Crossville Chronicle, Crossville, TN

October 8, 2013

Lion and the Lamb: The challenge of health care

By Ted Braun
Chronicle contributor

CROSSVILLE — Since the beginning of our nation, health care has been considered a privilege rather than a right. This has had serious consequences, resulting in a highly dysfunctional health system.

The figures are stark. Despite the fact that health care absorbs 18 percent of our nation's economy (twice that of other wealthy democracies), 48 million Americans lack health coverage, and 20 million more are underinsured. This has had an effect on both our death and bankruptcy rates. A recent study by Harvard Medical School researchers estimated that about 45,000 die annually for lack of affordable health insurance. And with health premiums doubling during the past decade, health care costs now account for two thirds of our nation's personal bankruptcies.

How is this health care money spent? Thirty-one percent of our nation's health care spending goes toward administrative costs, rather than care itself. Private health insurance companies divert a large amount of this income to advertising and marketing, sales teams, underwriters, lobbyists, executive salaries, and investors' shareholder profits.

Dr. David Dvorak, a member of Minnesota Physicians for a National Health Program, describes the advantages of a Medicare-for-all type single-payer system that would cover the needs of every citizen—inpatient and outpatient services, preventive care, prescription drugs, medical equipment, and mental health and dental care. Individuals could choose to see any medical provider. Deductibles and co-pays would be minimal or eliminated.

A single-payer system such as this would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses, and government, according to Dr. Dvorak, would be considerable. The non-partisan U.S. General Accounting Office has concluded that replacing the private insurers with a streamlined, publicly financed single-payer health care system would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Why didn't President Obama propose this plan in his Patient Protection and Affordable Care Act of 2010? He foolishly decided to let the Big Pharma interests reform their own system. They immediately discarded any single-payer/public option approach so that there would be no serious restrictions on rising drug prices.

The Act was designed to reflect eight principles: 1) Reduce long-term growth of health care costs for businesses and government. 2) Protect families from bankruptcy or debt because of health care costs. 3) Guarantee choice of doctors and health plans. 4) Invest in prevention and wellness. 5) Improve patient safety and quality of care. 6) Assure affordable, quality health coverage for all Americans. 7) Maintain coverage when a person changes or loses a job. 8) End barriers to coverage for people with pre-existing medical conditions.

The Affordable Care Act represents the biggest expansion of the safety net in forty years, and of health care since the introduction of Medicare in the 1960s. No Republican, however, voted in favor of the ACA. Conservatives generally oppose universal health care, believing that such care should be an individual matter without government involvement, and that the free market should be allowed to determine the cost and efficiency of health care. Tea Party members are presently leading the battle against it. And a number of Southern states are refusing to support its Medicaid expansion features that provide better coverage for people of color and the poor.

The insurance exchanges (or "marketplaces") that everyone not already on Medicare or Medicaid will be mandated to join opened for enrollment on October 1—a period that will continue until the ACA program begins operating in 2014. This will permit an additional 20 million Americans to receive health insurance.

There are still a number of intimidating hurdles in the ACA process. It is a very complex and complicated one, and not everyone finds the entering choice-making very user-friendly, especially those without internet access. Insurers are offering four levels of plans that will have the same essential services, but differ in the premiums charged and the amount of the bill that the insurance will pay. Bronze plans will pay 60 percent of an enrollee's covered medical expenses; silver, 70 percent; gold, 80 percent; and platinum, 90 percent.

The biggest flaw, however, is the fact that there will still be some citizens in the U.S. who won't be covered by the ACA health care program. 26 states, including every state in the South with the exception of Arkansas, have rejected the expansion of Medicaid. This will leave about eight million poor people, blacks, and single mothers uninsured. These would have been included in a single-payer plan.

Recognizing the various deficiencies in the ACA plan, Senator Bernie Sanders and Congressman Jim McDermott have introduced the American Health Security Act. Bernie Sanders writes: "Our bill will provide every American with healthcare coverage and services through a state-administered, single-payer program, including dental and mental health coverage and low-cost prescription drugs. It would require the government to develop national policies and guidelines, as well as minimum national criteria, while giving each state the flexibility to adapt the program as needed. It would also completely overhaul the health coverage system, creating a single federal payer of state-administered health plans."

It's time we changed health care from a privilege to a right.