Tag Archives: Medicare

Trump is Right: Healthcare is Complex, but it does not have to be

from “If You’re Not Making History, You Are History” by Bob MacDonald

 

No doubt about it, the healthcare system in America is a mess. Obamacare is not working as intended and the proposed Republican replacement is being castigated, even by Republicans, as potentially even worse. Democrats complain the American Health Care Act (ACA) takes too much away from people who need coverage the most. Republicans who oppose the ACA call it “Obamacare-lite” and complain it does not go far enough to repeal Obamacare; and that it creates an entirely new entitlement program.  

The reality is that resolving the healthcare challenge is simple, but it is made complex because Republicans and Democrats have diametrically divergent views on what the end result should be. In simple terms, the Republicans believe the answer lies in assuring that all Americans have “access” to healthcare coverage, while the Democrats believe the answer lies in assuring that all Americans actually have healthcare coverage. There is a big difference between having access to healthcare coverage that an individual needs but cannot afford and providing the needed coverage, regardless of the ability to pay.

This difference exists because the political leaders have failed to address and resolve the most fundamental healthcare question: Is basic healthcare a right or a privilege?

The Republicans believe that healthcare is a privilege, and thus, so long as there is universal access to healthcare coverage (no matter what form or price), the problem is solved. (It should be noted that prior to becoming president, Trump consistently argued that healthcare coverage is a right.) On the other hand, Democrats take the position that every American citizen, regardless of financial status, has a right to receive basic healthcare.

It is this philosophical difference that motivates the Republicans (believing healthcare is a privilege) to propose in the ACA that Medicaid (the state/federal plan that covers low income citizens) funding be slashed. (This is one of the chief reasons why the Congressional Budget Office estimated that as many as 24 million Americans will lose their coverage under the Republican plan.) Conversely, (believing that healthcare is a right) the Democrats used Obamacare to expand Medicaid that covered 15 million people who previously could not afford coverage of any type.

There can be no effective bipartisan agreement on the best form of a healthcare system, unless or until there is a debate and resolution of the question as to whether healthcare is a basic right of every American citizen or a privilege based on means to pay. If, as a society, we decide that healthcare is indeed a privilege, then the Republican ACA plan will work just fine. If, we as a society decide (as virtually every other industrialized nation has) that basic healthcare, like a basic education, is a natural right of every American citizen, then we can work together in a bipartisan way to find the best way to achieve that goal.

Repeal and Replace Obamacare

Ironically, if it is decided that healthcare is a basic right, it would call for the repeal and replacement of Obamacare, because it has failed to achieve the objective of covering all Americans. But such a replacement would be based on the rights of all, rather than the privilege of a few to have healthcare.

If this approach to repealing and replacing Obamacare is taken, the solution is right in front of us. It is a healthcare system already in operation. It has proven to be effective and efficient; it has high consumer satisfaction and acceptance. Maybe even more important, it is a plan that President Trump has endorsed and pledged to protect.

Taking the complexity out of the healthcare solution.

The simplest and most effective way to solve the healthcare crisis is to merge the Medicare and Medicaid systems into one program that, on a phased in basis, will provide basic health care services to every American citizen, regardless of age, social status or income.

There would be no need to create another bureaucracy. Both of these programs have processes and procedures in place and in point of fact are paying for the health services provided by clinics, hospitals and doctors for millions of Americans age 65 and over, along with millions more of low income citizens. Patients covered by Medicare are free to select any of the 95 percent of the doctors, clinics and hospitals that accept Medicare payments. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided.

Of course merging and expanding Medicare and Medicaid into a universal healthcare system can’t be done with a flip of a switch, but an organized phase-in of this system over time for those not currently covered under Medicare or Medicaid could smooth the way. This would allow for Obamacare, along with all other forms of healthcare such as individual and employer group plans, to be repealed and phased out at the same pace the new system is expanded.

Certainly there will be concerns about the cost of such a change, but a number of serious studies have concluded that diverting all expenditures on the current system (federal, state, individual and employer) toward this new system and combining this with premiums, deductibles and co-pays based on income, would create more efficiency and actually be less costly than the current system. President Trump has even made this point in interviews.

Using this approach to fixing the healthcare system could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal and replace Obamacare; Trump could remain consistent in his call for universal healthcare and his pledge to protect Medicare and, most important, all Americans could finally join the millions of citizens of every other industrialized nation in the world for whom basic healthcare is a right of citizenship, not just a privilege for the wealthy.

