Expanded Medicare is easy fix for health system

By Johnathon Ross, M.D.
The Blade (Toledo, Ohio), March 25, 2017

As a physician caring for poor and uninsured patients for decades, I can tell you that the Medicaid expansion under the Affordable Care Act (Obamacare) has saved lives and saved money. It has allowed access to care for hundreds of thousands of low-income Ohioans, leading to early diagnosis and treatment of disease, thereby preventing more costly care, severe disability, or death.

Gov. John Kasich understood these benefits and accepted the Medicaid expansion under Obamacare despite ideologically driven resistance from his fellow Republicans in the General Assembly.

Republicans in Congress have now outlined several tired and unproven ideas to replace that will likely gut the ACA Medicaid expansion. They plan to repeal the taxes on health-care corporations, health insurers, and the wealthy — taxes that helped pay for the Medicaid expansion for the poor and near-poor.

It is beyond comprehension that Congress, in a misguided drive to completely repeal the ACA, would cut this beneficial safety-net care away from poor patients. Real lives are being saved. Cutting or cancelling the Medicaid expansion will lead to higher costs, real suffering, disability, and deaths preventable with appropriate care.

At the same time, it’s important to understand that the ACA did not solve our problems. It didn’t attack the fundamental disease of American health care — its complexity.

Across the world there are only three simple systems proven to work: 1.) a publicly financed national health service, where doctors and other caregivers are public employees (much like our fire departments are set up), and where hospitals are publicly owned and budgeted (Sweden and the United Kingdom); 2.) a single-payer system, where health care is publicly financed but where doctors’ practices and hospitals largely remain in private hands (with hospitals getting lump-sum, annual budgets), and where a public authority negotiates provider fees and prices for medications and supplies (Canada and Taiwan); and 3.) a system of multiple, highly regulated insurers who offer a common, comprehensive benefits package, and where publicly transparent negotiations between hospitals and caregivers produce a single fee schedule and pooling of insurance funds that prevents gaming the system to avoid the sickest patients (Germany, Switzerland, and the Netherlands).

An improved and expanded Medicare for all, as envisioned in legislation introduced by Rep. John Conyers Jr., H.R. 676, would be the embodiment of the second, highly efficient approach. Everyone would be covered and there would be no co-pays or deductibles. The vast majority of households, on the order of 95 percent, would end up saving money.

The Medicare law already exists. Amendments to improve and expand it would be easy to do, either piecemeal or in a sweeping way. Medicare has been improved by amendment many times in the past 50 years. What is needed is the political will.

We know Medicare works. It has been successfully covering the most expensive and complex patients (the chronically ill, elderly, and disabled) that the private insurers would not insure prior to its passage in 1965.

Multiple studies agree that the simplicity of Medicare for all provides hundreds of billions in administrative savings that allow first-dollar comprehensive coverage for all without cutting the pay of caregivers. Medicare allows complete choice of caregiver and hospital. It would save lives, save money, and take the burden of seeking and purchasing health insurance off of businesses and individuals. An improved and expanded Medicare could provide liberal benefits and conservative spending. It is the logical and effective plan that could replace Obamacare to the benefit of all.

Dr. Johnathon Ross is an internal medicine doctor in Toledo.