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The complexity of the U.S. health care system makes it hard to evaluate the various plans proposed by the Democratic candidates for president. The simplistic slogan “Medicare for All” masks significant differences in what candidates are proposing and were expected to discuss in the debates earlier this week.
Bernie Sanders represents one extreme, arguing to completely replace private health care insurance with a public single-payer system that expands services and eliminates all premiums, deductibles, co-pays and out-of-pocket expenses in favor of increased taxes to pay for it all.
Studies have shown that this approach would obviously cost the federal government trillions more dollars over time but would decrease the private costs for individuals, who would pay less in taxes than they now do for insurance under the current system. The downside is that Americans are fearful of giving up the private health insurance they now have or would be forced to pay more taxes for insurance they don’t want or think they need.
The other major proposed approach to “Medicare for All” is simply to build upon and expand the Affordable Care Act, “Obamacare,” retaining the role of private insurance through employers or the state exchanges but adding a “public option” similar to Medicare that people without insurance could choose to buy.
Former Vice President Joe Biden and other moderates have advocated this alternative, which has the advantage of expanding health care coverage to millions of Americans without threatening a system that is increasingly working for the majority of Americans. But even this plan has a downside. Medicare and the proposed public option do cost the government less than private insurers charge, but they do so by putting sharp limits on what they pay hospitals and providers.
Centers for Medicare and Medicaid Services Administrator Seema Verma, a critic of Medicare for All, did make a good point on Monday when she said, “The secret of the public option is that it’s only cheaper because it uses the force of government to strong-arm doctors and hospitals into accepting below-market payment rates.
“Access will be compromised for patients,” she argues, “and reimbursement cuts in the public plan will shift more pressure to employer-sponsored plans to make up the difference, driving up costs for 180 million Americans with private insurance.”
Verma is right to note that Medicare and Medicaid pay providers significantly less than they otherwise charge, which could in fact limit provider participation and prompt higher prices for private insurance under an expanded public option. But that doesn’t mean a public option is not helpful. The government programs do have lower administrative costs than private insurance and no profit motive.
I would argue that if the government increases its reimbursement rates to fairer levels, which it should anyway, then providers and hospitals are more likely to participate and less likely to shift costs, keeping insurance reasonable for everyone.
What Verma doesn’t say is that the current system now engages in horrendous cost-shifting to pay for all the Americans who receive treatment without insurance. Nash Health Care Systems, for instance, is losing money every year because it has to treat patients who can’t afford to pay. One major reason is that the state hasn’t expanded the Medicaid program to cover as many as 500,000 residents — some undocumented — who can’t now get health care insurance but still need care.
Regardless of which health care system the candidates propose, there are some economic realities Americans need to face. One is that good health care costs money. It is not free; somebody has to pay for it, the only question is who. Secondly, the more Americans who can share the financial burden, the less it will be on any individual. That was behind the Obamacare requirement, first proposed by the conservative Heritage Foundation and repealed by Republicans, that people get some form of insurance. And finally, people will continue to have accidents and illnesses that require expensive medical care, especially in a society that is increasingly aging with chronic diseases.
Democrats now debating all these health care proposals may not have all the answers, maybe none of them, but fellow Americans should be grateful they are at least trying to come up with better alternatives to the broken health care system we have now. The Republican approach before and under Trump has been to try to kill off Obamacare in Congress and in court and to reduce health care coverage for millions, including those with preexisting conditions.
I haven’t heard anything proposed by the candidates that is any worse than what we have now, and much sounds better. Just don’t jump to judgment. Listen carefully.
Ken Ripley, a resident of Spring Hope, is The Enterprise’s editor and publisher emeritus.