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My Turn: Republicans should choose true reform of health care

By Robert S. Kiefner, M.D.
Concord (N.H.) Monitor, March 2, 2017

With the impending repeal of the Affordable Care Act, the Republican-controlled House and Senate have a unique opportunity to initiate truly universal and affordable health care through their support of “Medicare for all.”

In a commentary published last month in the Annals of Internal Medicine, Drs. Steffie Woolhandler and David Himmelstein report that a streamlined, publicly financed, privately delivered health care system would save in the realm of $500 billion annually. The breakdown includes $220 billion saved on paperwork and insurance overhead, $150 billion saved on hospital billing and administration, $75 billion saved on doctors’ billing and upward of $113 billion saved by aggressive bargaining with drug companies.

The value to the American consumer in terms of health and financial security? Priceless.

Sadly, Rep. Paul Ryan and Health and Human Services Secretary Tom Price have other ideas.

In their campaign not only to discredit Obamacare but to inadvertently make it look terrific in retrospect, the Republicans are looking to send our good citizens off on a health care scavenger hunt, equipped with a few meager tax credits and vouchers with which to purchase their overpriced and confounding private insurance policies.

The Republican proposals run the gamut from being merely inadequate to astonishingly inane, and clearly favor the wealthy. They are recommending that the age for Medicare eligibility be raised to 67 while simultaneously reducing Medicare funding, and that states accept inadequate “block grants” for their Medicaid populations.

Further, the speaker and his clueless colleagues would permit the sale of “mini-med” insurance plans with their mere illusion of coverage, and more tax breaks for health savings accounts with a wink to the more affluent taxpayer. By encouraging the interstate sale of insurance, the Republicans would undermine the already tenuous state-based consumer protections.

We have seen that for-profit models generally do not work in the world of health care. Patients cannot shop around for the “best deal” when they are ill or in crisis. Given the lack of transparency, real costs are impossible to discern and we all have had experience with a health care system that is difficult to access and impossible to negotiate. (“Your call is very important to us. The next representative will be able to serve you in approximately 34 minutes. Please enjoy another loop of music certain to make your head explode.”)

If we transition to a single-payer system, typical of all other industrialized countries, we could afford to cover everyone for outpatient and hospital care as well as medications and dental care, without the burden of increasing deductibles and co-pays.

Lobbyists for insurance companies and Big Pharma are spending billions of dollars each year to convince us (and especially Congress) that any move to publicly financed health care is wrong, as if the current system is working perfectly.

Now is the time to move forward, to build upon the gains achieved by the ACA toward a more comprehensive system with serious cost controls and universal coverage.

Relative to businesses, the taxes involved in financing this system would tend to be predictable, stable and significantly less than businesses are already paying for employee coverage. By eliminating the competitive disadvantage of our health care costs, we will be able to market our goods and services at a lower cost relative to other countries, while enjoying a healthier workforce. Sound good, Mr. President? We can even say that it’s your idea.

Building a wall of indifference between wealthy and poor patients looks to be the outcome of current “replacement” proposals. The Republican leadership must be convinced that they need to lead the effort toward true reform, and not be led like lemmings into the abyss.

Robert S. Kiefner is a family physician in Concord.


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