By Philip Caper, M.D.
Bangor Daily News, Nov. 15, 2012
Mercifully, the election is over. Obamacare is here to stay. A strong role for the federal government in moving toward the goal of health care as a right of everybody in the United States is now firmly and, in my opinion, irreversibly established.
Obamacare was a monumental political achievement in that it established an aspiration to health-care coverage for all Americans in federal law for the first time. President Barack Obama and former House speaker Nancy Pelosi deserve great personal credit for taking on this politically radioactive task.
But as a mechanism for providing access to health care for everybody at a reasonable cost, Obamacare has a number of serious shortcomings. Even if it works entirely as intended, it will still leave 25 million to 30 million people without any coverage at all. It lacks any persuasive mechanism for controlling the costs of public or private programs, meaning that insurance, even with federal subsidies, will likely become increasingly unaffordable.
It is way too complicated, and complications are expensive. To make it work will require thousands of federal regulations.
Deficit hawks will resist the expansion of Medicaid, the subsidies for the purchase of private insurance, the boost to community health centers, and funding for the exchanges that must be set up to create a more functional health insurance “marketplace.” The new law even includes funding for “navigators” to help people sort through the maze of insurance plans it creates.
Our fractured and fragmented health-care system will become even more so as Americans are further divided by income, employment status, and the type of insurance they choose in the exchanges. Despite the modest tax penalties, many will choose to remain uninsured, shifting the cost of care they may need to everybody else.
In previous columns, I have argued for a right to health care on moral grounds and on economic grounds. It’s actually cheaper to cover everybody than to figure out how not to cover some.
I would now like to make a case for less complexity in our health-care system. Much of the complexity of our existing system is defended as a way to preserve choice. But the virtues of choice are being vastly oversold, especially when it comes to how it’s paid for.
Most people care little about how their health care is financed. They do care about how it’s delivered. Medicare, financed largely by taxes, is far more popular with the public than private insurance.
The ability of individuals to make intelligent choices among insurance plans is an illusion. A recent column written by a Harvard-trained health-care economist drives this point home. Despite her extensive education and experience with health insurance, she was unable to choose the most appropriate coverage for herself when she really needed to. With deteriorating health and rising anxiety about her illness, worries about incurring a huge bill to get the potentially life-saving treatment for her brain tumor added to her stress.
Although some groups are more vulnerable than others to some diseases or injuries, when it comes to individuals, it’s nearly impossible to predict where and when illness or injury will strike or what its nature will be. Unless one has a pretty good crystal ball, the basic information needed to make an informed choice about a health insurance or prescription drug plan simply doesn’t exist.
The dilemma the health-care economist faced was not because of a lack of expertise, but rather a lack of necessary information.
Choice can be a good thing. But as anyone who has tried to navigate the Medicare prescription drug program can testify, there is such a thing as too much choice.
Rather than making our already byzantine health-care system more complicated, we need to make it simpler. We need to move away from health insurance and put everybody in the same tax-supported system.
As in Medicare, we could still give everybody a reasonable choice of doctors and other providers under an acceptable and enforceable budget. If every other wealthy country can do it, so can we.
Since everyone would benefit equally, it would be far more popular than what we have now. In other words, simplify our health-care system by enacting “Improved Medicare for All.”
It’s unlikely that could be done anytime soon at a national level, but I believe it could be done in Maine under the existing waiver provisions of the Affordable Care Act. Compared to our current system, it would be simpler, fairer, far more efficient and would allow us to join all other wealthy countries in making health care a right.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org.