An argument in favor of single-payer healthcare!

David Penner wrote of the concern that it is the year 2018, and patients don’t always receive good care and doctors question their career choice. How have we arrived at this tragic state of affairs? The answer is that our for-profit health care system is the principal cause — not only of poor patient care but physician burnout. Only a single-payer system, which is anchored in the idea that good health care is an inalienable right and not a privilege, will allow both doctors and patients to extricate themselves from this suffering.

Under the current system, millions of Americans are forced to go to doctors that they don’t want to go to and vast numbers of Americans are also regularly compelled to stop going to doctors that they have known for years and don’t wish to leave.

Due to a complicated health condition, patients have seen dozens of different doctors over the past two years. Should their insurance suddenly change, this painstakingly constructed system of specialists could come crashing to the ground. Being forced to leave a doctor that you have known for years is a shame — not only because no one will know your medical problems quite like they do, but because once a good doctor-patient relationship is lost, it is gone forever.

This revolving door is harmful to physicians because if a doctor has a practice with patients incessantly coming and going, it will invariably foment alienation — a driving force behind physician burnout.

The argument that a single-payer system would be impossible to implement in practice is contradicted by the fact that Canada — along with the overwhelming majority of countries in Europe and Russia — have nationalized health care systems that are in many respects superior to our own. How can we call ourselves a civilized nation when millions of Americans with serious illnesses are more fearful of bankruptcy and losing their insurance than they are of death from widespread disease?

There is no logical reason why a New Yorker should be denied the right to see any doctor that they wish to see at Lenox Hill, Mount Sinai, Weill Cornell, Columbia, NYU or Sloan Kettering. Isn’t it preposterous that millions of Americans live either within walking distance or a reasonable subway ride from these hospitals, and yet their health insurance prevents them from seeing the majority of physicians that actually work at these institutions?

The question of who will foot the bill should be asked, not in regards to who will pay for single payer, but in regards to how we can continue to maintain a system of nine-hundred military bases all across the globe. According to that great bastion of Marxist heresy The Washington Post, “The U.S. wars in Afghanistan and Iraq will cost taxpayers $4 trillion to $6 trillion.” And this was written on March 28, 2013. How many hundreds of billions of taxpayer dollars have we spent on sustaining this bloated empire over the past four years? Instead of using this money to establish an excellent health care system that we can be proud of, we are using this money to wage war. Think about that the next time someone says we can’t afford a single-payer health care system.

The exploitation of doctors has a disastrous impact, not only on their morale but on the quality of care they can provide. It’s analogous to giving a high school English teacher hundreds of students per semester and putting them in the impossible position of being unable to make detailed corrections to these essays.

Constantly attempting to come up with different business models is not the answer, since the underlying problem of a two-tier system where rich and poor get radically different standards of care will remain unchanged, while those with limited income will continue to be bombarded by unacceptably high premiums and deductibles.

Lamentably, the most pressing problem in this debate is the fact that millions of Americans continue to look at health care as just another business. The astronomical cost of college tuition has resulted in over a trillion dollars in student loan debt, while the quality of education has been steadily declining for decades. As with education, we can choose to either have a good health care system, or we can continue to allow a corrupt few to make staggering amounts of money while generating the most abject suffering and misery for untold millions of their countrymen.

Tying health insurance to one’s job is profoundly unethical, as the overwhelming majority of Americans with full-time jobs can be fired at the drop of a hat if they take a significant amount of time off from work due to illness. Moreover, primary care physicians who elect not to take insurance at all will not be able to provide patients with critical in-network referrals.

How can the adage “do no harm” be implemented in practice when vitally important hospital administrators, pharmaceutical CEOs and insurance executives whose only reason for getting involved in health care in the first place was to maximize the greatest possible profit, routinely make healthcare decisions? Remove the profit motive and compassion, dignity and humanity will be restored.

Why must we continue to allow parasites and con artists dictate to doctors how they can treat patients while dictating to patients which doctors they can and cannot see? Good doctors who are forced by insurance companies to provide patients with inferior care will be prone to feelings of guilt, shame, remorse, and depression. Indeed, this is a barbarous, unconscionable state of affairs, and it cannot hold water in any rational or civilized conversation.

The time has come for Americans to put an end to this foolishness and to disenthrall themselves from these corrupt elements that straitjacket and humiliate both doctors and patients alike.

