Let’s celebrate Medicare by expanding it to cover everyone

Sadly, Obamacare is incapable of remedying our broader health-care crisis

By Johnathon Ross, M.D.
The Blade (Toledo, Ohio), July 30, 2015

At a local Senior Olympics event a few weeks ago, I talked with other participants about our nation’s continuing health-care problems in the age of Obamacare. 

Many of them were over 65 and on Medicare, a government program that celebrates its 50th anniversary today. It provides indispensable, effective health care to about 55 million Americans.

I argued that the best  solution would be to expand Medicare to cover our whole population. Several people agreed with me. But one person bridled at my proposal, suggesting that a Medicare-for-all system would be un-American and ruin “the best health care in the world.”

America has some of the finest doctors and nurses anywhere. Our hospitals are well equipped, and our treatments and medications are typically world-class. We have the potential to be the best. But on many key indicators, we lag badly behind other nations in health-care quality and outcomes. 

A recent Commonwealth Fund study ranked the United States sixth among seven wealthy countries in quality of care, even though we spend almost twice as much per person on care as the average in these nations. Tens of millions of Americans  remain uninsured or under-insured. 

Health-care costs continue to climb. These costs are shifted to all of us in the form of higher premiums, co-pays, deductibles, and co-insurance. They deter people from seeking needed care — and the results of those delays are often fatal.

A Harvard University study estimates that among every 1,000 uninsured Americans, one will die from an illness that went untreated because of a lack of health insurance. Even when it goes fully into effect, Obamacare will leave nearly 30 million Americans without  insurance.

Nearly 30,000 of our family members, friends, and neighbors will continue to die unnecessarily each year from treatable illness. In the past 100 years, only World War II caused more annual American deaths.

A few days after the Special Olympics discussion, my daughter needed an immediate and unexpected cesarean section to deliver my first grandchild. There was no time to shop or negotiate for better prices or a lower-cost, higher-quality doctor or hospital or neonatal team. 

The procedure brooked no delay to enable the health-care free market to work. The most expensive services are often the most urgent and least negotiable.

My daughter and the baby are home and doing fine. I cannot imagine what this emergency could have done financially to her family if she were not well insured or she had been out of her provider network.

Yet I will hold my breath until all of the bills are in. Even a middle-class family like my daughter’s often gets slammed by out-of-pocket costs. This is the nature of American health care today, after “reform.”

The U.S. Supreme Court recently upheld a key provision of Obamacare that allows public subsidies to help families buy insurance through online exchanges. Had the court ruled otherwise, more than 8.2 million people would have lost their coverage relatively quickly.

Sadly, Obamacare is incapable of remedying our broader health-care crisis because it is built on a crumbling foundation: the wasteful private insurance industry. Health insurers strive constantly to maximize their bottom lines. 

The complexity of insurance plans — with variable benefits, deductibles, co-pays, and restricted provider networks — requires an army of bureaucrats and money-changers to collect the premiums. Providers must cope with this complexity when they bill for care.

This administrative nightmare wastes about $400 billion each year on needless paperwork. This waste feathers the nests of the bureaucrats who run the private health insurance industry and other corporate, profit-oriented interests in U.S. health care.

By contrast, Medicare operates with a minimum of overhead — about 2 percent, according to its trustees, compared with typical overhead of 12 to 19 percent for private insurers.

A publicly financed single payer of all medical bills would enable Americans to achieve truly universal care, affordability, and effective cost control. Co-pays and deductibles would be eliminated. You could go to the doctor and hospital of your choice.

We would best celebrate Medicare’s 50th birthday by expanding the program to all Americans. It should be protected, improved, and expanded, to make it even more efficient and effective.

Dr. Johnathon Ross, of Toledo, is past president of Physicians for a National Health Program.