Who is Really Responsible for Health-Care Ills?

Finally, an intelligent proposal for health-care reform from a well-known thinker, Charles Krauthammer … or so I thought.

The headline on a recent Krauthammer piece reads, “The Road to Single Payer Healthcare.” What I thought was an advocacy piece, turned out to be a lament about an inevitable future.

Krauthammer argues that ideological differences between the two major political parties as well as within each of the parties complicate a compromise health-care reform bill from moving forward, although a procedural strategy could work. However, Obamacare, flawed as it is, has created a national expectation in the words of House Speaker Paul Ryan “to give every American access to quality, affordable healthcare.” Such ideas as coverage for children on their parent’s plan until age 26, and coverage despite pre-existing conditions, are now popular among both liberal and conservative voters. While these are not consistent with a traditional Conservative or Republican policy approach, most concede that once these “rights” are granted to the American people, it is hard to take them back.

In conclusion, Krauthammer writes, “As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity of the universality of Medicare-for-all. Republicans will have one last chance to try and convince the country to remain with a market-based system, preferably one encompassing all the provisions that for procedural reasons had been left out of their latest proposal. Don’t be surprised, however, if single-payer wins out. Indeed, I wouldn’t be surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli dished the Whigs in 1867 (by radically expanding the franchise) and joins the single payer side.”

A single-payer health care system, once thought to be a non-starter in the U.S. Congress, is looking more and more attractive as a logical approach to health-care reform in America. I would argue that it may in fact be desirable, and here is why.

First, there is a reality check needed. With the baby boomers moving into retirement age, approximately 10 to 12 thousand Americans are becoming newly eligible for Medicare each day. That is about one every eight seconds through the year 2030. In addition, Medicaid roles are expanding all over the country as more and more individuals, and especially children, are being moved into that program. Both Medicare and Medicaid are single-payer government-provided insurance programs. It is estimated that, within the next 10 years, somewhere between 60 and 75 percent of the lives in this country will be insured under one of these two programs. In effect, we are already heading toward a single-payer system.

Here is another reality. Throughout the debate on repealing — or repealing and replacing — Obamacare, there have been a number of so-called flaws in the program that have been highlighted. Most notably, there is a concern that it costs too much and that the government is therefore expending too many tax dollars to subsidize insurance premiums. At the same time, there are complaints that patients cannot choose their own doctors and that insurance premiums continue to rise. Some complain that the 10 essential health care benefits required to be part of any insurance plan and the tax on those who don’t obtain medical insurance, are unfair. Others point to insurance companies abandoning participation in insurance exchanges as proof that Obamacare is unworkable. In short, the crux of the argument against Obamacare pits the individual against the government. People are being forced to participate in a flawed program designed by the government against their will, which limits their choices, costs too much money, and, in the words of the president, “is imploding.”

Some of this may be true and deserves to be addressed. However, there is one major entity that is left out of the equation, despite being responsible for many of the problems. That group is the medical insurance industry itself. In reality, the conflict over health care today is not between the individual and the government; it is between the government and the insurance companies. Patient choice was not taken away by Obamacare. Insurance companies have been curtailing choice for years before the ACA as they have moved away from open fee-for-service plans to closed-panel networks and HMOs as a method to reduce their expenditures. Premiums were rising exponentially well before Obamacare, and were in fact one of the driving forces behind its passage.

Former HHS Secretary Kathleen Sebelius wrote in 2011 about unexplained premium hikes of 50 to 80 percent, and about how the ACA would at least require a written explanation for any raise over 10 percent. Insurance companies have also engaged in many questionable practices to minimize their exposure, such as rescission, where long-time subscribers were routinely dropped from coverage as soon as they were diagnosed with a significant illness. Even today, medical insurance providers enjoy exemption from anti-trust laws allowing them to conspire to determine rates and insurance product design.

Lastly, health-care costs are rising exponentially, partially because of new technology, partially because of rising fees, partially because of defensive medicine and partially because of other factors. Both the government and the insurance carriers are trying to bring those costs under control. The government has an interest to save tax dollars and the insurance companies have an interest to maintain their high profits. The question is, who would we rather have in control of the limitations and rollbacks needed to control rising health-care costs, an elected government or an unregulated, profit-driven insurance industry?

Once we as a nation expect affordable and quality health care for everyone, the only logical approach would be to provide everyone with basic and catastrophic medical insurance by expanding Medicare to all. There would always be the option to supplement that coverage by purchasing enhanced insurance products, much like in the existing Medicare program. Costs could be controlled, coverage decision makers would be accountable, and everyone would have access to care. It is the most simple and efficient approach, as just about every Western democracy has discovered (most of whom have better health-care outcomes than we do). It will only happen when our elected representatives accept realities, and decide to solve a problem rather than spout ideology.