In this “through the looking glass” election cycle, when the topic of health-care is brought up the conversation defaults to Covid-19… mask or no mask?… when will there be a vaccine?… will there be a vaccine?… did the administration handle/mishandle its response to the pandemic?… and so on. However, this myopic focus on the Coronavirus places our nation at risk of ignoring the critical issues concerning U.S. health-care that will affect us citizens long after the virus has abated.
Health-care spending accounts for 18% of the nation’s GDP, and that number rises with each passing year. Health-care costs are hurting our economy and threatening the economic stability of American workers, with out-of-pocket spending outpacing wage growth. An astounding 53% of those insured in high deductible plans have less in their savings than the deductible amount. Twenty percent of Americans have put off care of a serious condition because they fear the cost of treatment, and 20% of Americans have been in medical collections. Over-utilization of testing and the performance of unnecessary procedures for nothing more than financial gain do occur and contribute significantly to the bloat of health-care costs. It can seem like an unfixable mess. We would do well to remember, however, that the U.S. health-care system can and does offer the very best treatments available anywhere on the planet. The education, skill, and commitment of its doctors, nurses, and researchers cannot be bested, but the system is hemorrhaging and is in need of revitalization and improvement. It is not in need of wholesale replacement. Our health-care system is sick, but we must not zip it into a plastic bag and dump it in the morgue.
Politicians from the political left who want a single-payer system are more influential than ever before. The current war cry from Democrats speaks to the “catastrophe” of what a Justice Amy Coney Barrett might allow the Supreme Court to do to the Affordable Care Act, but the real threat to health-care in America lies in Medicare-for-all legislation pending in the U.S. House of Representatives and the U.S. Senate. Two bills exist: H.R. 1384 sponsored by Representative Pramila Jaapal (D-WA) and S. 1129 sponsored by Senator Bernie Sanders (I-VT). Both of these bills force enrollment at birth. Both of these bills, if enacted into law, would make it unlawful for a private health insurer to sell insurance coverage that duplicates services covered under the national health plan and unlawful for an employer to provide benefits to an employee (or their dependents) that duplicates benefits covered under the national plan. These provisions are specifically designed to eliminate private health insurance and snuff out competition to a national Medicare-for-all system.
Competition, transparency, and free market forces are exactly what are needed to improve U.S. health-care. Not a sweeping takeover. Not a Washington D.C. directed and controlled monolith that guarantees long wait-to-treat times and limited patient choice. We need to change how health-care is sold and delivered, and the changes should make it easier for individuals and employers to know exactly what services, drugs, and hospital visits will cost. Physicians, so long the ostriches in the health-care debate, must pull their heads from the sand and become active participants in reform. Simple changes, if enacted, would level a playing field that is very much tilted against the consumers of health-care, and would work to eliminate much of the expense that has nothing to do with patient care and wellness.
If we are considering buying a suit or dress or eating at a restaurant, the price to be paid is a known quantity, but it is next to impossible for a patient to know, beforehand, the actual price for a procedure or test from a hospital or clinic. Layers of opaque price adjustments that vary depending on insurance provider, confusing medical codes, and less than helpful insurer and provider bureaucrats who insist that contracted rates are proprietary secrets and actively hide this information, all come together and form a barrier that keeps patients from knowing, upfront, what costs will be. Price transparency and easy access to this information is absolutely necessary to allow consumers to research, compare and choose where and from whom they will seek care; this has been proven to lower health-care costs by promoting competition and encouraging efforts to attract patients through lower prices and increased quality of care. Routine price transparency would also help to eliminate price gouging by providers and would do much to prevent an insured patient from receiving a surprise medical bill. Robust legislation is needed to require providers to publish actual, true costs for procedures, tests, and hospitalizations. Prescription drugs account for about 10% of U.S. health-care dollars spent annually. Here, too, cost and pricing transparency could lower expenditure. President Donald Trump’s recent executive orders aimed at passing-on insulin pricing discounts to low income Americans, allowing the importation of prescription drugs from Canada where prices are substantially lower, and prohibiting secret deals between drug manufacturers and pharmacy benefit managers that rob patients of drug discounts, are welcome and appreciated steps in health-care reform and improvement.
As a practicing surgeon, I cannot stress enough that active involvement by physicians in efforts to lower cost and raise quality is long overdue. Doctors carrying out the hard work of identifying and policing those who over-test, over-treat, and over-bill will help to lower rising costs and restore confidence in a profession that, frankly, has lost some of its historic credibility with patients.
A Medicare-for-all system would lack efficiency, would restrict patient choice, would guarantee longer waits for treatment, and would disincentivize individual practitioners and the medical tech and medical device industries, eroding their ethos of effort and innovation. However, these truths by themselves are no longer a sufficient argument to prevent a wholesale government takeover of health-care in America because our citizens are tired of rising costs and are terrified of economic ruin should they become seriously ill. Americans see their salaries and bonuses being consumed by escalating premiums and Everest-like deductibles. They have lost confidence in a health-care system that gives them undecipherable bills and stories of procedures done for monetary gain. They are at the tipping point. As a nation we are close, very close, to a radical change into a true single-payer system; Senator Sanders was joined by 16 other Senators as cosponsors of his Medicare-for-all legislation, and among them was Vice Presidential candidate Kamala Harris. Smart reform and improvement that ensures patients will see and know what they are getting for their payments, that eliminates the smoke-and-mirrors of price manipulation and kickbacks for services and drugs, and that empowers patients to shop and seek the best value and quality care in a free market environment….these are what are needed to lower rising costs, restore confidence in our health-care delivery, and prevent a true catastrophe in U.S. health-care.
Brian S. Christine, MD
Urology Centers of Alabama
Birmingham, AL
