Dude, where’s my democracy?

By Jeff Jane, M.D.
The (Grass Valley, Calif.) Union, March 9, 2017

Rep. Doug LaMalfa wants to repeal the Affordable Care Act, better known as Obamacare.

I agree with much of his position. His principal criticism is that insurance under the ACA is already too expensive and even rising.

Indeed, the Department of Health and Human Services estimates that premiums, deductibles, and copays will rise about 25 percent during this year. As Mr. LaMalfa correctly observes, "We spend over 17 percent of our economy on health care, nearly twice the level of other developed countries, yet our system fails to provide consistently high-quality care."

Along with many other people, Mr. LaMalfa blames the surreal expense of healthcare insurance on government. That's a false charge. The government only sets up rules for the private insurance corporations' participation, such as covering pre-existing conditions or covering children under their parents' policies until age 26. It's the corporations that set the rates.

Health insurance carriers have a fiduciary responsibility to provide a return on investment — that is, profit — to their shareholders. No matter how politicians slice and dice healthcare financing — such as reducing excessive regulations, allowing purchase of insurance across state lines, offering tax breaks and health savings accounts, establishing high-risk pools — profit-making entities will continue to take in far more than they give out, and patients will suffer an even more complex system.

Experts estimate the operating costs of healthcare insurance corporations to be 30 to 35 percent. In contrast, the operating costs of Medicare, a government agency, is around 5 percent.

That means 25 to 30 cents of each dollar we pay goes not to healthcare, but to corporate overhead, profits, and windfall executive compensation. For example, Aetna Insurance profited $31 billion in 2008, and in 2010 paid its CEO $24 million.

We've run out of options. Our choice has narrowed between what we have now, a system operated by companies that are certain to raise costs indefinitely, and a single-payer system equivalent to Medicare for all of us, and costing 30 percent less.

In fact, a recent Gallup poll disclosed that 58 percent of Americans favor replacing the ACA with a federally-funded system.

But healthcare reform isn't exactly what I'm writing about now; it's something more basic.

For several weeks, I've been trying to contact Mr. LaMalfa in order to initiate a dialog about the health insurance costs he's correctly criticized. I've written him emails, spoken with people on his D.C. staff and formally requested face time.

Although his aides seem intelligent, concerned and friendly, I feel like my messages have dropped into a mysterious black box that may as well be a shredder.

Of course, someone who represents over 300,000 people can't see each individual.

And further, it seems sensible for a representative to vote his or her conscience at times without checking the polls. But sometimes it's necessary to dialog with well-informed voters, since a representative can be stuck in an obsolete way of thinking or just flat-out wrong.

Without such a conversation, it's senseless to advocate for any issue whatsoever, since one is only talking to a wall.

Jeff Kane, M.D. lives in Nevada City, Calif.