “Republicans in Congress have many ideas that are more practical than the ACA,” but doesn’t divulge to us, his constituents, what those ideas might be. So here is a suggestion for Pitts and his colleagues: If you are really concerned about the 30 million Americans who remain without health insurance, and you don’t like the ACA because it “achieves too little at too high a cost,” then support the proposal of Rep. John Conyers, D-Mich., HR 676, the Expanded and Improved Medicare for All Act.
Medicare is arguably the most valuable and popular government program of the last half-century. Together with Social Security, it has lifted tens of millions of older Americans out of poverty. It has consistently out-performed the private sector, with lower inflation and much lower administrative costs than private health insurance.
Conyers’ proposal would build on Medicare’s success, extending it to cover not just the elderly and disabled, but all Americans. Like traditional Medicare, this “single payer” system would allow patients complete freedom to choose their preferred physicians and hospitals (no more “out-of-network” denials). Providers would remain private entities competing for our business, but would be paid out of a government fund rather than the myriad of competing and profit-driven insurance companies. By eliminating $400 billion a year in private insurers’ administrative costs, there would be enough savings to cover those 30 million uninsured, plus eliminate all deductibles and co-pays.
How is this possible? According to the Institute of Medicine, as much as 30 percent of our current health care expenditure is pure waste, amounting to some $700 billion per year. Much of this waste comes from the high cost of administering our needlessly complex system. Insurance companies, ultimately beholden to their stockholders, make money by providing insurance to the healthy while finding ways to avoid covering the sick. Private, for-profit insurance companies have overhead and administrative costs of 12 percent to 20 percent, compared to 1.6 percent for Medicare (according to the 2013 Medicare trustees report).
If expanded and improved Medicare for all, with no deductibles and co-pays, sounds too good to be true, remember that every other advanced country in the world has been able to provide universal coverage at a much lower per-capita cost than the U.S., with health outcomes often better than our own. Why do we settle for less?
As we approach the 50th anniversary of the passage of Medicare in July 1965, let us urge Pitts and his colleagues not to cut or further privatize Medicare, but protect it, improve it, and most importantly, expand it to cover everyone. Urge Congress to pass HR 676. That would be real health care reform.
Dr. Tom Gates is a family physician who lives in Manheim Township and has practiced in downtown Lancaster for 20 years.