Amid on­go­ing drama over health­care re­form, there’s an­other so­lu­tion hid­ing in plain sight

Modern Healthcare - - COMMENT - By Dr. Clau­dia Fe­gan In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealth­ Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@modernhealth­

Now that the Se­nate GOP’s Bet­ter Care Rec­on­cil­i­a­tion Act has crashed and burned, and ef­forts to re­peal the Af­ford­able Care Act ap­pear to have stalled, it’s time to con­sider an­other plan: im­proved Medi­care for all.

The Amer­i­can pub­lic has demon­strated they want real so­lu­tions, not empty prom­ises. Vot­ers are de­mand­ing change in both town halls and the halls of Congress.

The same day the Con­gres­sional Bud­get Of­fice re­leased its ini­tial anal­y­sis of the BCRA, the An­nals of In­ter­nal Medicine pub­lished a study called “The Re­la­tion­ship of Health In­sur­ance and Mor­tal­ity: Is Lack of In­sur­ance Deadly?” Based on the study’s find­ings, the an­swer is yes. A re­view of sev­eral other stud­ies shows that each year, for ev­ery 769 Amer­i­cans with­out health in­sur­ance, one will die.

Re­peal­ing the ACA would mean 32 mil­lion Amer­i­cans los­ing in­sur­ance, ac­cord­ing to the CBO, re­sult­ing in 42,000 un­nec­es­sary deaths. Com­bined with the 28 mil­lion who are cur­rently unin­sured, we would see a stag­ger­ing 78,000 Amer­i­cans dy­ing pre­ma­turely be­cause they are unin­sured. That’s more than will die of in­fluenza and pneu­mo­nia (57,000) or kid­ney dis­ease (50,000) each year. Lack of ac­cess to health­care is our na­tion’s eighth-lead­ing killer, a cri­sis our lead­ers can no longer ig­nore.

Dur­ing the 2016 cam­paign, Don­ald Trump promised vot­ers health­care re­form that would pro­vide more cov­er­age, bet­ter ben­e­fits and lower costs. None of the pro­posed GOP bills achieves th­ese goals, and they are widely un­pop­u­lar among both Democrats and Repub­li­cans. Of course the ACA also has come up short in de­liv­er­ing lower costs. And de­spite the ma­jor in­creases in cov­er­age, about 9% of Amer­i­cans are still unin­sured.

So the ques­tion re­mains: Have our elected of­fi­cials sim­ply run out of ideas?

Thank­fully, not all of them. Rep. John Cony­ers (D-Mich.) has in­tro­duced a bill called the Ex­panded and Im­proved Medi­care for All Act, a sin­gle-payer plan that would pro­vide im­me­di­ate, com­pre­hen­sive cov­er­age to all Amer­i­cans. The bill has gained 115 co-spon­sors, with a ma­jor­ity of House Democrats sign­ing on.

How does it com­pare to Pres­i­dent Trump’s health­care prom­ises?

More cov­er­age. Like en­roll­ment in Medi­care at age 65, all Amer­i­cans would au­to­mat­i­cally join a na­tional health plan, re­gard­less of age, em­ploy­ment, in­come or mar­i­tal sta­tus. Med­i­cal de­ci­sions will be made by pa­tients and providers rather than in­sur­ance com­pa­nies.

Bet­ter ben­e­fits. Medi­care for all will cover all med­i­cally nec­es­sary ser­vices, in­clud­ing den­tal, vi­sion and long-term care. Pa­tients can visit the doc­tors and hos­pi­tals of their choice.

Lower costs. By elim­i­nat­ing in­sur­ance mid­dle­men and their ex­or­bi­tant ex­ec­u­tive salaries, ad­ver­tis­ing and prof­its, Medi­care for all would yield about $500 bil­lion an­nu­ally in ad­min­is­tra­tive sav­ings. The pro­gram would be funded by pay­roll taxes that will be fully off­set by the vir­tual elim­i­na­tion of pre­mi­ums and out-of-pocket ex­penses for pa­tients. Med­i­cal bank­ruptcy would be a thing of the past.

Will it work? Medi­care for all isn’t a new or fringe idea. Sin­gle-payer sys­tems work in in­dus­tri­al­ized coun­tries world­wide, and most spend about half of what we do on health­care, with bet­ter re­sults.

Hid­ing in plain sight is a sin­gle-payer sys­tem called Medi­care, which is uni­ver­sally pop­u­lar among pa­tients and physi­cians, pro­vid­ing care to the old­est and sick­est Amer­i­cans with only about 3% in ad­min­is­tra­tive costs.

Polls show strong sup­port for a sin­gle-payer pro­gram, and health­care providers agree. Last month the Chicago Med­i­cal So­ci­ety asked more than a thou­sand mem­bers to rate com­pet­ing health­care plans. Doc­tors pre­ferred a sin­gle-payer plan 2-to-1 over the ACA and 3-to-1 over the GOP House bill, the Amer­i­can Health Care Act. Nearly 90% agreed that health­care is a hu­man right that should be avail­able to all in­di­vid­u­als, sim­i­lar to po­lice and fire pro­tec­tion.

We be­came doc­tors to help oth­ers heal and thrive. In­stead, we spend hours each day on in­sur­ance pa­per­work and billing, hours that could be—and should be—spent on pa­tient care. Medi­care for all is a sys­tem de­signed to serve the needs of pa­tients, not the profit mo­tives of in­sur­ance com­pa­nies.

Dr. Clau­dia Fe­gan is na­tional co­or­di­na­tor and past pres­i­dent of Physi­cians for a Na­tional Health Pro­gram. She’s also chief med­i­cal of­fi­cer for the Cook County Health and Hos­pi­tal Sys­tem in Chicago.

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