This is an opinion piece from Mike Oliver who writes about life and health issues for AL.com.
Obamacare is not health care reform. It’s a Band-Aid at best.
You could call it an attempt at insurance reform. And it has helped some people who had no insurance obtain insurance. But who are we kidding? We have more than 28 million uninsured people in this country. The percentage of uninsured went down at first under Obamacare from about 44 million. But now the rate of uninsured is going up again.
Last Friday, a federal judge in Texas ruled the Affordable Care Act unconstitutional. And the case could go to the US Supreme Court.
But Medicaid expansion, much of what Obamacare is about, is not health care reform. Let’s get serious and move the conversation to something substantial.
I want to know what is the case against a single-payer system? I’d really like to know why a single-payer is not legitimately considered an option in this county.
I’m saying this as someone diagnosed at 56 with a fatal brain disease, Lewy body dementia. I’m 58 now, they say the average lifespan for this type of dementia is 4 to7 years or 5 to 8 years after diagnosis.
I’m asking as someone who has covered health care for years as a reporter and editor in Alabama, Florida and California, as one who covered First Lady Hillary Clinton’s health reform attempts as it went down in flames.
I’m looking for real reasons why a single-payer is not the way to go. Just so we are clear, the answer of the above question is not that it is socialistic or socialism. That’s an observation or opinion as to what type of government policy it is.
Medicare might be described as socialistic. The Department of Transportation might be described as socialistic. After all, we collect and re-distribute tax dollars to build roads and bridges. But we have decided as a nation of some shared needs so government heads up that multi-billion-dollar endeavor.
But there’s already too much government in our lives I hear opponents of a single-payer system say. I say: We are the government.
So, please, help me understand why it is a bad idea. I go back to Medicare. It, too, is a multi-billion dollar endeavor, making up something like 15 percent of the federal budget. In general Medicare (not to be confused with Medicaid) gets pretty good marks for efficiency. Most folks have seen their parents or grandparents on Medicare, and they haven’t joined the communist party.
In one version of a single-payer, we would open Medicare up to everybody who needs it regardless of age. It seems like this would cost more money initially, and maybe so, but in the long run we will have a healthier, happier nation and less money going to high percentage profits of the health care industry.
And that will ultimately mean less spending on health-care. (If only political leaders looked long-term.)
Here’s the Medicare expansion idea. And here are four other models in which variations are used in England, Canada, Germany, France, Spain, etc.
The truth is the United States has universal coverage right now. That’s right. It’s just that there are many who use the emergency room as their doctor’s office. Their unpaid charges get passed on to paying customers, a phenomenon called cost-shifting. So medicines and treatment rise for the insured patient. Even those with insurance often have high deductibles that deflate the incentive to make a doctor’s appointment.
They get treated one way or another. Others wait to get better but end up getting worse — a cancer that could have been stopped is now too far along, for example.
I was doing a ride-around with an ambulance service in Orlando, FL, years ago and asked the driver about the health care of the people they pick up to take to the hospital.
“Health care for people out here is calling 911 ” was his response.
I think there are two things that help to understand why this is such a sticky and difficult problem. Typical business economics behind health care don’t operate in the interest of the patients or their outcomes. Think about it. The institutional financial interest is to treat more, test more, scan more, prescribe more.
Now good doctors may be outraged that I would insinuate their decisions are financially driven. And I believe doctors should have as much freedom as possible to make prognoses and treat patients.
Here’s a case scenario: A hospital on one side of town — Hospital A — buys an expensive laser treatment for brain tumors. It costs many millions but they have the only one in town. They figure they can charge $10,000 per treatment based on how many will use the treatment. On the other side of town, another hospital notices the business that the laser is getting, so they buy one. All good capitalism and competition, right?
The problem is there is a ceiling on the pool of patients. So hospital A starts seeing less patients because Hospital B picked them off. Economically, the overall revenue is down so Hospital A must increase the cost of the treatment or increase the patient population.
What they need is a good brain tumor epidemic. That’s a horrible thing to enter the psyche of a hospital or health care organization.
The other anomaly about health care reform is that there are huge financial interests which work against significant reform. I covered Hillary Clinton’s attempt to reform health care. It was not pretty. Too many cooks in the kitchen spoiled the broth, as the thick document that contained the policy was seized upon and ridiculed, probably rightfully so. Throwing an everything-but-the-kitchen-sink document out there was a major mistake, politically. Holding closed sessions with myriad special interests and academic experts was another political mistake.
Many remember the infamous “Harry and Louise” ads, but even more influential in the demise of Hillarycare was former New York Lt. Governor Betsy McCaughey. She wrote “No Exit,” which was published in the New Republic. Although it was a skewed screed with the appearance of an academic critical analysis, it was timely ammunition for Republicans looking to scuttle the plan.
That’s old news now.
Hillarycare like Obamacare was not systemic health care reform anyway. It tried to please everybody from consumer groups to insurers, from hospitals to the pharmaceutical industry. The result: Hillarycare died.
And now Obamacare has been ruled unconstitutional.
I wonder why we can’t create some new news without one person’s name on it. Call it Peoplecare.
I would start with a question:
Why not single-payer health care reform?
