Medicare expansion versus same worn-out platitudes

By Jack Bernard
Ledger-Enquirer (Columbus, Ga.), July 16, 2016

My party, the GOP, is once again running for election this year on the old slogan of “repeal and replace Obamacare.” I agree that the Affordable Care Act (ACA, Obamacare) has major issues, but the key question remains: What should be its replacement? We differ drastically on the answer.

The GOP, led by Speaker Ryan in his recent policy pronouncement, is once again simply rehashing the worn-out notions that they have stated in the past: expanding of HSAs (Health Savings Accounts); lessening provider liability; selling insurance across state lines; and changing Medicaid from an entitlement to a block grant.

There are major problems with every one of these simplistic, piecemeal, marketplace “solutions” -- too many to detail in this limited space.

My answer is comprehensive, effective and efficient: Medicare for All. Here is my rationale.

Studies have shown that there were about 50 million U.S. residents without insurance prior to Obamacare. Under the ACA, 12.4 million signed up through the exchanges and now have insurance, as well as millions more under Medicaid expansion provisions. As opposed to what my avowedly religious Republican brethren preach, from a moral standpoint the ACA is clearly better than what we had previously.

Unfortunately, the ACA has problems. The Medicaid expansion provision was made voluntary by a politicized Supreme Court. Expansion does a lot to help very low-income, mostly working people who cannot afford insurance premiums and are ineligible for supplements … but only in the states accepting federal dollars (90 percent federal funding long term). So the percentage of uninsured remains much higher in many “red” states. Plus, tens of millions are still without insurance and will be for the foreseeable future under the ACA.

Further, because the ACA is built on the defective private insurance model, it will never be very effective or efficient. And with no ACA public option, insurance companies will take advantage of consumers, price gouging, especially where there are few options.

Long-term, Obamacare does little to contain costs, the “affordable” portion of the Affordable Care Act. Again, this is because private insurers are at the core of the program.

As opposed to some in my party, I do not believe that we can just repeal the ACA and go back to what we had before. It is also unrealistic to propose simply doing away with Medicare and Medicaid in their current form, as Ryan and other GOP leaders propose. Advocating for this policy will just ensure that the GOP becomes a regional party, permanently losing national elections.

Let me be very clear. As a proven fiscal conservative, I generally do not like high taxes, especially when public money is going to the wrong places and programs. In my two terms as a Jasper County commissioner, I was the driving force in my county to lower the rate of increase in property taxes from 10 percent a year to just 1 percent annually for the years I was in office. That was one of the lowest rates of increase in the state.

So why do I want to see more government involvement in our health insurance system via Medicare expansion to everyone?

Because -- based on their experience -- taxpayers (especially senior citizens like me) love their Medicare and, as opposed to some government programs, Medicare works very well.

And it is efficient, reducing marketing and overhead costs. Medicare has overhead expenses of only 3 percent compared to up to 20 percent for private insurance companies.

Single payer (Medicare for All) simplifies billing on the physician side as well. One recent study showed that a typical U.S. orthopedic surgeon spent over $80,000 a year just on billing due to our complex array of private insurance companies and plans. A similar surgeon in Canada spent one-fourth of that amount. The same would be true for our hospitals which have extensive, and extremely costly, billing operations.

Before Obama ran for the presidency, he was in favor of single payer. He has since indicated that he changed his position because we have to work with the system that is currently in place. That is D.C. code for he could not handle the politics -- the influential insurance/pharma/provider lobby. Not surprising, since he came into office with very limited experience on the national level, naively expected some GOP support (which never happened) and saw any insurance expansion as a political win.

Obama, by nature a cautious moderate, made a major mistake in abandoning his principles so quickly. He should have reversed course after the ACA was passed and established a Presidential Commission to determine the exact benefits and costs of converting our current non-system to single-payer, Medicare for All.

Studies by the respected Physicians for a National Health Program (PNHP) have shown that this conversion is financially feasible. More can be found on their website:

Only through executive action will we get verification of this premise via an impartial study. I hope that Trump or Clinton will have the political courage to move on this item once elected.

Jack Bernard is a retired senior healthcare executive and served as the first director of health planning for the state of Georgia. He is a former chair of the Jasper County Commission and of the Jasper County Republican Party.