The prevailing crisis in health care, a financing issue at its core, has dominated our national conversation lately. History buffs may recall the 14 points in President Woodrow Wilson’s plan to end the First World War a century ago, eliciting French leader Clemenceau’s remark: “Even God Almighty has only 10 points!” Wilson was also the first president to propose a national health care system for America.
The following points, considered seriously and dispassionately, should be helpful toward achieving affordable, equitable and quality universal health care:
1) Any restructuring must ensure protecting and strengthening of the Affordable Care Act (Obamacare) in the interim.
2) Prescription drug costs must be reined in by presidential executive action to negotiate with Big Pharma and, if needed, by regulation.
3) The next president can lower the eligibility age for Medicare to 50 with no new congressional legislation, a public option with no buy in.
4) Children till age 18 will be enrolled into Medicare starting from birth, again as a public option.
5) The above four steps taken at the outset are certain to create a formidable constituency by the end of the first term of the new president that will then be demanding with fierce urgency a publicly funded system in our country, long available in all other advanced-economy nations.
6) Resist fear-mongering about people being kicked off existing plans. Once the “Improved Medicare Plan” is enacted, hopefully in 2024, those opting to stay with private insurance will be free to do so, even while all medically necessary services become available as social insurance via the public purse. Insisting on lived truths would fire up people to persist in the struggle against corporate stranglehold.
7) No banning of any insurance company is required, as the market forces should be allowed to work. The supplemental policy market will remain intact in the new era.
8) Ninety-five percent of Americans will experience less overall health care spending, even with a spike in payroll deductions shared between employer and employee.
9) The top 5% will experience a modest health care surcharge. A teeny two cents per dollar wealth tax on assets above $50 million or on ostentatious consumption and a 0.1% transaction tax on Wall Street are considerations for sourcing the requisite revenue.
10) The middle class and the near-poor will see not a penny of the tax burden, while gaining access to guaranteed first-dollar coverage for all necessary care within a comprehensive benefit package without paying premiums, deductibles, copays and other burdensome out-of-pocket expenses.
11) Choice that matters – of doctors and other practitioners and of hospitals and other care facilities – will only be fortified under the reorganized system. About 55 million current Medicare beneficiaries have not clamored for its repeal for lack of choice to be under private insurance.
12) Overall costs will be reduced by about $600 billion annually for the country and for households to significantly under $5,000 a year for a typical family of four, down from a total of $20,000 now. Global budgeting for hospitals, negotiated professional fee-setting for doctors and other clinicians, and elimination of waste, fraud and profiteering are in the toolkit available under the Medicare for All Act.
13) Reimbursement rates for doctors and hospitals will be higher than under the existing Medicare. Significant savings attainable in a nonprofit system will permit nurses and other direct bedside care providers to be better compensated.
14) Funding for retraining employees displaced from the current setup, and for skilling up for transitioning into the expanded workforce needed for providing elder care, child care and many other job openings to be had when the entire U.S. population of 330 million comes under the system is incorporated into the act. Struggling, fund-starved rural and urban hospitals, teaching hospitals and biomedical research institutions will get sufficient funding to accomplish their service mission under a commissioner and an Office for Primary Care, both envisioned in the current bills in Congress (H.R. 1384 by Rep. Pramila Jayapal of Washington and S. 1129 by Sen. Bernie Sanders of Vermont).
A careful perusal of the above points should suffice for formulating a generally well-informed opinion on the topic. Apply them as a yardstick for the several other proposals and plans out there in this election year.
These signposts, it is hoped, will serve as a guide on the journey to the promised land of health care justice in America. The cost of the status quo is hundreds of preventable deaths a day. The citizen stakeholders do have it in their power to generate the necessary political will that is conspicuously absent in the majority of our elected leadership.
Alas, sadly, it needs to be said: If facts were horses, beggars would ride.
(Dr. Ahmed Kutty lives in Peterborough.)