Over the last two weeks I have offered columns about the state of our healthcare system (Republican Invisible Care Act, Sept. 30 and Healthcare By the Numbers, Oct. 7). The gist is there are challenges to Obamacare, the existing law, that are poised to shut down coverage for massive numbers of Americans and raise costs for all of us against the will of a majority. Although healthcare is a nonpartisan issue, we all get sick and need medical assistance that does not send us into bankruptcy, how we pay for that care is divided by political thinking.
What exists as law was never intended to last ten years in its original form. Changes that were expected as Obamacare was put into practice and nurtured over time are that states should continue to expand Medicaid for their poorest and sickest population. Private insurance companies should continually monitor and make their policies more in line with the needs of marketplace buyers. Eligibility for Medicare would drop to age 60. A public option added to policy choices would provide competition so that marketplaces become more affordable. Except for Medicaid expansion, none of this was done.
Another facet of our healthcare system causing havoc is the reliance of millions on healthcare insurance being inextricably linked to employment. This flaw has been made painfully clear as nine million workers who have lost jobs due solely to the COVID-19 pandemic have also lost insurance, exacerbating their family’s desperation. Yet another problem of employer-based insurance is exposed in Atul Gawande’s “New Yorker” column, “Rescuing The System” (Oct. 5). The cost of providing group policies adds an average of fifteen thousand dollars per worker. That equates to a 15% tax on fifteen-dollar-per-hour jobs. This extra cost creates motivation for employers to outsource or automate their business. With our current job/healthcare bond, this incentive makes both less secure.
Politicians talk about their economic policy, their education plan, their ideas on improving infrastructure, cleaning the environment, and a separate healthcare system. We need to unite them into a single conversation––one flowing sentence gently separated by commas, not individual paragraphs hard-stopped by periods. Each policy influences the others. Leading the debate should be how we provide healthcare insurance as our national ethos. Gawande agrees that “fixing economic and racial inequality isn’t possible without fixing healthcare.” Without an entire nation healthy enough to pursue life and happiness––health independent of the job they have or the amount of money in their bank accounts––pursuits of good schools, clean air, safe water, and roads free from potholes become secondary issues.
Republicans promising a bigger and better plan that will be cheaper and more effective than Obamacare have spent the last 10 years unsuccessfully trying to figure out how to do that. The ACA lowered uninsured numbers by 40%, but the Republican plan today is to throw out the entirety of Obamacare and, by default, let private insurance companies, once again, have free reign over what kind of coverage citizens get and how much we pay for it. We’ve seen that opera with its tragic ending. We’ve seen what happens when healthcare insurance is managed by corporate leaders for whom the major concern is maximum profit for administrators and share-holders, not first and foremost health issues.
The reason Republicans have been having difficulty presenting a fair and universal overhaul of healthcare insurance management is that there simply are not many choices. Affordable policies that do not discriminate against sicker, poorer people, narrow the choices even more. Options come down to this: 1) Allow private insurance companies to sell policies but regulate coverages and costs. Republicans don’t want this due to an adversity to ever regulating private industry. 2) Allow private insurance companies to sell whatever policies they like at whatever cost, but offer public option policies with lower costs and wide-ranging coverages. Republicans don’t want this due to an adversity to government intervention into the private market. 3) Offer widespread government subsidies so that no citizen pays more than an affordable percentage of their income for insurance policies. Republicans don’t want this due to an adversity to redistributing wealth. 4) Expand Medicare, Medicaid, Tricare, and SCHIP so that everyone in the country is covered, thus eliminating private insurance and profit from the equation. No one would pay a premium, but everyone would pay more taxes––less overall––to fund the universal program.
67 countries around the world offer either government funded or a hybrid of public and private healthcare insurance in which everyone is covered. Systems all include government direction for standards of coverage and cost control achieved through legislation, regulation, and taxation. Republicans don’t want this because it is socialistic.
By eliminating premium costs and charging government to tax and manage healthcare insurance, all of the 67 countries with universal coverage pay much less for all citizens to be covered than the U.S. pays for still spotty coverage.
Choices are few and Republicans don’t like any of them. Too bad. It’s time to let the ACA stand, take on the task of feeding it, and make the necessary adjustments so that prices can be controlled, coverages improved, and finally allow our last percentage of uninsured citizens to freely and fully take advantage of all America has to offer. If it takes a constitutional amendment to stabilize healthcare, so be it.
Margie Gregory says
Mr.Donnelly, If you would reside in a country that had Universal Health Care, you would learn and understand the perils afforded the residents.
I have friends living in Canada who actually come to the United States for treatment of a serious health issue. I have friends living in Canada who have to wait months before receiving the health care they require. I had friends who lived in Canada that actually died waiting for needed health care. This isn’t what you want for America, is it? I hope not.
Terry Donnelly says
Ms. Gregory, You, or your Canadian friends, are at odds with the numbers. 82% of Canadians like their healthcare system better than what is offered here and Canada’s system is ranked, worldwide, better than ours. Doctors like it as they get paid quickly and fully. There are problems and waits for specialists can be as much as two months. The Canadian system is ranked very high in critical emergency care and more average for chronic illnesses––still higher than the U.S. I do want better care for America and Canada and 66 other countries seem to offer a better, if not perfect, solution.
Margie Gregory says
I’m not sure where you’re getting your information from Mr. Donnelly. I know where mine is coming from. Residents of Canada, and believe me, I know quite a few.
Terry Donnelly says
I have several references. One is Nanos Research, a Canadian non-profit that reported 86.5% positive rate for Canadians responding about their healthcare system. This number is supported by a Canadian government study, “A Federal Report on Comparable Health Indicators” http://www.medicare.ca. I also read from a former American doctor now working in Canada that he prefers the Canadian system for several reasons including the non-profit aspects. The essay was published in the Journal of American Medicine. I’m not Canadian, but I too know Canadian residents who spend time in the U.S. They all approve of their system and wait until they go back to Canada to schedule medical visits and procedures. I’m sure your experiences are accurate as well. The nature of diseases and the expanding knowledge of how to deal with them are unpredictable, so giving ourselves the best chance to pursue a healthy life is an important debate.