“Farming looks mighty easy when your plow is a pencil and you’re a thousand miles from the corn field.”
Dwight D. Eisenhower
Trump once thought health reform would be easy. He found out differently.
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The “meanness” of the newly-minted, ultra-secretive Senate bill comes as no surprise to me. It builds on the exact same foundation as the House bill, using the same heartless Ayn Rand derived philosophical base.
When it comes to health care reform, Health and Human Services Secretary Tom Price and House Speaker Paul Ryan are the brain trust of the GOP. Conservative pundits tout their revolutionary new ideas, but let’s examine what they have proposed in the past, before the House Trumpcare (AHCA) fiasco.
Speaker Ryan’s claim to fame is fiscal austerity. He has advocated major cuts to health care spending, but at what price? Ryan’s pre-Trumpcare “Better Way” proposal (sound familiar?):
▪ had provisions whereby older people could be charged five times as much as younger workers for coverage
▪ permitted premium rates to rise to unaffordable levels for those with pre-existing conditions
▪ capped employer tax breaks for provision of coverage
▪ cut $180 million out of Medicaid due to block grants
▪ would have caused tens of millions of people to lose insurance by dumping the ACA (Obamacare)
Ryan has also called for making Medicare a voucher program. While containing federal expenditures, this strategy will dump the rising cost of health care on seniors. If through some miracle Trumpcare is enacted, expect this initiative next.
Trump’s first health reform mistake was basic, but profound. By nominating Price, he put the fox in the hen house. Trump inherited Ryan. However, he chose Price, inheriting all of his baggage.
Dr. Price formerly worked at Grady Hospital, which serves many indigents. Most physicians who see the sort of problems which emanate from lack of care are empathetic to the problems of our less fortunate citizens, but certainly not Price. Coming from a long line of affluent physicians, he was born on third base, but believes he hit a triple (much like his benefactor, Trump).
Price’s pre-Trumpcare House bill:
▪ repealed Medicaid expansion entirely, dumping millions of poor mostly working people into the private market
▪ gave meager tax credits based on age…only $1,200-$3,000 when family coverage now averages $18,000 year
▪ denied coverage for people with pre-existing conditions unless they have continuous insurance for 18 months prior to applying
▪ limited tax breaks for businesses, discouraging them from offering comprehensive policies
▪ ended the ACA limitation on premium costs for seniors (now a max of 3 times younger enrollees)
Price was clearly not the one to run DHHS, especially when one looks at the contributions to his campaign. Over a two year period he received: $409,000 from health professionals; $167,000 from insurance sources; $158,000 from big pharma; $74,000 from HMOs; and $42,000 from hospitals and nursing home companies. Per the Wall Street Journal, he purchased stock in firms while advocating for the companies he was investing in. Did anyone in the Trump transition team really believe he could be objective or ethical in his DHHS role?
Repealing the ACA and substituting the Senate version of Trumpcare will be traumatic, something the CBO score shows. Many millions will lose insurance. Others will end up with policies with so many coverage exemptions that the policies will be ineffective in protecting them from financial ruin. But, there is a better way.
Gallup (12-16) studied the issue of efficiency in our health care system and found that our system was very inefficient. While still failing to cover 30 million of us, the percentage of GNP devoted to health care rose from 9 percent to 18 percent over just a few decades.
However, Gallup also pointed out that Europe’s single payer systems had the leverage to control costs. The Physicians for a National Health Program web site (www.pnhp.org) has specifics about how Medicare for All can be financed here.
Price and Ryan can be prevented from carrying out their radical, ideologically driven, unproven theories by the Senate which should (and I believe will ultimately) reject McConnell’s push to buy a “pig in a poke.” The real question then becomes “what will Trump do to cover everyone, per his campaign claims”?
Trump advocated for single payer as recently as 2015. He wrote a book in 2000 in which he praised Canadian health care, their version of Medicare for All.
In 2016, the Commonwealth Fund issued a report, “International Health Care System Profiles.” The results of this analysis by a much respected not-for-profit group are startling. Even more amazing is the fact that it has received very little coverage.
Australia, France, Canada and Germany, all have health care financing systems based on a centralized, unified governmental presence, similar to (but different from) Medicare for all. The United States, on the other hand, has a very decentralized uncoordinated financing system which emphasizes private insurance for everyone except the elderly, disabled, veterans and the very poor.
How do they compare? Let me give you a hint; we lose on every cost and access measure.
Our annual per capita expenditures are $9,364. Other nations ranged from $4,207 in Australia to $5,119 in Germany.
U.S. out of pocket per capita expenses are $1,034. Out of pocket in other nations ranged from $305 in France to $644 in Canada.
Hospital expenditures per discharge are $21,063 here. It ranged from $5,900 in Germany to $16,451 in Canada.
So, based on the data, the USA’s “private, free competition” system is much more expensive than the governmentally-based systems elsewhere. At the same time, 9 percent of our population is uninsured. All of other nations above have 100 percent coverage of their citizens.
The usual conservative response is that our system is always more responsive. The data shows that this right-wing knee jerk response is untrue. The data is mixed.
Based on survey data, 33 percent of USA respondents state that they have experienced access to care barriers due to cost of care. Other nations ranged from 7 percent in Germany to 17 percent in France.
Ease of getting after hour care was fine for 51 percent of Americans. Sixty-four percent of Germans and Frenchmen were fine, as were 63 percent of Canadians. Australians were the only ones worse than us, with 44 percent.
Finally, let’s look at the ability to get a same day appointment for primary care. Only one nation, Canada at 43 percent, is worse than the U.S. (51 percent). In Australia, for example, 67 percent of citizens can get a same day appointment.
So, the bottom line is that overall we are currently much worse than the majority of developed nations studied regarding access to health care. The conservatives have either lied to the American public or they have refused to take the time to study the issue, preferring instead to just recite ideology.
Given the above, the path for the future is clear. Have a bi-partisan committee appointed by Congress to study the health-care financing and delivery systems in place in these nations and make a recommendation back to Congress.
If this were done objectively, rather than politically and ideologically, the results would be a certainty. Some form of single payer, Medicare for all, would finally be enacted here.
Jack Bernard retired as a senior level executive with a national health care firm. He served on the Jasper County Board of Commissioners from 2005 to 2012 and has twice served on the Jasper County Board of Health. He was also chairman of the Jasper County Republican Party.