By Ahmed Kutty, M.D.
Monadnock (N.H.) Ledger-Transcript, August 26, 2019
In her piece of Aug. 6, Jill Schafer Hammond detailed an excellent analysis on the varied policy positions among the Democratic presidential contenders. Significantly her insights align with key arguments long advanced by advocates and activists for a National Health Plan (NHP). She is hard hitting when pointing out the proclivity of insurance companies to “take away your insurance when you’re sick.”
Reviewing “all those plans” proposed under the rubric of Medicare for All (MFA), from Medicare for Most, Medicare for Anyone…to Medicare4US2, it is worth mentioning that at least ten seemingly similar plans were available for tabulation by Austin Frakt and Aaron Carrol in the New York Times on Feb. 21, 2019. Jill’s support for an incremental approach to health care reform is grounded in unawareness that MFA legislation by Rep. Pramila Jayapal of Washington (H.R. 1384) and the companion Senate bill (S. 1129) by Bernie Sanders DO supply the legislative provisions and energy needed for running the critical final – lap sprint to the finish line of achieving “everybody in-nobody out” coverage for ALL Americans.
President Johnson’s Medicare Act of 1965 establishing healthcare insurance for seniors and Medicaid for the poor, the Children’s Health Insurance Program (CHIP) in 1997 under President Clinton, the Affordable Care Act of 2013 by President Obama, the Veterans Healthcare System by President Hoover in 1930, Tricare (CHAMPUS) for the military and the Federal Employees Benefits Plan (FEHB-DCSHOP) in 1956, and the Indian Health Service in July 1955, and others are ALL component parts of the huge patchwork system we have ended up with today. And all did INCREMENTALLY extend healthcare services to different population groups.
Ms. Hammond’s bullet points in paragraphs three and five DO strongly make the case for a publicly-funded privately-delivered program when she calls for “breaking down the silos” and “unifying government payment for all that healthcare.” What needs greater emphasis is that a unitary national payment mechanism confers via the power of the purse, on the NHP awesome clout to control costs, a critical weapon in the arsenal for waging the inevitable war to reign in rampant and unfettered pricing banditry over goods and services, uniquely manifest among the industrialized nations only in the US. And as Jill alluded to, effective measures like bargaining and negotiating to set reasonable prices/charges will enable the desired redirection of our finite healthcare funds towards preventive care, health maintenance, community medicine, and public health services, and also to redress the prevailing maldistribution of professional manpower, with a glut of specialists and a shortage of primary care doctors, and of provider concentration in urban areas while the rural hospitals and clinics struggle to survive.
Nobody’s coverage will be taken away when MFA is introduced. Instead, everybody will be covered under a simplified, streamlined, comprehensive, national, sustainable, and affordable plan, at an estimated savings of $500 billion a year from the $3.6 trillion we expend as a country currently.
What is TAKEN AWAY are payments of premiums, deductibles, copays, coinsurance, coverage caps, and exclusions. All medically necessary conditions will be covered, and appropriate clinical services will be available with NO payment at the point of service, including long-term care, prescriptions, dental, vision and hearing care, mental health services including substance dependency, community and home-based care, and more in a nonprofit setting. The cost burden of MFA, projected at about $3 trillion per year will be spread over the entire taxpayer base of 320 million Americans in a single risk pool.
Rolling out MFA, a national health plan as social insurance, need not be catastrophically disruptive. Contrary to widespread predictions, Medicare’s startup in July 1966, which I directly experienced as a trainee physician, was very uneventful and to my knowledge in the succeeding half-century plus, NO beneficiary of Medicare has asked for disbanding of the program on grounds of “free choice or government meddling.”
Proponents of the baby steps inherent in the incremental pathway to healthcare reform are well aware that such policy positions are incapable of furnishing urgently needed succor to 80 million uninsured and underinsured in our midst, and for the victims of the opioid epidemic in our state and many more, locked out of the for-profit system we live under. They must be held morally accountable for the atrocities being visited upon our fellow Americans such as: 30,000 preventable deaths nationally with about 150 from the Granite State, 2.2 million medical bankruptcies, with an estimated 1,400 in New Hampshire, and their unconscionable acquiescence at siphoning off healthcare premium dollars into astronomical compensation packages for healthcare CEOs and board directors.
When ultimately a NHP is in place, hopefully in the medium term, Americans will look back aghast, wondering why it took us more than a century to join the ranks of other advance-economy nations in providing healthcare as a basic human right! An instance of American exceptionalism?
Dr. Ahmed Kutty is a retired physician and activist with Physicians for a National Health Program (PNHP) Granite State chapter.