Originally published in The Hill on 11/30/16.
What does the recent election cycle portend for health care in America? Not good if we go by the recent and current debate over further reform of our dysfunctional system. The non-debate has been shallow, barely covered by the mainstream media, and uninformative at this important juncture in deciding where to go next in U. S. health care.
We have three basic alternatives in how we finance health care: (1) continuation of the ACA with changes as needed; (2) repeal of the ACA and replacement by a GOP "plan"; and (3) enactment of a single-payer Medicare for All system of national health insurance (NHI). But you would never know that from the debate, which lacks details of the first two options and remains silent on the third.
Now that "conservatives" run the government in a new Trump administration, what can we anticipate? We are already seeing an alarming evidence of racism, misogyny, bigotry, and authoritarianism at the highest levels of appointments in the White House and some members of Congress. We can expect efforts to dismantle the ACA, leave more millions uninsured, cut backs of Medicaid by block grants to states, and further privatization of Medicare and Medicaid while reducing regulation and protecting the profits of insurers, drug companies and other corporate stakeholders in our medical-industrial complex. (1) The GOP's claims that "Competition will work" have been discredited over the last two-plus decades. Health care prices and costs will continue to soar as health care become even less affordable, choice more restricted, coverage more skimpy, and as outcomes of care continue to worsen.
What we all want and need now is an honest and substantial debate over our three major options to reform U. S. health care. Debate over these alternatives should be non-partisan, not a left-right or top-down issue.
In the aftermath of the 2016 elections, conservatives now largely run the government at both federal and state levels. If we were to base our future health policies on conservative principles, what would they be? Donald Light, Ph.D, professor of comparative health care at the University of Medicine and Dentistry of New Jersey and researcher at the Edmond J. Safra Center for Ethics, has noted that conservatives and business interests in every other industrialized country have endorsed these four conservative moral principles--anti-free-riding, personal integrity, equal opportunity, and just sharing. He proposes these 10 guidelines for conservatives to stay true to these principles:
- Everyone is covered, and everyone contributes in proportion to his or her income.
- Decisions about all matters are open and publicly debated. Accountability for costs, quality and value of providers, suppliers, and administrators is public.
- Contributions do not discriminate by type of illness or ability to pay.
- Coverage does not discriminate by type of illness or ability to pay.
- Coverage responds first to medical need and suffering.
- Nonfinancial barriers by class, language, education and geography are to be minimized.
- Providers are paid fairly and equitably, taking into account their local circumstances.
- Clinical waste is minimized through public health, self-care, strong primary care, and identification of unnecessary procedures.
- Financial waste is minimized through simplified administrative arrangements and strong bargaining for good value.
- Choice is maximized in a common playing field where 90-95 percent of payments go toward necessary and efficient health services and only 5-10 percent to administration. (2)
If we were to reform health care financing along these conservative principles and hold so-called conservative legislators to these conservative principles, our third option, single-payer NHI, would be the only alternative to meet these criteria.( 3) Let's have that debate in the name of democracy and fairness, working toward the common good.
A just-completed Reuters poll puts health care at the top of what Americans want the new administration to address in its first 100 days, above the economy and immigration. (4) Let's demand more transparency and accountability for factual media coverage during and beyond this critical period.
John Geyman, M.D. is the author of The Human Face of ObamaCare: Promises vs. Reality and What Comes Next and How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans
- Cohn, J, Young, J. Not just Obamacare: Medicaid, Medicare also on the GOP's chopping block. Huffington Post, November 15, 2016 - http://www.huffingtonpost.com/entry/obamacare-medicaid-medicare-gop-chopping-block_us_582a19b8e4b060adb56fbae7
- Light, DW. A conservative call for universal access to health care. Penn J Bioethics 9 (4): 4-6, 2002. - http://www.pnhp.org/news/2002/february/a-conservative-call-for-universal-access-to-health-care
- Comparison of our three alternatives. In The Human Face of ObamaCare: Promises vs. Reality and What Comes Next. Copernicus Healthcare. Friday Harbor, WA, 2016, pp. 201-209 - https://www.amazon.com/Human-Face-Obamacare-Promises-Reality/dp/1938218027
- Kahn, C. Americans want Trump to focus on healthcare first: Poll. Reuters, November 17, 2016 - http://www.reuters.com/article/us-usa-trump-poll-idUSKBN13C2HM" target="_hplink">http://www.reuters.com/article/us-usa-trump-poll-idUSKBN13C2HM