The $3 trillion elephant in the presidential campaign

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Feb. 16, 2016

Remember the heated discussions about health care in the Republican debates? No, you don’t, because they were arguing about things like fantasy football. In fact, all we heard about health care was, “Repeal Obamacare!”

We get it, being a member of The Repeal Obamacare Club is a prerequisite for running for president on the GOP ticket, as is having no plan with which to replace it.

Jeb Bush promotes tax credits for individuals to purchase “affordable” and “portable” plans. We hope Bush thinks “affordable” means less than 10 percent of annual income, but given that he wants to retain the same insurance industry whose bureaucracy now consumes 30 percent of every health care dollar, it’s unlikely.

Ben Carson supports health savings accounts, a great idea for healthy and wealthy individuals, but a terrible idea for everyone else who would be more deeply trapped in increasingly expensive plans. It’s a particularly bad idea for women, whose annual cost of care typically is $1,000 more than it is for men.

Ted Cruz crows, “Repeal every blasted word of Obamacare.” With what? All the problems Obamacare addressed? Crisis treatment in ERs instead of prudent prevention? Denials for pre-existing conditions? Denials for people with the audacity to get sick and actually use their insurance? Annual and lifetime caps?

Marco Rubio, like Jeb, would give you a refundable tax credit to purchase insurance. How does that control costs? And how is that so different from the premium subsidies provided by Obamacare, which Rubio opposes?

Donald Trump promises: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” So far, Trump offers no details. He either doesn’t have them or doesn’t want us to know them. But when he does, they’ll be “fabulous!”

And what about the Democrats? Hillary Clinton would retain the Affordable Care Act and lower out-of-pocket and prescription costs, but she hasn’t said how. The Affordable Care Act has saved countless lives, but it is essentially an insurance-reform/subsidy program, not the comprehensive solution our nation needs to remedy our chronic bloating of health care costs.

Bernie Sanders supports HR 676, the Expanded and Improved Medicare for All Act, co-sponsored by Rep. William Lacy Clay and 63 other U.S. representatives. It’s a comprehensive plan with robust details. It provides full coverage without premiums, like people enjoy in all other advanced countries, at roughly half of what we spend per person in the United States today.

Any candidate who isn’t forthcoming with these details is ignoring our current dire reality. Our health care system has a literal death grip on this nation. It is the new “giant sucking sound” of money being vacuumed from our entire economy and into health care’s deep, private-profit pockets.

More than another cycle of modest reform, we need to base our solution upon our nation’s most successful health care system, Medicare. We need to divorce our health insurance from our employers, releasing businesses from that burden and giving job mobility back to employees. We need to implement universal access to health care, paid for by progressive taxes, delivered by the world’s best doctors and hospitals. We need to replace our woefully wasteful private insurance system with the efficiency of Medicare.

By eliminating sales, marketing, underwriting and other non-productive administrative functions required of private insurers, Medicare’s overhead is 2 percent; private insurance’s is 18 percent.

We have some of the best health care in the world, but far too many Americans can’t afford to use it, and everyone pays way too much for it. Medicare offers 50 years of proof that our government can administer health care as well or better than anywhere else in the world. Let’s make it available to each and every American, and demand that anyone running for high office explain how they could do better. They won’t because they can’t.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program — Missouri chapter.

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