America cannot be a superpower with a substandard health care system

By Ahmed Kutty, M.D.
Monadnock Ledger-Transcript (Peterborough, N.H.), Aug. 16, 2016

In July 1965, President Lyndon Johnson had to settle for half a loaf, in lieu of the full loaf that three predecessors in The White House (Teddy Roosevelt in 1912, FDR in 1935 and Harry Truman in 1948) had proposed or attempted to legislate: a national health plan. The compromise reached, accommodating powerful opposing interest groups, gave us the Social Security Title XVIII Act, better known as Medicare, which went into effect 50 years ago this July.

Now in its “middle age,” the program has a proven track record of success in its mission of providing publicly financed health care for America’s seniors. Given its enduring popularity, it is time to review the stance of our two major political parties on health care security in general and Medicare in particular.

The Republicans in their long-awaited plan, recently authored by House Speaker Paul Ryan and offered after acrimonious and divisive attempts at a “repeal and replace” campaign launched in response to the Affordable Care Act (Obamacare) of 2010, seek to gut most of the significant gains achieved by the ACA. Their plan calls for slow, steady and subtle attempts to privatize and eventually kill the Medicare program as we know it today.

Starving by funding cuts to traditional Medicare, generous funding of the part-privatized Medicare Advantage plans and granting rule-making discretion to compliant federal agencies are some of their tools to bring about the demise of the social insurance program for the health care of seniors, who would then be on the hook for huge medical bills when a major or catastrophic illness strikes.

Then “you are on your own,” which is consistent with the zeitgeist as perceived by the Republican Party.

No surprise there!

The Democrats are saying that we have delivered the best reform in 2010 and are now on to other priorities. The fact that about 27 million Americans will remain uninsured and about 30 million underinsured after full implementation of the ACA in 2018, remain just numbers in the political calculus of the party elite. Martin Luther King’s words, “Of all forms of inequality, injustice in health care is the most shocking and inhuman,” fall on deaf ears within today’s Democratic Party. Any party in America that will heed King’s call appeared destined for political extinction until recently.

Among the major party presidential candidates, Sen. Bernie Sanders provided the most powerful, galvanizing and unwavering support for “Medicare for All”: a bold move to establish a national health care plan. Negotiations in July between the campaigns of Clinton and Sanders led to compromise, and the Democratic Party platform now promises (1) to lower the eligibility age for Medicare to 55, (2) to offer a public option in the ACA exchanges, (3) to lift the ban on Medicare from negotiating drug pricing and (4) to increase funding for qualified Community Health Centers. Alas, platform promises are non-binding.

While welcome, the incremental approach of the Democratic establishment, including Obama and Clinton, is a far cry from the much-needed basic structural reform of financing our health care system, as advocated by Sanders and others, and embedded in the bills before Congress: S. 1782 in the Senate by Sanders (and Rep. Jim McDermott’s companion bill on the House side) and H.R. 676, sponsored by Rep. John Conyers of Michigan.

The details in these bills show the plans’ financial viability and fiscal soundness, to cover all 320 million Americans under a universal, comprehensive, publicly funded program for financing health care at a cost to the nation that would be less, by a half a billion dollars, than we spend currently.

A majority of health care economists agree that that our health care costs of $3 trillion a year, amounting to 18 percent of our GDP, are unsustainable. All other major advanced economies spend an average of 9 to 10 percent of their GDP and secure coverage for all their residents. Per capita we expend $18,000 per year while Canada, the EU countries, Japan, Taiwan and Australia, among others, get all necessary health care for their citizens at approximately $9,000 per capita annually.

An average family with an annual household income of $55,000, currently paying about $11,000, including premiums and out-of-pocket deductibles, would pay $4,000 a year as taxes under the national plan and get far better, comprehensive coverage with no premiums, deductibles or copays. For about $5,000 to $6,000 – and by some estimates no more than $9,000 a year per household – we could have a publicly funded, privately delivered (as we do now) program in which everybody is in and nobody out. We must agree with President Truman, who said in 1948, that “We as a nation can afford this.”

A century ago, Lloyd George, the British prime minister during World War I, said: “You cannot run an A1 empire with a C3 population.”

We, the people, must send a message, loud and clear, to our elected leaders and candidates for offices from president on down, that America cannot build an A1 21st-century economy, and remain a superpower, with a C3 health care system. For the law stating that the arc of the moral universe bends toward justice to be operational, people must do the bending.

Dr. Ahmed Kutty is a retired physician who lives in Peterborough.

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.