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PNHP RESOURCES

Affordable Insurance Or Affordable Healthcare

By Lynn Moses Yellott and Chess Yellott, M.D.
The Observer (Shepherdstown, W.Va.), May 7, 2015

Reflecting the excessively long and tortuous law, a lengthy and complicated Observer article (April 2015) asks “Has the Affordable Care Act Met Expectations?”

The article confines itself to the same narrow limits the corporate media and Congress happily imposed on themselves when the bill was hammered out. The undue influence of the health insurance industry and free market advocates convinced politicians and others with power that Medicare for all should be off the table. Likewise, last month’s article ignored the option of Medicare for all along with two key questions.

The first is: Does the Affordable Care Act (ACA) ensure quality healthcare for everyone at a reasonable cost?

The answer is no, and the reasons include:

“Affordable” health insurance is no guarantee of affordable healthcare. In many cases, “affordable” insurance premiums have both high deductibles and high out of pocket maximums.  As a result, too many people delay needed care and get sicker. They are forced to choose between healthcare and other necessities.

The narrowed provider networks imposed by the insurance companies (not by government) restrict patient choice. If doctor and patient conclude that an out-of-network physician, lab, or hospital is best, the cost to the patient can be exorbitant.

Although this point and our previous were included in the article, they were made by a spokesperson who went unchallenged in her characterization of the ACA as a “federal takeover of healthcare.” As a result, the reader may come away with the impression that narrow provider networks and unaffordable out-of-pocket expenses result from government controlling our healthcare. On the contrary, the ACA represents the escalation of the takeover by the health insurance industry.

No other country spends as much per person for medical care as the US. Other countries have better outcomes on numerous measures. Why?

Because preventive care and management of chronic illness are affordable in other nations. People are able to get needed treatment early enough to prevent the conditions from becoming more serious and treatment more costly.

Other countries prevent drug corporations from gouging patients. Thus medications are much more affordable. The ACA sags under the weight of Big Pharma. Here, staff and providers continue to waste time deciphering more and more complex drug formularies. As a result, many patients experience delays in getting their medicines while also paying unnecessarily high prices.

No other developed nation allows the use of free-market pricing for medical care. They recognize that healthcare is a human right, not a commodity, and supporting healthcare for all improves the well-being of their country.

In other developed countries, healthcare dollars are not spent on insurance companies who deny care in order to make a profit.

As good as it gets?

On to our second question: is the ACA the best we can do? The answer is also no. There is no perfect solution, but one proposal should have been highlighted in the article and should have been seriously considered by Congress: Expanded and Improved Medicare for All Act (HR 676).

HR 676 provides publicly funded, privately delivered healthcare for everyone. All medically necessary care is covered, birth to death. You choose any doctor, hospital, lab, diagnostic services, dentist, therapist, audiologist, etc. None is “out of network.” Private pay and private insurance are allowed only for procedures deemed not medically necessary, such as elective cosmetic surgery. Physicians and other providers would negotiate their reimbursement rates with the government; pharmaceutical prices would be negotiated also. And few physicians would flee to other countries because all other developed countries have similar systems.

How would we would pay for HR 676? Through a fair tax. Your healthcare tax dollars would go to healthcare and not be wasted on premiums, copays, deductibles, campaign contributions, lobbying, insurance executives’ exorbitant salaries, profits, advertising, armies of paper pushers denying claims, multiple and confusing billing systems for providers, nor on medical office staff paid to resubmit claims and wait on the phone for insurance and drug corporation approvals.

An important analysis by economist Gerald Friedman reveals that HR 676 saves enough money to provide all medically necessary care for everyone — as well as funding to train health insurance-company employees for the new jobs that would be created.

We heard the thunderous outcry, “Don’t touch my Medicare,” when folks were misled to fear that the ACA would take it away. So why don’t we institute an improved Medicare for all? Those who would argue that we can’t afford it are also being misled by those same corporate interests who want to maintain their profits.

If the political mess, fueled by vested interests, does succeed in rescinding the ACA, will we be ready to demand that it be replaced by something better, such as HR 676, or will we be content to return to pre-ACA conditions?

Those discouraged by the well-financed opposition to the ACA may conclude that achieving improved Medicare for all is impossible. Let’s stop accepting this fatalism and start effectively organizing to demand improved Medicare for all. To become active in the local effort, email epspan@gmail.com.

Chess Yellott, recently retired family doctor from a community health center, and Lynn, longtime human rights advocate, have been active in the Eastern Panhandle Single-Payer Action Network, a chapter of Physicians for a National Health Program. They reside in Shepherdstown, W.Va.

References:
www.pnhp.org/news/2013/february/4-things-to-know-about-medicares-overhead-costs
www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/
http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-c...
www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
http://pnhp.org/blog/2013/07/24/why-does-u-s-health-care-cost-so-much-th...
http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-health...
www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf

http://wvobserver.com/2015/05/affordable-insurance-or-affordable-healthc...