Medicare is the solution to our health care woes

By Ed Weisbart, M.D.
The Kansas City Star, May 17, 2017

I applaud The Kansas City Star for addressing complex health policy issues through many recent columns, including one on May 10 by U.S. Rep. Kevin Yoder among others. Unfortunately, these authors are misinformed in critical ways.

Why are premiums going up and insurers withdrawing from markets? As imperfect as the Affordable Care Act may be, extreme partisans have blocked the pieces of the ACA that would have prevented these problems. They cut all the funds for the portions of the ACA that were intended to limit the losses of insurers, and cut all the funds for educational components that would have attracted lower risk uninsured enrollees.

Too many states have used their legislative authority, created by the ACA, to block these unjustified increases in premiums. Those states that did so have had far lower increases in premiums and more stable marketplaces. It is appalling to hear these politicians declaring the failure of the ACA after they themselves voted to destroy the very features that would have prevented these problems.

There is a simpler and more robust solution hiding in plain sight: HR 676, the Expanded & Improved Medicare for All Act. First introduced in 2003, it has now reached a record high of 108 co-sponsors. The bill very simply calls for improving the known problems with Medicare and providing it to all Americans.

Medicare is a remarkably successful public health program, with American seniors having nearly the longest life expectancy of any industrialized nation. (American life expectancy ranks near the bottom until we reach the age of Medicare eligibility.)

Medicare is also remarkably efficient. Traditional Medicare reports an overhead of 1.4 percent, increased to 6 percent when including the increased overhead of Parts C (“Medicare Advantage”) and D (the Medicare drug benefit), which are delivered by the private insurance industry. By comparison, Aetna, Anthem and United each report overheads greater than 18 percent.

Critics say our nation cannot afford to do this, but they’re wrong. There are at least 25 studies at both state and federal levels demonstrating that the savings of a Medicare-for-all strategy would match or outweigh any additional costs. Economists estimate that anyone earning less than $500,000 per year would save more by eliminating health care premiums, co-pays and deductibles than any small increase in the taxes needed to fund this.

Critics also say the free market will solve our health care crisis, but the health care market is unlike most other products. Despite market solutions, our health care costs are roughly double those in any other industrialized nation. About 750,000 of us travel overseas every year for health care because our “free market” has phenomenally higher prices than their universal programs.

More than 1 million Americans currently have GoFundMe accounts to pay for their surgery, chemotherapy and other medical expenses. Health care is the most common driver of American bankruptcy.

Why has our free market failed so miserably? Perhaps because health care cannot and will not be solved by the free market. The largest health care expenses happen when we are ill, desperate and vulnerable. At those moments, we are the least able to shop around. That’s not how a free market works.

The country would win, most individuals would win, but sadly, the health insurance industry and pharmaceutical manufacturers would not.

I consider myself a fiscal conservative and a proud American patriot. For both reasons, I find it disturbing when I hear people say the United States is unable to develop a health care system that performs as well as the rest of the modern world. We have already built that solution: Medicare. Improve it, and give it to us all.

We are Americans. We pride ourselves on our innovations and know-how. We are just allowing ourselves to be misled by those who gain from our neglect.

Ed Weisbart, M.D., is chair of Physicians for a National Health Program — Missouri chapter.