Kamala Harris, Alexandria Ocasio-Cortez push to end private health insurance
Rhode Island Rep. David Cicilline weighs in on the future of health care in America.
Sen. Kamala Harris, who is seeking the Democratic presidential nomination, veered away from President Obama’s famous line – “if you like your doctor you get to keep your doctor” – Monday night when she called private health insurance “inhumane” and proposed a government-run alternative.
Speaking at a CNN town hall event, Harris, D-Calif., touted her “Medicare-for-All” plan. But in doing so, she clearly took aim at the employer-based health insurance system and at private health insurance purchased by individuals and families in the United States.
When CNN host Jake Tapper asked Harris if people could keep their current health insurance under her plan, she indicated they couldn't. So rather than simply expanding Medicare, she clearly wants to move toward a single-payer government health insurance system.
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According to a Census Bureau report published in September, 56 percent of the U.S. population is covered by employer-based health insurance and another 16 percent of the population is covered by health insurance they have purchased on their own. In all, that amounts to 217 million people who could lose their current health insurance coverage under the Harris plan.
In advocating for the elimination of private health insurance altogether, Harris said it is the insurance companies that stand in the way of access to health care.
As practicing physician, I strongly disagree with the senator’s ideas.
For one thing, private insurance is deeply imbedded in our health care system. It isn’t going away no matter what a politician says to garner support.
Private health insurance expenditures reached $1.19 trillion in 2017 and accounted for 34 percent of total national health care spending.
And even our public insurance plans are intertwined with private insurance. Some 33 percent of Medicare beneficiaries were enrolled in Medicare Advantage plans run by private health insurance carriers as of 2017.
Among traditional Medicare beneficiaries, about 25 percent have Medigap plans purchased from private health insurance carriers.
And beyond the monetary concerns and the threat to innovation and the employer-based health insurance system, Medicare-for-All poses another problem: the system would require the hiring of a huge government bureaucracy enforcing numerous rules and regulations getting in the way of doctors providing the best and most suitable care for their patients.
And that’s just Medicare. A total of 39 states have Medicaid managed care contracts with private carriers to cover some or all of their Medicaid enrollees.
Current Medicare provides health insurance for people 65 and older, while Medicaid provides health insurance for people with low incomes. Both provide care for people with disabilities.
The private health insurance system is the best fit for many of our latest and greatest new health care solutions. Genetics-driven, the new worlds of immunotherapy and robotics offer emerging tests and treatments that are personalized, and work best with a free-market system that stresses competition, choice and price transparency.
The Trump administration has made gains in these areas by introducing more choice into the insurance market with skinny plans – meaning plans that provide basic coverage at a relatively low cost designed to meet the needs of people without serious health problems. The administration has also enabled faith-based health insurance plans to cover more people and added association plans that also work across state lines.
The goal is to have more Americans getting the health care they actually need at a lower cost.
This is the opposite of what expanding government-run health care offers us. Heavy government regulation – as with ObamaCare – stifles innovation. It provide dysfunctional coverage that doesn’t work for doctors (offering narrow networks of doctors and hospitals), patients (requiring high insurance premiums and prohibitive deductibles) and insurers (severely limiting or eliminating profits and incentivizing healthy people to go without insurance).
The Medicare-for-All plan being touted by Sens. Bernie Sanders, I-Vt., and Harris would cost $32 trillion in taxpayer funds to transition to – and that’s without counting the inevitable jobs lost from an entitlement taking the place of a hard-earned benefit with the destruction of the enormous employer-based health system.
So while Medicare-for-All may sound good at first glance, the enormous price tag and its other disadvantages show it comes at a great cost.
In addition, there is simply no way that this type of insurance is geared to handle the latest immunotherapies or genetic-based personalized treatments. There is already prohibitive rationing of care and waiting times to receive health care in Canada, our single-payer health insurance model to the north.
And beyond the monetary concerns and the threat to innovation and the employer-based health insurance system, Medicare-for-All poses another problem: the system would require the hiring of a huge government bureaucracy enforcing numerous rules and regulations getting in the way of doctors providing the best and most suitable care for their patients.
The more time doctors have to spend filling out forms and appealing decisions by far-off bureaucrats, the less time they have to provide the best individualized medical care catered to meeting each patient’s needs. Keep in mind that Medicare today already fails to adequately compensate health care professionals for many of the services they provide.
Before changing and ballooning Medicare in a way that will significantly diminish its quality and functionality further, I wish Sen. Harris would consider that 28 percent of primary care physicians already don’t accept the Medicare we have now.
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I wish that we physicians were more a fundamental part of health reform, since most of dedicate our lives to providing the best care we can to our patients. That’s an important fact that is too easily overlooked.
I wish I was more hopeful that this important message will reach and affect Sen. Harris and others who are proposing a radical overhaul of our current health care system. The last thing we doctors and our patients need is another enormous government-run bureaucracy of the kind that is too often plagued with problems and woefully inadequate for patients in other nations around the world.
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