Sen. Bernie Sanders turned a key plank of his quixotic presidential campaign into new legislation meant to expand health care coverage to all Americans. It’s a bold idea that addresses a genuine problem, which is why liberal Democrats such as Sens. Elizabeth Warren and Kamala Harris back the idea. But Sanders et. al. are aiming for the impossible when something more plausible could accomplish the same thing.

Sanders wants to scrap the entire private insurance system and enroll everybody in Medicare, the health care program for seniors. Doctors and other providers would stay the same, in theory, but there would be no insurance companies and workers would no longer get coverage through an employer. The elimination of middlemen, along with the government’s enhanced bargaining power, would supposedly lower costs, benefiting everybody (except insurance company employees).

The Sanders model is “single-payer”: The government would pay for everything. It would lead to “universal coverage,” which means everybody would have insurance. But single-payer and universal coverage is not the same thing, and it’s possible to have universal coverage without the government running everything.

Sanders rightly points out that every other developed country has universal coverage for its citizens. Even President Donald Trump has said he’d like to see “insurance for everybody.” But that doesn’t mean a giant government program is the only way to do it.

How can we achieve universal coverage?

A hybrid system, with both public- and private sector elements, is probably the most likely path to universal coverage in the United States. Employer-sponsored plans already cover nearly 160 million Americans — half the nation’s population. Rolling everybody off those plans into some kind of government program would be inconceivably complex. The scale of snafus would make the botched rollout of Obamacare in late 2013 look like a well-choreographed ballet.

The employer-sponsored health care system could definitely be cheaper and better, and it imposes the strange burden of providing health care on companies that don’t exist for that purpose. But it’s also one part of the health care system that works reasonably well, and leaving it in place would amount to doing no harm.

The worst part of the U.S. health care system involves people who don’t get coverage from an employer and don’t qualify for Medicare or Medicaid. The 2010 Affordable Care Act addressed that problem by subsidizing insurance premiums for lower-income people and expanding Medicaid. But there are still roughly 28 million adult Americans with no insurance, many who simply find it too expensive. A couple million more don’t qualify for subsidies and pay exorbitant premiums to buy coverage in the individual insurance market. This is where any effort to achieve universal coverage needs to begin.

Counting everybody who receives an ACA subsidy, there are perhaps 40 million Americans who aren’t covered by Medicaid, Medicare or an employer plan. If they could get insurance, we’d have universal coverage, or come very close. Meeting the needs of 40 million people is daunting, but it’s better than dealing with the 200 million who would need insurance if we scrapped the employer system. And the smaller target would require fewer of the tax increases that would be needed to pay for a Sanders-style program.

If the employer-sponsored system remained intact, the government could then be the insurer of last resort for everybody who didn’t get insurance through his or her job. Some people worry about the creep of “socialized medicine,” but the idea of government-provided catastrophic care has had support among Republicans in the past. The legendary conservative economist Milton Friedman proposed government-provided catastrophic care back in 2001. Mitt Romney, when he was the Republican governor of Massachusetts, put a government-backstop plan in place statewide in 2006. Instead of Medicare for All, the more workable idea is Medicare for More.

What does Medicare for All means for prices?

Sanders argues that all Americans need to be in the same insurance pool — Medicare — for the government to negotiate the best prices. But there are already 44 million people in Medicare, and 62 million in Medicaid, making them both giant insurance pools. Switzerland boasts lower costs and better health outcomes than the U.S., with a total population of just 8.5 million. Medicare is more bound by laws that limit its bargaining power — on prescription drug prices, for example — than by lack of heft.

Even a hybrid system of universal coverage would be politically difficult to pull off. Critics worry that any effort to expand the government’s role in health care could inevitably lead to a single-payer system so there would need to be safeguards meant to keep the employer-sponsored system in place. Medicare is due to start running short of money in 2029, and anything that adds to its financial burden will hasten that day of reckoning. Finally, voters usually dislike change, so they’d have to be thoroughly sold on Medicare-for-more to pressure Congress to give it a shot. But Medicare for All might be a start.

The Budget deal is approved and it includes significant changes for healthcare.

Susannah Luthl stated that after a five-hour shutdown, Congress early Friday passed a massive budget deal that will have a significant impact across virtually every sector of the healthcare industry.

