The Health Care System’s Current Status
Health care in the United States is an issue with serious ethical and financial impacts at the national, corporate, and individual levels. It is a difficult issue to understand because of its complexity, lack of transparency, and associated disinformation. However, the system’s current state and trends make it imperative that health care becomes a leading platform issue in the 2020 Presidential election. Here are some examples of the most troubling characteristics:
- Annual deductibles have increased by 300% since 2006
- U.S. pays 100% more for prescription drugs than the top 10 most industrialized countries
- Almost 30 million Americans are uninsured and almost 60 million underinsured
- Commercial insurance overhead is 250% higher than the average of the top ten most industrialized countries
- 62% of current bankruptcies (8% in 1981) are due to health care costs and 50% of those bankruptcies occur to middle class families with health insurance
- U.S. spends twice as much per capita than the other top ten most industrialized countries
- U.S. health care spending is 18% of GDP vs. 12% average for the top ten most industrialized countries. Furthermore, we are trending to reach 25% by 2050
Yet, despite spending substantially more than any other comparable developed country, our system produces several critical outcomes:
- Ranks 29th in life expectancy of the top 35 world industrialized nations
- Ranks 20th in pregnancy survival of the top 35 world industrialized nations
- Ranks highest in rate of infant mortalities among the top ten most industrialized countries
- Ranks 11th out of 11 among the top ten most developed countries in the domains of access to health care and equity of access across incomes
Proposed and Implemented Republican Reforms
To date, Republican reform initiatives have focused on:
- Repeal and replacement of the Affordable Care Act (ACA)
- Elimination the ACA’s individual enrollment mandate
- Elimination of Market Place premium subsidies
- Development of capped Medicaid block grants to the states
- Reintroduction of modified short-term commercial health plans that sell for about 50% of ACA compliant plans and offer higher commissions. These plans also replace the ACA 90-day limit with a 12-month limit including the option to renew for up to three years. However, these plans eliminate the ACA’s protections for pre-existing conditions and lifetime caps on benefits. They also have very restrictive drug formularies and do not include preventative, maternity, mental health, and substance abuse benefits.
Congressional gridlock has blocked any substantive reform movement. What little concrete change we have seen to date (i.e. the short-term commercial plans) has come via Presidential Executive Order. However, the Administration did campaign to Repeal and Replace the ACA with something better utilizing small government and private market principles and systems. Unfortunately, those principles and systems are not new and account for the current state of affairs.
The Democratic Proposals
There is no unified health care reform proposal espoused by all of our current presidential candidates. Yet, there appears to be a consensus that health care is a right and that the U.S. health care system should provide unencumbered access to quality health care no matter how old, sick, poor, or unemployed we become. The details of each candidate’s proposal are still works in progress, and the differences between them exceed the scope of this article. However, they all presently appear to fall into one of three strategic approaches:
- Fix and expand the Affordable Care Act
- Reintroduce commercial insurance market reforms (i.e. mandatory essential services, eliminate pre-existing condition exclusions)
- Reintroduce the individual mandate
- Provide universal coverage via Medicaid, employer sponsored coverage, and subsidized market place policies for moderate income individuals
- Introduce a public option plan that would compete with commercial plans
- Hybrid ACA / Medicare / Commercial market system
- Combine all of the above ACA reforms with a Medicare public option
- Include the option to stay with an employer sponsored plan
- Medicare for All
- Expand Medicare to cover all U.S. citizens
- Expand Medicare benefits to include more prevention and long-term care services
- Eliminate deductibles, copays and coverage maximums
- Eliminate commercial (for profit) health insurance plans
- Fund these reforms via employer payroll tax and progressive personal income taxation
Important Decision-Making Considerations
It is imperative that Democrats make the 2020 election a referendum for substantive health care reform. Our 2020 Democratic Party platform must make equally accessible and progressively financed health care a right for every U.S. citizen! Such a plan will certainly threaten powerful vested interests and unleash campaigns of misinformation and fear. Therefore, our support must be informed by proven principles and practices from domestic research and the many other successful international models. These are key characteristics found in that research and/or comparable national systems:
- Maximum participation – The larger and more inclusive the demographics of the risk pool the lower and more stable the per person cost. The existence of multiple risk pools invariably leads to cherry picking well members and congregating the sick and disabled. We will not be able to care for the old and infirm without the participation of the young and well.
- None to minimal deductibles and co-pays – These fees discourage early intervention and wellness leading to more expensive care later.
- Low administrative complexity and expense – Best systems use the least revenue for non-direct healthcare services (i.e. marketing, overhead, dividends). Current commercial overhead average = 30% vs. Medicare = 4%.
- Total health care expenditures averaging 12 % of GDP – U.S. system currently at 18% and growing at a much faster rate than our aggregate GDP. This is unsustainable and the longer we wait, the larger the requisite tax hike or spending cut.
This article is a cursory description of our health care system, some key outcomes, and proposed reform options. The primary goal is to elevate or emphasize the importance of making substantive health care reform a leading issue of the 2020 election. That goal includes the caveat to be prepared for a formidable assault against change from vested interests that will seek to divide and frighten. Therefore, it is equally important that every organization and individual claim their vested interest and take the time to become informed advocates. And last, we must do everything possible to make this a non-partisan issue because a high quality and accessible health care system is key to everyone’s pursuit of life, liberty, and the pursuit of happiness.
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