We need more than Obamacare

By Neil Shulman, M.D., and Jack Bernard
The Gazette (Cedar Rapids, Iowa), June 30, 2013

The authors of this article have both spent many decades in the health care field. We have seen both the positives and negatives of U.S. health care delivery and financing.

Furthermore, we have thought about how heartless some of us have become over the past few decades. As the most religious developed nation on earth, it is hard to fathom how we as a country can be so callous to our less-privileged citizens.

It is an inconvenient truth that working people in Iowa and around the nation are suffering physically and financially under our current system. Although Obamacare (and Medicaid expansion) is not the option preferred by the authors, as we state below, it is still much better than what we have right now.

In this vein, we were pleased that Iowa’s governor and legislature decided this session to accept Medicaid expansion, via the unique Iowa Health and Wellness Plan. They are to be commended for bucking Tea Party pressures and taking the federal money. If acceptable to the federal government via a “waiver,” the Iowa plan will reduce real suffering for at least some low-income Iowa residents (and improve the financial picture for hard-pressed providers).

Common cases

Many taxpayers are unaware of the suffering, exacerbated by the current health financing system, referred to above. Here are two cases encountered under our existing delivery system; the story is the same in virtually every state:

Case 1 — A 30-year-old small business owner got an object in his eyes. He can’t get it out. So he goes to a large hospital emergency room where he waits to see a doctor so his eye will not become permanently damaged. While waiting, his eye tears up and the object comes out on its own. The doc comes into the examining room, looks in his eye, and miraculously, the object has come out on its own. The patient does not have health insurance, so he is charged more than a patient who is insured: $2,000. The hospital ends up turning over the case to a collection agency.

Case 2 — A 32-year-old woman with an abscess in her liver has the abscess surgically removed. She has insurance under her dad’s policy. However, after the surgery, she loses her coverage and the scar at the site of the surgery is very painful. She cannot get an appointment to see the surgeon without a cash upfront advance payment or insurance. The pain is so bad that she has to get relief in a hospital ER frequently for the next two years — total cost more than $23,000. Now this debt is turned over to a collection agency. And the pain continues.

Many of our state and national legislators continue to be completely disconnected from the underserved segment of the population. They choose to believe that care is readily available and that we have the best health care on earth, regardless of ability to pay. It fits their political philosophy, but, based on the facts, they are 100 percent wrong.

We are the richest and most powerful country on earth. It is up to each of us to step up to the plate. We must tell our elected officials both in Iowa and across the nation that what is morally correct is to have health care as a right of all Americans, not a privilege.

Medicare for all

The best way to achieve that goal will always be Medicare for All.

A bill has been introduced in Congress that promotes single payer. If it is ever adopted, a Medicare For All system would eliminate all the game-playing under our existing system. Medicare has administrative costs that are only 3 percent versus 20 percent to 30 percent for private insurers.

Other nations that have adopted similar single-payer systems have achieved much more effective health care delivery and financing. Morbidity and mortality rates are much better than in our nation, while per capita costs are often half ours. The World Health Organization ranks the U.S. health care system 37th, behind the rest of the developed world.

Medicare For All would simply take our existing national health insurance program, Medicare, and expand it beyond the elderly. It could be funded via payroll taxes, shared by employers and employees.

More on this topic can be viewed at the Physicians For A National Health Program (PNHP) website:

Dr. Neil Shulman, of Decatur, Ga., a practicing physician for a several decades, is an associate professor at Emory Medical School. He is the author of “Doc Hollywood”, which he also produced as a movie. Jack Bernard of Monticello is a retired senior health care executive who has worked extensively with Iowa hospitals, including the Iowa Health System (now UnityPoint Health).