Saturday, May 6, 2017

A healthcare system that works - is it too much to ask?

[William Blake, Pestilence, c. 1780-84]
Most of my Facebook friends are proclaiming the evils of the AHCA, the new GOP healthcare bill. I agree with them that it is at best deficient and at worst cruel, and I hope it never becomes law (Senators: do your job!).

But I fear that my AHCA-hating friends—as well as those who proclaim the evils of the ACA (Obamacare)—are ignoring the bigger picture. Whether we hate Trumpcare more than Obamacare or Obamacare more than Trumpcare, we all need to consider three things:

1. While a lot of people were helped by Obamacare, some people were hurt by it. We won't be able to fix American healthcare until we listen to their concerns.

A British friend of mine opened up a Facebook discussion about the GOP bill, inviting her American friends to comment. She got plenty of comments from supporters of Obamacare (including me). She also got comments like this: “The cost of premiums have risen dramatically, while the actual coverage is diminished.”

People posted that, under Obamacare, their healthcare insurance costs rose “by double digits,” “massively,” “astronomically,” “by 40% overnight.”

They told about huge premiums—$9000 a year for a single person, $19,200 for a family—with deductibles almost as high as the premiums. “One middle-income person could easily spend $20k before being reimbursed,” someone wrote.

Many family physicians relocated, people said. Insurers shut down, care became less accessible, and confusion reigned. “I’ve spent literally dozens of hours on the phone fighting for care that was promised and then roadblocked,” one man wrote. “It’s a mess.”

These commenters may not know that the average cost of health insurance premiums actually rose considerably less after Obamacare went into effect than in the preceding decade.

They may not realize that the low-cost insurance they had before Obamacare probably did not cover the full cost of catastrophic illnesses, would have gotten increasingly expensive as they got older, and would have bumped them if they ever put in a major claim.

What they do know is that they can't afford healthcare insurance and often can't even find healthcare providers. That's a national disgrace. They need compassion, not lectures about the virtues of Obamacare.

The second thing we all need to remember is this:

2. If people are suffering under Obamacare, they are likely to suffer even more under Trumpcare. We won't be able to fix American healthcare until we recognize that change does not equal improvement.

Under the current GOP plan, some people will be able to save money. They can choose to go without insurance altogether, or they can buy a cheap plan that will help them with minor problems but leave them high and dry if major problems strike. Young and healthy people and people with limited incomes may find one of these options attractive. They may not realize that being uninsured or underinsured could cost them their homes, their credit rating, and even their lives.

Under the current GOP plan, Medicaid, one of the most successful plans for insuring the poor, will be cut back. Once again people will go to hospital emergency rooms for primary medical care (the most expensive possible approach), or will skip it altogether. Insured people may not care if uninsured people die prematurely, but they should at least worry about public health if inadequate healthcare leads to uncontrolled epidemics.

Under the current GOP plan, since a fair number of healthy people will choose to be un- or under-insured, premiums for the rest of us are sure to rise. Even if everybody chose to be insured, premiums would rise, because the GOP still believes, against all evidence, that competition among healthcare providers will contain costs.

Only one group of Americans will be sure to benefit from the GOP plan. "While the Affordable Care Act raised taxes on the rich to subsidize health insurance for the poor, the repeal-and-replace bill passed by House Republicans would redistribute hundreds of billions of dollars in the opposite direction. It would deliver a sizable tax cut to the rich, while reducing government subsidies for Medicaid recipients and those buying coverage on the individual market" (Scott Horsley, NPR, May 4).

Yes, I believe that Obama improved America's healthcare and that Trump will make it worse—but that's not my point. American healthcare was badly flawed before Obamacare, is badly flawed with Obamacare, and will be badly flawed under Trumpcare. It's not all that important to know which system is the very worst. What's vitally important is to come up with a system that works.

3. Our choices are not limited to Trumpcare and Obamacare. Why can't we scrap both plans and come up with something really good?

There are so many models we could choose from, if only we'd pay attention to healthcare systems in other nations.

Do our legislators know that the U.S. spends far more per person on healthcare than Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, or the U.K.—and yet in every one of those nations, people live longer, have less infant mortality, have fewer seniors with two or more chronic conditions, and have less obesity than we Americans do? And that they achieve these results in spite of the fact that in 10 of those 12 nations, more people are daily smokers than in America, and that in all 12 nations, the population is older?

Do our legislators know that in the U.S., for every dollar spent on healthcare we spend only 56 cents on other social programs, whereas in the other 12 countries, for every dollar spent on healthcare they spend between $1.00 and $1.88 on social programs? (You can check these statistics and learn even more fascinating facts about healthcare in other nations here.) Read my post about how healthcare (primarily intervention after a health problem has occurred) is more expensive but less effective than social services (primarily services that may prevent health problems) in keeping a nation healthy. Why are we doing things backwards?

Why aren't our legislators studying the healthcare systems of these 12 nations?

Why don't they notice that the other countries vary widely in how they finance healthcare—some by single payer, some by private insurance, some by a combination—but they all limit what providers can charge?

Why don't they notice that the other countries differ widely in who provides the care—some through the government, some through private providers, some through a combination—but they all provide it to everybody?

Why don't they consider the evidence that social spending prevents illness and therefore lowers treatment costs while improving effectiveness?

Why don't they imitate some system that has already been proven effective, rather than constantly trying to tweak a malfunctioning system that has never manged to keep costs down and has never provided healthcare for all?

And if our lawmakers are incapable of coming up with a satisfactory healthcare system, why do we keep voting for them?


Sandra Clapp said...

Great information LaVonne, thanks! I hope more people will read this and care. I don't understand all this myself. Why are Americans so worried about making sure everyone has health care, and why can't they realize it would cost us all less. I just don't understand.

Christine Palank said...

these are for sure the questions asked in the last 2 decades. Answer?? I do believe this Administration will see the struggles of our last in trying to satisfy all but until the politicians bring in the health care experts, not their lobbyists, we will continue to make poor health care policy based on the good of party VS the good of the people. great article. thanks