The current conversation regarding health care reform in the U.S. is essentially pointless. It can be boiled down into four statements: Obamacare stinks, so we need to get rid of it; Obamacare doesn’t stink, so we just need to improve upon it; the insurance companies are to blame, so a government single-payer system is the best idea; the government is to blame, and only the free market can fix health care. Beyond staking out one of those positions, we don’t get a whole lot of substance. It’s going to take a great deal more than that if we want to fix what is wrong with American health care.
The American health care system is defined by three main problems. Too many people lack access to care. Health care costs too much, both for individuals, and for the nation as a whole. And American health care is low-quality care. It should be added that American health care is a bureaucratic and administrative nightmare for both patients and providers alike. Any serious proposal must address all of these issues.
Obamacare focused primarily on improving access to care by increasing the number of people who could obtain health insurance. Even in this area, Obamacare fell short. There are still many millions of uninsured Americans. In addition, insurance is far too expensive for many. Worse still, even with insurance, many people can’t get the care they need, and remain unprotected from financial ruin.
The more recent Republican reform plans are a travesty, addressing none of the issues satisfactorily. The big question is why they would propose such a mockery?
Senator Sanders’ Medicare for All single-payer bill addresses access and cost issues (at least for individuals) far better than either of the previously mentioned plans, and therefore is worthy of serious consideration, no matter your political leanings. Many question how we would pay for BernieCare and whether we want government in control of health care to such an extent? These are valid concerns that need to be discussed.
Because the Republicans embarked on a new attempt to repeal Obamacare the same week as BernieCare was proposed, it is natural to compare the two plans. But there really is no comparison. Single payer is a serious attempt to fix things, and Trump-Ryan-McConnell Care is not.
What I would much rather see is a debate pitting BernieCare against a health reform concept popular with many physicians, as evidenced by how often I see it mentioned on the blogosphere. I’m not sure the concept technically has a name, so I’ll call it “The Enlightened Health Savings Account (HSA) Plan.” The basic HSA concept (not this enlightened one), where individuals maintain an account that would cover medical expenses, would likely just be inadequate. The people who need help the most, the poor, would be unable to come up with the money necessary. In addition, any serious medical issue could wipe out an HSA in days.
But an enlightened HSA plan, as I imagine it, could be much more interesting. Here are the details. Every adult individual would be required to maintain an HSA at a certain level (let’s pick a number, say $5,000). Starting and maintaining that amount could be subsidized according to income. Every year, the first $5,000 of an individual’s non-preventive medical care would be paid from the HSA. The individual would entirely control what they spend their HSA money on. Preventive care (cancer screenings and immunizations), on the other hand, would be organized and delivered by the government, all for a small annual fee (I’ll choose $250 as the amount). All non-preventive medical costs that exceed the HSA amount would be covered by health insurance. Because insurance would cover far less care (it would be true catastrophic insurance), it should be far less expensive. The government could even place a cap on the annual cost (how about $2,500).
Without a detailed economic analysis (and debate), I’m not sure if these numbers are realistic, but imagine if they were. In such a plan, there could be 100 percent access to care. And an individual’s annual costs would be limited to a maximum of $7,750 in any year, though many years might be much less. If you didn’t use your HSA money, you wouldn’t need to replace it the next year. And insurance would be capped at $2,500, but companies could compete on price, so might be less.
Government would be largely out of health care, and by giving people choice over the use of HSA money, and savings if the money is not used, individuals would have an incentive to take care of themselves and choose wisely about the care they do receive. On the other hand, because their potential expenses are capped, they would not be hesitant to seek care when necessary.
Obamacare seems doomed to failure. For-profit insurers have too many incentives, to make money and to deny care, to be the answer we need. And despite their call to just improve the plan, Democrats don’t seem to have any great ideas how to do it.
And the recent Republican reform plans aren’t serious attempts to fix things. Even if their plan did pass, we would be revisiting the issue again in the near future.
On the other hand, an “enlightened single-payer” approach, that successfully answers questions about how we would pay for the plan and included specific plans to reign in our out-of-control government health care bureaucracy, deserves serious discussion. And I would love to see it debated side-by-side with an “enlightened HSA” concept like the one described above.
Only with a real, detailed discussion about health care reform will we ever make progress. Empty rhetoric is getting us nowhere. If we worked together (seems far-fetched, I know), and were open to new ideas, and engaged in real, substantive discussions, we could fix American health care.
Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD. He is the author of Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.
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