Thursday, August 23, 2018

Thoughts for Elul 4

The story is told of the Wise Men of Chelm (okay, maybe the story was somewhere else but we’ll go with it) that the mayor saw what was going on with the space race.  He gathered all the scientists, engineers, mathematicians and other brilliant people, and gave them the charge to come up with a space program that would top all the others.  He sequestered them for several months, and finally the lead scientist reported back to the mayor.  “We’ve come up with an amazing space program. Really yuge! It’s bigly!  We’re going to build a rocket and go to the sun!” The mayor asked, “Isn’t it awfully hot there?” The lead retorted, “It’s not a problem – we will go at night!”

The moral of the story? A program built by a committee is destined to be hugely flawed. And so goes the Affordable Care Act (ACA), commonly known as Obamacare.  This was modeled on Mitt Romney’s program in Massachusetts, and is a very difficult program for many to deal with. The ACA brings many important features, such as eliminating pre-existing conditions clauses, and mandating coverage for many conditions previously not covered.

But, it is a very troubled program.  Insurance companies are pulling out of a lot of markets, coverage isn’t uniform, and some states put more money into it than others. The result is that many people pay huge enrollment fees and huge deductibles for spotty coverage.

When the program was being worked on, many experts urged Congress to enact universal Medicare.  Currently, anyone in our country over 65 or on Social Security Disability is eligible for Medicare. The program has its quirks and problems, but over all, it’s a very effective program. And because it is a single payer program, providers know what they will get paid, and what to charge their patients.
Opponents to universal Medicare decry the huge costs to the government, to enact such a program. Would it be expensive? Of course it would.  If there were negotiated pharmacy prices, the way the VA does, it would be much better, though.

But here’s the thing. If you look at the per capita cost of Medicare and compare it to the per capita cost for medical care for ALL Americans, or look at the current total outlay for medical costs in our country, including associated costs for people who don’t have good coverage, the costs are way higher currently than they would be under Medicare.

People argue that they wouldn’t want the Federal Government managing their care. Too centralized. Taxes too high. Etc.  Plus Big Pharma and the insurance lobbies don’t like it because it will cost them a lot of money.

Tricare, the military program, uses insurance companies to manage the care and pay the benefits, and Tricare does the overall policy and rules management.  The VA has its own network, and uses contracted providers as well. As a retired Navy officer and disabled veteran, I receive benefits from all three.  It is crazy that I have three policies. I have great care, but it’s very complex too.

If we were to take the best of all three programs, and put it together, we could have health care coverage for ALL Americans, that would not break the bank. Taxes would have to be higher, but in the end, the total outlay would be much less, and productivity would increase because people would be healthier.

It is past time for single payer insurance in our country!  May we see a new year come in with health and prosperity for the USA and the whole world.

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