Health care: What now?

By Jack Bernard
Columbus (Ga.) Ledger-Enquirer, July 6, 2012

Times are hard. Major changes are needed, politically, economically and socially. Statistics show that the U.S. spends much more than other nations and that our mortality and morbidity outcomes are not as good, as anyone who has studied the problem knows. In this vein, more Americans are coming to see the benefits of reforming our health care “non-system.”

Public-spirited Americans have been trying to do this for the past 75 years but have been thwarted by special interests. According to Dr. Robert McElvaine of Milsap College in Mississippi, a 1937 national survey indicated 79 percent of the American public favored the federal government providing free medical care for those unable to pay. The insurance, physician, pharmaceutical and hospital lobbies, which still exist today, were simply too strong for FDR to overcome.

Since then, initiatives have been put forth by several other administrations to establish national health care insurance. The only real legislative successes were Medicaid and Medicare under Johnson and SCHIP for children under Clinton (whose broader reform effort was sunk by the insurance industry and self-interested others).

So you have to hand it to Obama politically for getting the Affordable Care Act passed. But is the ACA the right prescription for the country? Not in my opinion.

The ACA is based on Romneycare, which has increased access but done nothing to restrain cost escalation. Massachusetts has had a dramatic rise in health care expenses since Romneycare’s enactment, something that will occur nationally under the ACA. Insurance companies are still in charge and will make record profits, more so than ever before.

We have a much better solution to the worsening health care access crisis: Expand Medicare to cover all. Polls show that most Americans support Medicare. Why? Because Medicare works. When combined with supplemental private policies, it currently provides a base level of coverage for those over 65, plus more coverage as desired. Why not simply expand it to cover people under 65?

Private providers will continue to deliver health care and physician relationships will be preserved, as they are for Medicare recipients right now. Expanding Medicare is not “socialism” -- the outlandish charge made by fanatics when a single-payer system is discussed -- any more than the government operating Veterans Administration hospitals is communism. And do you know of any patriotic older Americans who are so unhappy with their “socialistic” Medicare that they want to give it up?

Medicare administrative costs (3 percent) are much lower than the private insurance sector, which spends about one-third of our premium dollars on marketing-related costs. Cost savings will be achieved. Further, if current Medicare efforts regarding determining best medical practices are expanded under a single-payer system, more cost savings can be obtained. This will largely offset any increased systemic costs.

Yes, there will be cost-shifting from businesses to government. This will make our industries more competitive with foreign manufacturing, which does not pay health benefits to its employees. That’s a real stimulus for American car manufacturers and other who export.

And there will be cost shifting from state and local governments, which are now picking up part of the tab for indigents and their employees, to the federal government where it belongs. This may not solve the state budget crisis, but it sure won’t hurt.

As someone who has made his living as an executive in the for-profit health care system, I understand well the dirty little secret of why many health-care-related businesses, professionals and organizations are opposed to expansion of Medicare: It may lower their earnings. For this reason, the extent of lobbying by these groups cannot be underestimated. However, health care providers and political figures must do the right thing to regain the confidence of the public. And that is Medicare coverage for all.

Jack Bernard, a Jasper County commissioner and former chairman of the Jasper County Republican Party, is now a private consultant for small business.