Broad health-care reform needed, not just budget adjustments

 

Health-care reform is certain to be one of the bigger items on the national agenda between now and November, right after the economy and jobs, which are interrelated.

The economy is coming back after the Great Recession. But the recovery is very slow, resulting in continued high unemployment here and nationwide.

Whenever the economy falters, the number of uninsured and Medicaid recipients goes up. The Center for Studying Health System Change found that employer-based health insurance dropped from 63.6 percent to 53.5 percent nationwide from 2007 to 2010.

Similarly, a Gallup study showed that the total uninsured in the United States rose from 15 percent to 17 percent from 2008 to 2011. The 2011 Georgia rate is even higher, 22 percent, one of the highest nationally.

Furthermore, many of the insured have to pay more and more of the premium cost as employers cost shift. We are undergoing forced health-care rationing caused by economics.

 

NOW IS THE time for good Americans and Georgians to pull together and take care of the less-fortunate who have lost their jobs because of circumstances beyond their control. But many elected officials are not moving in that direction.

U.S. Rep. Paul Broun of Athens is cosponsoring a bill that is a bold attempt to do away with Medicaid in its current form and convert it to a block grant to states. This bill is modeled after the discredited attempt by the House to convert Medicare into a state block grant program, doing away with Medicare as we know it. It will certainly fail in the Senate and is only a political ploy in an election year.

As the former director of health planning for the state of Georgia, I like giving states a say in how money is spent. But this new bill is just plain bad legislation that dumps the growing Medicaid problem onto each state. It will hurt low-income citizens in Georgia who already are hurting because of an economy that has never fully recovered.

Doing away with Medicaid as we know it is not the way to control costs. It results in rationing care to the needy based on a budget, without addressing underlying systemic problems.

There is a closely related attempt by U.S. Rep. Paul Ryan and others to supposedly “reform” Medicare, this time via a proposal to convert Medicare into a private insurance program. Again, Rep. Ryan is shortsighted in his approach, substituting budgeting gimmicks for real progress in solving foundational issues.

Rather than moving for broader change, creating a more efficient system that can maximize high-quality outputs, he is concerned simply with budgeting and shifting the costs away from the national government and onto someone else.

Strangely enough, he is simultaneously proposing House Resolution 452, a bill that repeals the Independent Payment Advisory Board. This nonpolitical board is part of the Medicare Decisions Accountability Act of 2011, and was specifically set up to keep the politics out of health care and to make Medicare cost-effective.

What is the solution? Not the Affordable Care Act, or “Obamacare.” Even if the individual mandate survives the legal challenges at the Supreme Court, the ACA still does not change the system. Insurance companies still will maximize profits and cost will rise.

 

THE ALTERNATIVE is to do what the rest of the developed world has done: single-payer Medicare for all, with private physicians providing care just like they do for most people right now.

In 2000, the World Health Organization, a respected international group, issued a report ranking the U.S. health-care system 37th in the world. A 2010 New England Journal of Medicine article ranked us first in health-care spending but 39th for infant mortality and 36th for life expectancy.

In 2008, U.S. per-capita spending was $7538 while spending for France, with better health outcomes, was just $3,696. Clearly, more than just a budgetary adjustment is needed.

Physicians for a National Health Program has been a leader in the fight for universal Medicare. Studies by PNHP members have shown that administrative expenses for Medicare are just 3 percent, while for-profit insurance companies spend 31 percent of their revenue on marketing and other administrative costs.

During the Kennedy-Nixon debates, what later became Medicare was termed “socialism” by President Nixon. He later came to better understand and support this very popular, all-American program. Tell our elected officials to do what is right for the American people – the expansion of Medicare to cover all age groups.

 

(The writer is a retired health-care executive who is on the Jasper County (Ga.) Commission and Board of Health.)

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