Trump Should Focus on Replacing Obamacare

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A cornerstone of Trump’s campaign for president was the promise he would repeal and replace Obamacare. And rightly so, because Obamacare is an unmitigated failure. The promise of Obamacare was to provide “patient protection and affordable healthcare” for some 40 million uninsured Americans. The plan has failed on both points.

The saga of Obamacare is a great example of wanting to do the right thing, but going about it the wrong way. Obamacare as we know it came about because President Obama capitulated to the merchants of the devil – the health insurance industry – in order to strike a deal on healthcare reform. The great myth surrounding Obamacare is that it is some type of government provided healthcare coverage like Medicare, but it isn’t. Under Obamacare the government has nothing to do with the type of coverage offered, the quality of the services provided or the cost consumers pay for healthcare; that is all left up to the whims of private health insurance companies.

Obamacare is nothing more than a (clunky, complicated) website that is intended to match-up those who need healthcare coverage with private, for-profit insurance companies looking to sell their policies. The only requirement for insurance companies to market their policies on the “exchange” is that pre-existing conditions are covered and children can be included under the policy until age 25. Beyond that, insurance companies are free to determine the structure of the policies, the provider networks the insured must use, deductibles and the co-pays – the amount the insured must pay out of pocket; and those can run as high as 40 percent of medical charges. Most important, the insurance companies are free to charge any premium they desire and increase those premiums at will. In short, Obamacare has become nothing more than a profitable boondoggle for insurance companies. As usual, the ones left holding the short end of the stick are individuals who most need and can least afford healthcare coverage.

In addition, employers who are mandated to provide employees with healthcare coverage are free to use all sorts of machinations to avoid this responsibility. (For example, hiring employees as part-timers and making sure they work less than 40 hours a week.) This forces the employees to use the Obamacare website and be pillaged by the insurance companies.

Be careful what you wish for …

With a Republican soon to be in the White House, the Republicans in Congress who believe healthcare is a privilege based on the ability to pay, rather than a right of citizenship, are stupid-drunk giddy over the prospect of killing Obamacare, but they need to be careful what they wish for. There may be one problem that could turn their dream into a nightmare. While that Republican soon to be in the White House has savaged Obamacare, he has consistently supported the rights of every American to have healthcare coverage. Over the years Trump has repeatedly praised the concept of universal healthcare.

On 60 Minutes Trump said, “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say ‘No, no, the lower 25 percent that can’t afford private.’” He continued, “I am going to take care of everybody. I don’t care if it costs me votes or not.”

On the Larry King Show Trump bluntly proclaimed, “If you can’t take care of your sick in the country, forget it, it’s all over … I believe in universal healthcare.”

In his book The America We Deserve Trump wrote, “We must have universal healthcare … I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses …”

So the Republicans in Congress may be in for a bit of a surprise blowback from their Republican president when it gets down to the nitty-gritty of repealing Obamacare, without offering a reasonable alternative for millions of Americans who lack access to healthcare or don’t have the ability to pay the exorbitant premiums charged by private insurance companies.

What is the alternative that Trump could propose?

If Trump is sincere in his belief that all Americans should have affordable access to basic healthcare services, he could achieve that goal by simply expanding the scope of two healthcare plans already in existence – Medicare and Medicaid. Medicare provides effective and efficient medical care for millions of Americans age 65 and over. Medicaid – a combination of state programs funded by the federal government – provides medical care to millions of low income individuals.

The point is that these two programs have processes and procedures in place and in point of fact are paying for the healthcare provided by hospitals, care givers and doctors for millions of Americans. Patients are free to select any of the 95 percent of hospitals and doctors who accept Medicare payments to provide their care. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided by private hospitals and doctors.

So the question is: Why not repeal Obamacare and replace it with the two national healthcare programs already in existence and functioning effectively? There is no need to create an entirely new bureaucracy. The simplest and most direct way to offer basic healthcare to all Americans at affordable costs is to expand and enroll everyone – at all ages – into Medicare or Medicaid.

Of course, this can’t be done with a flip of a switch, but an organized national phase-in of Medicare over time could make it happen. For example, in the first year those 60 to 65 would be eligible for Medicare, then the next phase would include those 50 to 55, and so on until everyone is covered. This would allow for Obamacare to be repealed and phased out at the same pace Medicare is expanded.

This approach could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal Obamacare; Trump could remain consistent in his call for universal healthcare and, most important, all Americans could finally join the millions of citizens of every other industrialized nation in the world for whom basic healthcare is a right of citizenship, not just a privilege for the wealthy.

