Opinion Columns & Blogs

Repeal ACA and install ‘Medicare For All’

Elizabeth Stone, 29, outside of INOVA Fairfax Hospital Center where she underwent an autologous stem-cell transplant in 2013, in Fairfax, VA, Tuesday, Oct. 24, 2017. Stone was diagnosed with lymphoma in her mid-20s, and with treatment has kept the cancer in check for five years. She doesn't qualify for subsidized premiums, but without the ACA she questions if any insurer would have covered her.
Elizabeth Stone, 29, outside of INOVA Fairfax Hospital Center where she underwent an autologous stem-cell transplant in 2013, in Fairfax, VA, Tuesday, Oct. 24, 2017. Stone was diagnosed with lymphoma in her mid-20s, and with treatment has kept the cancer in check for five years. She doesn't qualify for subsidized premiums, but without the ACA she questions if any insurer would have covered her. AP

“Americans who get their health insurance through government-sponsored or assisted plans, such as Medicare and Medicaid or veterans insurance, are more likely to be satisfied with the way the health-care system is working for them than those who have employer-paid insurance or who pay for insurance themselves.”

Gallup (11-6-15)

Modern Healthcare ran a column awhile back about the political death cycle of Medicare for all and proffered the opinion that it was not a valid replacement for the ACA. Based on the facts, I totally disagree.

I was in the health-care field for over 25 years as a state regulator, hospital system executive and national hospital service corporation VP and SVP. And, I was a Republican county commissioner and county party chairman in Georgia.

I understand both the business and political side of health-care reform, including the recent GOP efforts. But, my position may surprise you: the Affordable Care Act (Obamacare) does not go far enough either on access, cost containment or consumer protection. And, I do not support the radical views of former Secretary Tom Price of the Department of Health and Human Services and House Speaker Paul Ryan that Medicare should be changed to a voucher system and Medicaid be delegated to the states via block grants, throwing tens of millions off government insurance.

Folks who have no health insurance, 30 million Americans even after Obamacare (ACA), would have continued to have no insurance under the failed (but not truly dead) Price-Ryan policy initiatives while tens of millions more would have lost coverage. Tax credits (maximum of $3,000 in the original Price plan) are not sufficient to offset the premiums for a typical family (over $18,000). Furthermore, the majority of bankruptcies in America still happen because ordinary working people cannot pay these ridiculous medical bills — not because they are lazy, as some talk show hosts would have you believe.

Not that folks with insurance are doing all that well either. Due to cost shifting by expense battered businesses, between 2003-2010, insurance premiums for covered families went up over 50 percent (Commonwealth Fund study) and co-payments/deductibles are rising as well. Gallup states that people getting insurance on their own are not as pleased (65 percent) as Medicare enrollees (77 percent). Those with employer based insurance are only a bit better (69 percent).

What is the solution to bankruptcy, premium escalation and other related issues? President Trump, Speaker Ryan and former Secretary Price wanted to abolish Obamacare (currently covering 20 million Americans) for starters, with little to replace it with other than an incoherent set of private market theories.

People on the right essentially want to do away with government insurance completely and have the powerless folks on the bottom negotiate individually or in small groups with providers, as was done a century ago. That goal is the not so hidden thrust behind health savings accounts, high deductible plans and much of the “Price-Ryan health policy agenda,” recently and conveniently adopted by Trump this year.

More realistic expert sources, such as the respected Physicians for a National Health Program (www.PNHP.org), believe that the only way to stop cost escalation, have affordable universal access and so forth is to have one payer to pay the bills, providing the leverage needed to offset big pharma and other special interest groups.

A single payer (Medicare For All) has the cards to play in this high stakes game, as opposed to powerless individuals who are at the mercy of well-funded, well organized entities like massive insurance and drug companies. And, Medicare has overhead of only 2 percent versus an average of 12 percent for insurance companies.

Jack Bernard was the first director of Health Planning for the state of Georgia and worked for national hospital systems. He retired as a senior level executive with a national healthcare firm.

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