We’ve all heard it: America’s health care system is on life support. Last month a Gallup poll showed that 70 percent of Americans believe our system is in crisis, and health care was a top issue for midterm voters according to exit polls.
Since Democrats assumed the majority in the House of Representatives at the beginning of the year, they’ve been focused on oversight actions to counter the Trump administration’s regulatory efforts on short-term health plans and Medicaid work requirements.
But they’re not stopping there.
Last week, progressive House Democrats revealed their “Medicare for all” bill. Introduced by Rep. Pramila Jayapal, D-Wash., it goes further than Sen Bernie Sanders’, I-Vt., proposal from nearly four years ago. Not only would it move every American onto a single public insurance provider within two years, it would also ban employers from offering their own private plans to compete with the government plan.
Even one of the largest medical groups, the American Medical Association, which supported the Affordable Care Act, opposes this bill.
Although the bill has no immediate chance of passing it already has 107 co-sponsors. This confirms not only a party-wide shift to the left, but an agenda that includes liberal health care reform as a priority.
And as Democratic presidential candidates emerge in rapid succession, the cry for universal health care is only getting louder. Their promises sound idyllic, almost Utopian. I too would love full benefits without having to work or pay for them. But is this even conceivable? Let’s crunch the numbers.
If it costs $100 for a provider to safely and effectively deliver health care, Medicaid pays that provider $85 and Medicare pays $80. This is the law, and not open for negotiation. Private insurance pays $115 for the same care.
In other words, hospitals lose money on patients covered by Medicaid and Medicare, and need to make up that loss with private insurance. But Democrats like presidential hopeful Sen. Kamala Harris, D-Calif., want to “eliminate all of that” private insurance.
Imagine if Apple spent $100 to make an iPhone, but charged customers $80 to buy it. Simply stated, Apple would be bankrupt before it even got started. Unless, of course, we all chipped in and paid Apple directly from our paychecks every Thursday via a new tax, whether we owned an iPhone or not.
This is essentially what Democrats want to do. If we want to keep doctors employed and hospital lights on, and protect access to life-saving treatments, we’re going to need to pay for it somehow. And the answer for Democrats is always the same: raise taxes and lower reimbursements.
In New York and New Jersey where I practice medicine, the political consensus about how to offset Medicaid losses was simple: inflate statewide taxes and reimburse the physicians less for their services. My husband is a private neurosurgeon who specializes in strokes, aneurysms, tumors and vascular malformations of the brain and spinal cord. Nearly overnight his reimbursements for these lifesaving procedures were cut in half and some even more drastic than that.
How will we continue to convince the brightest and most talented among us to assume these high-risk roles if we can't compensate them appropriately for their skills?
Unfortunately, the Republicans have fumbled repeatedly in their efforts to construct a viable alternative. Ultimately, President Trump took it upon himself to dismantle some of aspects of the Affordable Care Act. He eliminated the individual mandate, introduced short-term health plans, and, with a renewed focus on drug prices, lessened FDA obstructionism and improved overall price transparency.
In his State of the Union address last month, President Trump not only demanded transparency from hospitals and drug companies, but necessitated that insurance companies report their reimbursement rates. Finally, someone is calling on the massive insurance industry to disclose its role in rising fees.
This demand for transparency is essential but must go even further to involve patient responsibility. Individuals are unaware of the costs of their health care. We the people are not focused on preventing costly diseases, 50 percent of which are avoidable. To use the iPhone analogy again, while you could buy a new iPhone if you drop yours, it’s cheaper to not break it in the first place.
Human beings, and economies for that matter, are not static. They are dynamic with innumerable variables, and they must be managed by a system that can accommodate innumerable scenarios. Having one, immutable, constrained and costly system is not only unfeasible, it is inviting disaster.
The president has a small window to make a dent in health care and give hope of a path forward that does not involve single-payer. Republicans would need bipartisan support to pass any sort of legislation and let’s be practical – that isn’t going to happen. So President Trump must continue to put pressure on the drug and insurance industries to lower costs.
If he can do that, maybe, hopefully, Americans will realize that we don’t need “Medicare for all.” Right now, they are sick of the status quo and want new results, even if it means the end of quality health care. The time is now for action to avoid the catastrophe that will ensue if the current system is transformed into single-payer.