Care act doesn't solve core problems
By K.W. Hillis
The Lawton (Okla.) Constitution, Jan. 19, 2014
LAWTON, Okla. -- Affordable Care Act reforms address some problems with health care in the U.S., but it doesn’t solve core issues, said Dr. Ed Weisbart, chair of the Physicians for a National Health Program (PNHP) -- Missouri Chapter.
An advocate of a single-payer national health insurance system similar to Canada’s or Great Britain’s health care systems, Weisbart met with The Lawton Constitution editorial board last week to talk about those core issues and a new bill before Congress.
“We have a crisis in health care in the United States. It undermines our ability to compete globally. It places huge burdens on businesses and on families. It is the biggest driver of bankruptcy in the country. It makes people vulnerable to having real estate bankruptcies,” he said. “That is going on in the context of our wasting approximately a third of what we pay on health care on the administration of it compared to other countries, where they spend around 2-5 percent on health care (administration) ... (we pay) 31 percent.”
The waste of that money “that doesn’t, in fact, impact health outcomes, drives me crazy,” said Weisbart, a self-described fiscal conservative who practiced as a family physician in Chicago for 20 years and then was the chief medical officer for Express Scripts in St. Louis, Mo., before retiring three years ago.
Fixing those problems and core issues will take a lot more than the ACA, which will still leave some people at risk for bankruptcy due to medical bills not covered by insurance, many not insured and more underinsured than before, he said.
The answer for him and members of the PNHP is a single-payer national health insurance program that is an “improved Medicare for everyone.”
"Medicare’s overhead is roughly 2 percent ... (and up to 5 percent according to some people). But it is nothing like we are spending today. So I look at that and I look at the fact that most seniors like their Medicare program and most seniors have to buy supplements to their Medicare because Medicare is imperfect. What I think makes the most sense is we somewhat fix those problems with Medicare, those gaps, embed those supplements into the core program and then get rid of the 65-year-old age limit and give it to everybody.”
The cost of covering everyone from birth would be covered by going from a 31 percent overhead to a 2-5 percent overhead, he said.
“It more than pays for delivering care to everyone and that makes us able to compete globally ... it is a simple concept, really.”
This concept is laid out in a 30-page bill - H.R. 676, Expanded & Improved Medicare for All Act - which Rep. John Conyers, D-Mich., introduced to the House of Representatives in February 2013. The bill is now in committee and can be read in summary or in full at http://congress.gov.
The bill “establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care,” according to the bill’s summary at congress.gov.
Other key features of the bill, listed by PNHP, are: “Universal, comprehensive coverage; no out-of-pocket payments; a single insurance plan in each region, administered by a public or quasi-public agency; global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds; free choice of providers; public accountability ... ; ban on investor-owned, for-profit health care providers; and protections of the rights of health care and insurance workers.”
The basic problem with the U.S. health care system, even with ACA, is that for other than high-tech health care - the U.S. leads in longest survival rates for those diagnosed with any cancer - the U.S. rates are surprisingly low in other areas, he said. Those areas include the numbers of maternal and infant deaths and that the U.S. ranks No. 51 in life expectancy. Before universal health care was introduced in Canada, Canadians had the same life expectancy as those in the U.S. “Now it is 2 1/2 years longer than ours ... The point is we don’t have a business model for the things that actually improve life-expectancy for most Americans.”
Even with the advent of ACA, many people who are under 100 percent of the poverty level will still lack any health coverage at all because half of the states did not expand Medicaid to cover those people. Getting insurance via the ACA marketplace “is better than being uninsured, but it is mediocre insurance,” he said, explaining that most insurance requires individuals to pay 10 to 30 percent of the costs, “so underinsurance is the new norm in this country.” ACA also won’t change the 31 percent administrative overhead or personal bankruptcies due to medical costs.
Horror stories about long waits for care and other problems in universal health care systems are often cited. Weisbart suggested that actual data from those countries and the context of that data paints a different picture.
One study examined the wait time for elective surgery in various countries, using waiting more than four months as the metric.
“In the the United States, less than 10 percent of people wait that long. In Canada, which is the worst in their study, 25 percent of people wait more than four months for elective surgery. That is not the image we have of 80 percent of people waiting months ... the thing to think about is that Canadians and (other single-payer countries) spend only a small portion of what we spend on health care.”
Despite the wait, there is an upside, according to Canadians surveyed.
“Every one of them will say ‘that is awful.’ ... they will all complain, but in the next breath they will say ‘but I know that when I get cancer, when I get this or that, I will be seen immediately, I will be seen for free ... and if I have to make a tradeoff, I’d rather wait a few months for my elective surgery for the security of knowing that when I have a major problem I’ll be taken care of,’” he said.
Other stories about Canadians flocking to the U.S. for health care and physicians moving to the U.S. are also not supported by data, Weisbart said, explaining that valid data from health care systems worldwide can be accessed on the Organization for Economic Co-operation and Development’s website, www.oecd.org.
Weisbart said there are safeguards built into HR 676 for those who are worried about big government deciding what type of health care Americans get.
The safeguards include the premise that everyone in the country is covered under the plan so the people making the decisions of where monies go are invested in the results. Another safeguard is regional boards made up of patients, physicians and others.
The result of everyone getting the same access to care determined by the boards would allow the U.S. population to get what it wants most - "to see the doctor of their choice and go to the hospital of their choice,” he said.
With this plan, “the ones that lose are the insurance industry and the drug and (medical) device industry,” he said. Despite the reduced compensation and incentives to drug and medical device companies that help with medical breakthroughs, “the vast majority of medical breakthroughs in this country is funded by the National Institutes of Health ... it is government funded.”
The ones that win “would be everybody else.” There would be a rise in taxes, but “without premiums or copays, 95 percent of the people would pay less, not more.”
He doesn’t expect the U.S. to really have a serious discussion about the proposed single-payer system until 2015, when those who didn’t get insurance under ACA will have to pay a tax penalty.
“Then I’m hopeful that ... the country will be ready again to engage in a serious debate of a fundamental health care reform. (But) as we wait, more and more people die and more businesses can’t compete globally,” he said.
K.W. Hillis is a staff writer.