Why The Two Political Parties Fail at Health Care Reform
Political left-right analogies are not apt regarding health care. The choice is not “free-market” health care vs. “socialized medicine” - a label incorrectly applied to single-risk-pool insurance. U.S. medicine is primarily privately-provided, whereas, insurance that operates properly is socialized. With a sustainable, comprehensive universal model, everyone contributes to single-risk pool coverage based on ability to pay, and each receives all medically-necessary health care. Single risk pool insurance immediately eliminates 30 percent inflated administrative/overhead costs of the multi-payer insurance model.
Affordable Care Act Based on Unsustainable Profiteering/“Free-market” Model
Ironically, “Obamacare” targeted by Republicans is built around the Republican-advocated “free market” multiple-payer insurance model. The Affordable Care Act (ACA) reform model was conceived by the Nixon administration in ‘71, elaborated by the Heritage Foundation in 1989, introduced in 1993 by Republicans as the Health Equity and Access Reform Today (HEART) Act, and implemented by Massachusetts Gov. Mitt Romney in 2006 - each version almost identical to the ACA, excluding the ACA’s Medicaid expansion.
Health care treated as a corporate profit-center has contributed to the upward wealth transfer for over 40 years, as taxpayers heavily subsidize insurance and pharmaceutical industries. Insurance middlemen optimize profits by practicing “Denial Management,” denying benefits while shifting costs and risks to the insured.
Multi-payer insurances protect their bottom lines, shifting costs and risks to the insured by: 1) Increasing premiums, copays and deductibles - perversely named “Consumer-directed” plans by the political right 2) Limiting benefits 3) Restricting and changing formularies 4) Limiting provider networks - requiring change of plans for many, as providers and insurers leave networks.
Full choice of providers exists only with traditional Medicare. Would people rather a choice of profiteering insurances or a true choice of providers?
Republican-Proposed Health Reform
Paradoxically named “Empowering Patients First Act,” HHS Secretary Tom Price’s draft reform plan is designed to disempower the elderly and the poor first, i.e., cutting Medicare by $449 billion over a decade, and slashing Medicaid funding to state governments by more than $1 trillion, while catapulting Medicaid’s poor into private individual insurances. Benefiting the wealthy are tax credits for purchase of private insurance. Unlimited insurance copays and deductibles for the elderly would become “as much as the market will bear.”
Paul Ryan’s ironically-named “patient-centric,” “Better Way Plan,” seeks privatization of Medicaid and Medicare, providing a fixed-sum voucher for purchase of private insurance. Pre-existing conditions are not covered if a person’s coverage lapses for even a day.
Republican "high risk pools" would isolate the sick, increasing their costs and taxpayers’ subsidies. Ryan allocates $25 billion for high risk pools over 10 years, short of $178 billion annual taxpayer cost projected by the Commonwealth Fund . Concluded another Commonwealth report: “....national high‑risk pools... are... ultimately unsustainable... insurance works best when risk is evenly spread across a broad population” - precisely the principle of single-risk-pool insurance.
Other Republican “solutions” include tax-advantaged Health Savings Accounts (HSAs) (benefiting the wealthy), and selling insurance across state lines - distancing in-network providers and bypassing state regulations.
Washington Revolving Door Makes Congress Subservient to Industry
Democrats and Republicans alike have cycled through the legislative/corporate lobbyist revolving door. A legislator who passes legislation to financially benefit industry often exits Congress to become an industry lobbyist, generously rewarded.
Architect of the 2003 Medicare Prescription Reform, Part D that subsidized pharmaceutical and insurance industries, Rep. Billy Tauzin (R-La) was rewarded $218,000. One provision of Part D forbids Medicare from negotiating lower drug prices; another requires purchase of coverage from private insurance companies. Upon leaving Congress, Tauzin became CEO of PhRMA, compensated $2 million annually.
ACA reform gifted industry with a mandate to buy private insurance. Before and after writing health care reform in Sen. Max Baucus’ office in 2009, Liz Fowler was an executive with WellPoint, the largest U.S. commercial health insurer. In 2012 Fowler took a senior position with Johnson & Johnson, member of PhRMA. Citing “a leveraged buyout of democracy,” Bill Moyers noted, 34 former Baucus staffers sprinted through the revolving door to become lobbyists - many for the health care industry.
Named by Mike Pence “the most principled expert on health care policy,” HHS Secretary Tom Price treats the $3.2 trillion health industry as his personal profit center. Investing thousands in medical device maker Zimmer Biomet, he subsequently introduced a bill benefiting the company. Price reportedly got a discounted price on a private stock offering available to a select few, apparently violating the Stock Act prohibiting insider trading by congresspersons.
Both Republican- and Democratic-authored health reform pays allegiance to crony capitalists who fund their campaigns - many from health care industries.
SINGLE RISK POOL HEALTH INSURANCE - SUSTAINABLE, UNIVERSAL, COMPREHENSIVE
U.S. 2015 health costs of $3.2 trillion, about $9,990 per person, and 17.8 percent of U.S. Gross Domestic Product total almost twice the health costs of other developed nations enjoying universal coverage and better outcomes. Single risk pool coverage could cut U.S. annual health costs by one-third.
Provides Cost Control & Long-Term Sustainability
- The larger the risk pool, the more efficient/universal the coverage. The federal Medicare model is more sustainable than any state or fragmented multi-payer model.
- Large-scale cost controls include annual negotiated provider fee schedules; negotiated bulk purchase of drugs and medical equipment; institutional global budgeting (hospitals and nursing homes) that avoids costly per-person billing.
- Separate operating and capital budgets necessary for cost-containment; operating funds designated for community needs.
- Redirects $400 billion annual savings from administrative waste (paperwork, overhead etc.) to health care, without a net increase in health spending.
Structurally More Effective & User Friendly
- Eliminates uninsured - 28 million in 2015 - and comparable numbers of under-insured.
- Not dependent on employment status
- Access to all medically necessary services - evidence-based (quality) health care
- Single large network with full choice countrywide of providers and hospitals; uninterrupted continuity of care.
Provides first-dollar coverage
- Single Risk Pool Insurance - everyone receives health care as needed, without facing financial ruin from medical bills.
- Eliminates inflationary private insurance premiums, copays and deductibles that are barriers to access, and administratively unwieldy.
- No multi-tier insurance coverage - all have full access to medically necessary health care.
- Eliminates the notion of health care as a “commodity,” i.e.,“bargaining at the emergency room door” for care.
Utilizes Progressive Financing
- U.S. taxpayers already pay 65% of all U.S. health care costs including subsidization of public employees, Congress, private employer plans, and those at 300% of poverty through ACA Exchanges. Universal single-insurer adds no net cost increase.
- Progressive payroll deduction based on income is reconciled on the annual tax return; low-income subsidized.
Simplifies billing
- One plan using one billing form - eliminates multiple rules, redundant documentation, and large staff.
People’s Will vs. Corporate Bottom Line
A majority of Americans in 2017 ranked health care costs their number one concern, surpassing jobs. A 2015 Kaiser poll demonstrated that “nearly 6 in 10 Americans, 58 percent, support a Medicare‑for‑all model of reform”. A Gallup poll reported that 41 percent of Republicans favor replacing the ACA with “a federally funded health care program providing insurance for all Americans.”
The will of the people has been superceded by Washington lobbyists promoting the false rhetoric of "free market" health care that serves only the corporate bottom line. People must demand what works for them - improved Medicare-for-All to replace the ACA. Stay tuned for innovative financing of single-insurer.....