By Deane Waldman, MD MBA - 20/07/20
Both Republicans and Democrats in Congress have bought into three healthcare lies: big, bigger, and biggest. The first says health insurance is what we need. The second presumes that having insurance means you will get care. The biggest lie is that Washington will deliver timely medical care for all Americans.
Political leaders, media experts, and the Congressional Budget Office measure success in healthcare by the number of people with health insurance, preferably government-supplied, no-charge, tax-payer paid for coverage. After Congress passed the Affordable Care Act in 2010, President Obama clarified the intent of his namesake law: to reform health insurance, not medical care.
C. 102 of the Medicare-for-All bill, H.R. 1384, claims to provide "universal coverage." No where does it show how covering everyone will provide the care it says Americans "deserve," especially as it would reduce payments to physicians by 40 percent.
The big lie says that the ultimate goal of healthcare is to insure everyone. It isn't. Healthcare is, or should be, all about care.
A widely accepted falsehood is that having insurance coverage means you get the care you need when you need it. Experience in the state of New Mexico, Texas, and New York demonstrates the opposite: as more people are insured by the government, access to care goes down.
Via Medicaid expansion, New Mexico gave new insurance to more than 300,000 individuals. Despite the infusion of $3 billion in additional federal dollars into state coffers, the cost of the ObamaCare mandates cost $3.4 billion, creating a $417 million shortfall in the New Mexico Medicaid budget. To balance the books, the Land of Enchantment's Medicaid program had to cut its already low payment schedule to doctors even further. As a result, there were fewer doctors to care for Medicaid patients. By increasing the number of government-insured individuals, care became LESS available.
Texas has the highest uninsured rate, 17 percent, in the country. New York State has the lowest at 5.4 percent. New York satisfied its residents' primary care needs 45 percent of the time while Texas did so 71 percent of the time.
The biggest lie says Washington will provide all the health care we need, when and where we need it, for free.
Government-controlled healthcare has two fundamental flaws. First, it is highly dollar inefficient and thus incredibly expensive. Forty percent of U.S. healthcare spending - more than $1 trillion per year - produces no patient care. Since federal bureaucracy takes the first and largest chunk of healthcare spending, providers and institutions must make do with whatever is left.
Second fundamental flaw: the government has only one way to control costs: medical rationing. It reduces reimbursement schedules to providers, limits payments to institutions, and denies authorization for expensive treatments. As a result, wait times to see a family physician are now more than four months, almost half of U.S. physicians cannot afford to accept new Medicaid patients, and "47,000 veterans may have died waiting for care."
For five decades, Washington's fixes for healthcare have made things worse, not better. Healthcare has become Washington is the cancer-it cannot be the cure. We need to release healthcare from federal control. Healthcare should return to the states, where it belongs according to the U.S. Constitution.
The Tenth Amendment states, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people." In simple terms, Washington is constitutionally prohibited from being in charge of healthcare.
What is healthcare without federal control? It is called StatesCare, where Washington plays no role, and where the states singly or in groups decide what type of healthcare system will best serve their residents.
Advocating for a single payer healthcare system in his home state, California State Sen. Ricardo Lara (D-33) said, "Given this picture of increasing [federal] costs, health care inefficiencies, and the uncertainty created by Congress, it is critical that California chart our own path." Despite Gov. Jerry Brown's fear that single payer "can't work," shouldn't 39 million California residents be allowed to decide for themselves? Other states should be afforded the same freedom and independence, instead of having Washington impose its one-size-fits-all model on everyone.
Not only are the state legislatures more responsive to constituents and more dollar efficient than Washington, they can also serve as testing grounds suggested by U.S. Supreme Court Justice Louis Brandeis. In the 1932 case New State Ice v. Liebmann, he wrote that a "state may, if its citizens choose, serve as a laboratory" to "try novel social and economic experiments without risk to the rest of the country." Healthcare needs Justice Brandeis' "laboratories of democracy." The states are the perfect vehicle.
StatesCare is the answer to big, bigger, and biggest healthcare lies.
Why Read This Article:
Both Republicans and Democrats in Congress have bought into three healthcare lies: big, bigger, and biggest.
By Deane Waldman, MD, MBA, author of "Curing the Cancer in U.S. Healthcare"
Professor Emeritus of Pediatric, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; and author of award-winning, "Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine."
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