So What Exactly is Wrong With “Single-Payer” Healthcare?

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About a month ago, I posted a blog (click here to read) making the case that Obamacare has failed to achieve its primary objective of providing affordable healthcare for all Americans. While 17 million more Americans now have health coverage under Obamacare, it is far from affordable and there are still almost 30 million Americans who lack any form of healthcare. My suggestion was to repeal Obamacare and replace it by expanding Medicare and Medicaid, so that all Americans would be guaranteed access to basic healthcare.

The reaction to the blog was swift and sometime acerbic. Comments split pretty much along party lines, but by far most of those who opposed my proposal did so by criticizing it as a “single-payer” system. I was not surprised by that, but that argument is an old dog that just won’t hunt any longer.

You see, “single-payer” is a dog-whistle phrase the insurance industry – and their lobbyist friends – created and have used for decades to protect their turf in the healthcare business. The “single-payer” concept has become a code-word derisively repeated ad nauseam by the insurance industry and its supporters, arguing that “single-payer” is a dark conspiracy of the part of the government to usurp the freedom and right of Americans to select a personal healthcare provider and manage their own healthcare.   

The strategy employed by the insurance industry in this deceitful, greed-driven approach has been to shift the focus away from the need and right of individuals to access affordable healthcare and instead, make it a debate about individual freedom. That’s a nice trick if you can pull it off, but the insurance companies along their well-funded friends have done it.

For decades, the idea of a single-payer healthcare system has been metaphorically the “third-rail” of politics that was so charged with controversy that politicians were afraid to touch it. We see how terrified politicians are to take on the NRA and responsible gun control; well it has been the same with politicians taking on the insurance industry with a single-payer system of healthcare. The chief reason President Obama was willing to accept the insurance industry centered cumbersome system of “insurance exchanges” that are at the core of Obamacare was because he feared taking on the myths of “single-payer” head on. The result is that the insurance companies get their way and their profits and the rest of us are stuck with a muddled, inefficient and high-cost healthcare system. And millions more Americans still lack access to basic healthcare.

So What Really is a Single-Payer System?

A single-payer healthcare system is simple. Under such a plan the government would collect the taxes and premiums needed to fund universal healthcare. The government would then contract with and reimburse private doctors and hospitals for the healthcare services they provide.

What would such a plan look like and how would it work?   

Well, many may not realize it, but Medicare is an example of this dreaded single-payer system. Medicare has proven to work well and covers millions of Americans – including me — without a loss of freedom or choice. Anyone covered under Medicare has the right to choose any doctor or healthcare provider they desire; so long as that doctor or hospital accepts Medicare. The most recent survey determined that over 90 percent of all doctors and virtually every hospital accepted Medicare payments.

It should be noted that Medicare gives those covered the freedom to not only select their personal provider, but virtually any type of medically necessary service. For example, Medicare covers the reasonable costs of doctor, hospital, preventative care, long-term care, mental health, reproductive health, dental, vision, prescription drug and medical supply costs. Contrary to what critics of the single-payer system claim, Medicare actually expands the freedom of individuals to manage their healthcare, because it lowers the financial barriers to selecting the doctor or hospital they choose.  

Those fearful of a single-payer system might suggest that such an all-encompassing government program would be inefficient and costly. Based on the history of other government programs, that might seem logical, but the reality is that the administrative costs for Medicare are at about 2 percent of total services. At the same time, the overall embedded administrative costs in the private healthcare system amount to over 30 percent of the services provided.

The insurance industry and its supporters argue that expanding the single-payer concept of Medicare and Medicaid to all Americans would bankrupt the system, but the truth is it would secure the financial viability of both programs. The system could be funded with premiums paid (based upon ability) by those covered and employer health taxes (employers would actually save money by not being required to provide coverage), but the most significant funding would come from savings obtained by replacing the current system of patchwork coverage. America now has the most inefficient and highest cost system of any industrialized nation; while failing to provide coverage for all citizens. Redirecting the expenditures from this failed private system would provide more than adequate funding for the single-payer Medicare and Medicaid systems. Furthermore, with everyone covered under the same plan, the government would have the clout to monitor and control the costs of services and medication.

The bottom line is that it is all well and good to discuss and debate whether all Americans should have a right to basic healthcare and if expanding Medicare and Medicaid is the way to provide it. However, to base opposition to these questions solely on the “evils” of a single-payer system is to fall prey to the self-serving, greedy and disingenuous arguments of the health insurance industry.  

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