After the Obamacare Apocalypse: The Future of Health Care Reform
Health care reform isn't going to go away, and it shouldn't. According to CNN (October 30), the average increase for a Silver plan in the United States is increasing 37%. Those who receive taxpayer-subsidized insurance will be spared the brunt of these substantial increases. The taxpayers will not as they fund these subsidies.
According to the Bureau of Labor Statistics, the 12-month inflation rate is 1.9%.
We have a health care problem, and Congress has to date done nothing to solve this mess impacting 12.2 million citizens created under the Obama administration. This health care problem is stifling economic growth and crowding out innovation in other sectors of our economy, and it is every bit as dangerous as our $20 trillion of accumulated debt, built with our permission by our elected officials.
To the starry-eyed dreamers for single-payer...it won't happen. We have powerful forces with powerful lobbyists influencing our elected officials of both parties in Washington. Here are a few on the "A" list:
1) AARP. Any attempt to reform Medicare ($594-billion federal expense in 2016) into a fiscally sustainable model has been met with resistance even as the worker-to-beneficiary ratio has decreased from 3.7 workers per beneficiary in 1970 to 2.6. Most recently, AARP opposed the move to raise the Medicare eligibility age from 65 to 67. Knowing that 25% of Medicare's expenses are in the last year of one's life, where does AARP stand in reducing the cost of end-of-life care?
2) AHIP (American Association of Health Insurance Plans). They continue to demand taxpayer subsidies to the tune of $7 billion (NPR) in 2017 to insure those covered by the exchanges. Why do taxpayers need to subsidize the insurance industry?
3) AMA. Why haven't nurses, midwives, and physician assistants been given a greater scope of care in our health care? Why are there only 141 medical schools in the USA? The limited supply of medical schools in conjunction with a limited role for other health providers results in a limited supply of physicians, resulting in a greater demand for services, resulting in a greater price for physician services. Does this serve the patient? Why does Australia recommend colonoscopies in specialized circumstances (such as a family history of colon cancer) and the USA recommend colonoscopies for everyone over age 50?
4) AHA (American Hospital Association). The merger of hospitals (many "non-profit") into various health systems was driven by the Affordable Care Act as an effort to circle the wagons and protect themselves from an overreaching government. This has resulted in cartel-like behavior that has resulted in increased costs being passed on to patients and third-party payers such as insurers and our government. If we were to have Medicare for all, do you believe that hospitals would accept a 33% loss of revenue from those covered via private insurance? Wouldn't this loss of revenue result in many hospitals no longer being financially viable? According to the Becker Hospital Review, the hospital bed occupancy rate is 61%. Doesn't this make a case for an oversupply of hospitals? If the federal government were to advocate closing (or reducing the scope of care) at a hospital, do you think members of Congress would let this loss of jobs happen in their districts? Have you watched the fight members of Congress put up when a military base is going to be closed?
5) Pharma. Here in the U.S. (according to GoodRx.com), you can buy a year's supply of AbbVie's Humira (you've seen the advertisements, haven't you?) for $54,444 per year. You could also get the same Humira in the U.K. for $12,561 per year – same 40-mg pre-filled pen. Do you think Big Pharma is going to allow a 77% reduction in price for Humira? How about the Harvoni course of treatment that is $96,000 that you can purchase in India for $1,000 (generic Harvoni)?
6) ABA. What would happen if we embraced the French model of reimbursing malpractice claims outside the U.S. legal system at a fixed rate? Wouldn't this free up our courts and result in quicker justice for victims of malpractice? According to JAMA, the 2015 cost of defensive medicine was $46 billion.
7) The states. According to the Kaiser Family Foundation, in 2014, the range by state for per Medicare beneficiary cost per year ranges from $12,614 (New Jersey) to $8,238 (Montana). Why would a state that manages its health care costs better than the national average of $10,986 per Medicare beneficiary give up that competitive advantage that results in an overall lower cost of living and a lower cost of doing business? Why should states that manage their health care costs better than their fellow states give up their competitive advantage?
Absent any concessions from these powerful organizations, "Medicare for All" will only soak the taxpayer and continue to suck the life out of our economy (and suppress our birthrate). The problem is the cost of health care and the powerful lobbies that prop up our Medical Industrial Complex. (Remember the phrase "Military Industrial Complex"? That phrase first gained mainstream usage when used by President Eisenhower in his farewell address in 1961!)
As with any association or union, the goal is to serve the interests of the members. Associations pay powerful lobbyists to represent their causes to our elected officials – which isn't necessarily the cause of the American taxpayer and citizen.
We need to come to terms with who is enabling the Medical Industrial Complex: our elected officials.
How do we defeat these powerful forces that pander to our elected officials? The answer lies in we the people taking control of our health care and understanding that the goals of the Medical Industrial Complex do not align with ours. Our enemies prey on our fear, causing us to misdirect finite resources.
Any change that can de-centralize decision-making away from Washington and empower the patient is a good place to start in our efforts to rein in the cost of health care.