Sen. Rand Paul (R-Ky.) forced lawmakers to miss a midnight deadline to keep the government’s light on, criticizing his colleagues for adding to the nation’s ballooning deficit.

“I can’t in all good honesty, in all good faith, just look the other way because my party is now complicit in the deficits,” Paul said during his filibuster.

Eventually, a bipartisan coalition of senators came together to pass the bill on a 71-28 vote. The House, in a 240-186 vote, approved the bill at 5:30 a.m. ET. President Donald Trump signed the continuing resolution a couple of hours later. Although the bill outlines budget goals for the next two years, lawmakers will face another deadline of March 23 to approve detailed agency appropriations.

The budget deal, applauded by healthcare stakeholders, is the most significant healthcare legislation written since the 21st Century Cures Act even though it came largely as a surprise and was written behind closed doors in the Senate.

It includes a wide array of healthcare measures, including four additional years of Children’s Health Insurance Program funding, $6 billion for the opioid epidemic, two years of funding for community health centers, and disaster aid funding with two years of full federal reimbursement for Puerto Rico’s Medicaid program.

It includes the Chronic Care Act from the Senate Finance Committee, which will let Medicare Advantage plans tailor their coverage for patients and expand telehealth services, among other things.

The package also includes a provision that hastens the closure of the Medicare coverage gap for Part D drug costs for seniors—the so-called donut hole—as well as a measure to slow the rollout of the Merit-based Incentive Payment System, which makes providers accountable for saving Medicare money. The donut hole provision lowers beneficiaries’ co-pays, while drug companies’ discounts will be higher.

It repeals the Affordable Care Act’s Independent Payment Advisory Board, a panel charged with finding savings for Medicare. So far the panel hasn’t been triggered, but the Congressional Budget Office projected that doing away with IPAB could increase Medicare spending by $17.5 billion.

While the Chronic Care Act, funding for community health centers and Medicare extenders passed in the House continuing budget resolution earlier this week, the majority of the health package was worked out privately in the Senate and came as a surprise to House lawmakers.

For example, the Medicare donut hole provision—which comes at a cost to pharmaceutical companies—was unexpected even by House Energy and Commerce Chair Greg Walden (R-Ore.), who told reporters Thursday lawmakers may take another look at it later.

“I support the overall package. I’d have written it differently because I think there are some public policy issues that we’ll probably have to address later on because they could have an effect of actually raising list prices,” Walden said Thursday, before the shutdown. “We would have to study the impact, but this was something that to my understanding came in from the Senate side, so we were not, how shall I say it diplomatically, consulted much. I was aware of it at the end.”

For Paul, the problem came down to the deal’s expansion of the deficit. The bill would raise government spending to unprecedented levels and add an estimated $320 billion to the deficit in 10 years, according to the Committee for a Responsible Federal Budget.

The House conservatives, mainly the House Freedom Caucus and Republican Study Committee, did agree with Senator Rand Paul.

The White House issued a statement that included a rundown of its support for the healthcare measures.

“The Administration supports other components of the Bipartisan Budget Act, including greater certainty for the Children’s Health Insurance Program, an extension of funding for Community Health Centers, and repeal of Obamacare’s Independent Payment Advisory Board (IPAB),” the statement, obtained by Modern Healthcare, said. “The IPAB authority allows an unelected, unaccountable board to undertake major changes to the Medicare program. The repeal of IPAB furthers the President’s goal of repealing and replacing Obamacare.”

As a patient who has Medicare, I want to tell all that Medicare is not a free insurance program. My wife and I pay thousands of dollars each year and not all of our needs are covered. It dictates the coverage that we get such as normal eye exams are not covered and colonoscopies and mammograms are scheduled sometimes out of regard for need and specific diagnosis.

Also, are we who just had a reduction in taxes with the new Tax bill how will it be paid for? Will we need to increase federal income taxes or payroll taxes as various states who are trying health care system for all or is Congress going to institute a federal sales or value-added tax? Will any of these be accepted by the voters and therefore by the politicians? Lots of questions but they are all important to consider.

Additionally, unlike other countries with single payer, universal or socialized medical systems, we are the only country to have issues with malpractice/no tort reform and how expensive medical education is to our potential physicians.

More to consider next week and finally our book “Searching for Excellence” is being printed. Yeah!!