Al Franken in his latest book addresses the false claim that the United States already has the best health care system in the world. Yes, he acknowledges, if you’re just talking about Minnesota’s Mayo Clinic, it might have a ring of truth, but a few world-class hospitals and clinics don’t make a national health care system.
Franken wryly observes that the United States “didn’t have a health system — we had a number of health systems. If you were in Medicare or Medicaid, you were in the Canadian system: single-payer. If you were in the military or the VA, you were in the British system: socialized medicine. If you got your insurance through your employer, as most Americans did, you were in the German system. But if you didn’t have any health insurance, you were in the Cambodian system, where one illness or injury could literally ruin or even end your life.”
According to the Bloomberg Health Care Efficiency Index, the United States ranked not first among the 55 countries studied but 50th. Jordan, Columbia, Azerbaijan, Brazil and Russia ranked lower. Other studies show that the United States ranks worse when counting deaths due to coronary heart disease than more than half the countries in the world. We have the highest rate of diabetes in the developing world and are only middling in dealing with cancer as a cause of death. The infant mortality rate in the United States was 42 percent higher than the average in comparable countries. Overall, we ranked last among the 16 high-income nations of the world on deaths preventable by timely access to health care. Although the Obama changes brought health care to millions more Americans, all of this means we have a long way to go in improving our health insurance systems, and clearly taking more people out of the system cannot be an acceptable solution.
So, what can we do today to save what we have, even without what the right would label a radical overhaul?
First, a modest proposal: separate out the question of tax cuts for the wealthy from the health care debate and look for an immediate compromise which is revenue neutral. Leave the question of taxes for when the Republicans bring up tax reform — if they do. Take taxes out of the equation for now and you don’t have to cut Medicaid, or eliminate insurance payment for routine annual exams or colonoscopies or mammograms, or allow insurance companies to resume rejecting people with pre-existing medical conditions, or price insurance policies out of reach for people over 50.
Second, stabilize the existing subsidies which help people buy health insurance coverage with a multi-year guarantee; that alone should resolve the problem of insurance companies bailing out from many of the states facing because of the impossible uncertainty.
Third, address the problem caused by the Supreme Court ruling that the federal government couldn’t require the states to accept Medicaid expansion if it required the states to contribute to funding five or ten percent of the additional cost. Instead, make Medicaid expansion an outright unconditional grant to the states for six or seven years, without the payback requirement that Chief Justice Roberts found coercive, and only thereafter require 5 or 10 percent state funding thereafter and only with the voluntary agreement of a recipient state — and then dare those states which rejected almost-free expansion not to continue with the program which by then would have been providing health care to hundreds of thousands of their residents for those six or seven years.
And then, for goodness sake, stop calling for repeal of the system. That’s as much of a non-starter as calling for repeal of Social Security or Medicare — ain’t going to happen. Words count, and if anyone really thinks the health payment system can be advanced even a tiny bit — and by no means a permanent fix, but at least move us forward — stop poking your opponents in the eye with a sharp stick.
Will any of this actually happen? Probably not. There may be too many “repeal or die” advocates to get enough Republican support even with Democrats on board. Eight years of Republican demands for nothing less than total repeal of Obamacare — note, they never refer to it as the Affordable Care Act (it’s official title) but bridle if we call their current efforts Trumpcare, which is obviously now becoming a kiss of death — may have locked them out politically. How many people will die, become much sicker or consume their savings on medical bills before then is uncertain; what is definite is that a lot of people will be much worse off until something constructive is done.
Arne Werchick is a retired attorney living in Kailua-Kona whose 50-year law practice emphasized health care issues.
