Texans don't like Obamacare, but what are the alternatives?

By Jack Bernard and Barbara Carr
Abilene (Texas) Reporter-News, Aug. 18, 2013

Supreme Court finds “Medicare For All!” constitutional.

No, this is not what is on the horizon. But Obamacare is on the minds of Texans, who ask: What about 10 or 20 years from now?

Let’s take a look at the health expenditure trends in Texas over the past decade.

A recent Commonwealth study showed that family premiums are at record highs in Texas — $14,526 in 2010. What is even more disturbing is that premiums were just $9,575 in 2003. That constitutes a rise of 52 percent in a few short years. But Texas is not alone.

Nationally, family premiums were $13,847 in 2010, a 50 percent increase from 2003. Projections are that, using the same rate of increase, it will rise to $23,793 by 2020. The study’s writers hope that the Affordable Care Act (ACA, Obamacare) will lay the foundation for slowing this rate of growth. But will it?

Why are these costs increasing? It’s certainly not because more people have health insurance, as the opposite is true. More people are losing insurance every year.

The problem is we have a fee-for-service system, where the more you use the more you pay, regardless of the outcome. Health care, in many ways, is still a cottage industry, where every hospital designs its own disease care framework. Health care needs to work smarter, not harder, and take a look at best practices “not invented here.”

In the words of Dr. Cosgrove, CEO of the Cleveland Clinic: “We do not have a system of health care delivery in the U.S. It’s a series of mom-and-pop shops all over the country, and it has not been systematized.”

Congratulations to Obama for doing what no other president has been able to do: get near universal coverage into law (that is if Medicaid is eventually expanded by heavily politicized “red” states such as Texas).

According to Harvard studies, about 50,000 Americans die each year due to lack of insurance. Many others suffer. Is this the America that we want to pass on to our children? No. Even if half the uninsured become covered, per the latest CBO projection, it is a very good thing.

Our position is that there is a lot to like in the ACA (Obamacare) when it comes to expanding access, though its benefits will be limited if states such as Texas choose against their own interests and refuse to expand Medicaid, letting the federal funds go to the blue states in the northeast and far west. And the recent decision by Texas and five other states to refuse to enforce the ACA’s regulations is strange, at best.

On the other hand, we see very little in the ACA that will constrain long-term cost increases.

For arguments’ sake, let’s assume we have a continuing rise in health care expenses. What alternatives are left?

The Ryan approach embraced by the Republican Party only deals with public expenditures, Medicare and Medicaid. It wants to make Medicare a voucher program, pushing costs onto the elderly, and Medicaid a block grant, forcing states to cut programs/recipients or raise taxes.

Neither of these budgetary gimmicks addresses the cause of health care inflation, private insurance and practice patterns being key. Therefore, neither will slow the private sector premium increases, rather than simply limiting government expenditures.

At that point, Medicare For All, with reimbursement based on need and accepted medical practice norms, will be the only answer that the nation can reasonably consider.

Under Medicare as it is currently run in Canada, there is universal budgeting and no opt out by physicians and hospitals. Costs of pharmaceuticals are controlled and much less than here. The per capita health care expenditure in Canada is only $4,363 whereas it is $7,960 in the U.S. under our current system.

Long term, Medicare For All will be enacted here if not for humanitarian reasons, then simply for cost containment.

Jack Bernard is a retired senior level executive who has worked for several major for-profit health care firms, including NME (now Tenet) in Dallas. He also worked with Hendrick Medical Center on cost. Barbara Carr is an adjunct professor at Eastfield College in Dallas and has 20 years of experience in Texas health care firms and hospitals.