Well, it has finally happened; they are going to repeal Obamacare. Critics say just tear it up! I never did like it, way too complicated.
Well, how did we get to where we are today? Our current employer-based insurance system was encouraged to expand by President Roosevelt during World War II, when wage controls prevented companies from increasing their workers’ wages, but allowed companies to expand health benefits to attract workers. Employers have been able to claim premium payments as a tax-deductible business expense, while employees’ health benefits were exempt from taxes, so the government for all these years has been subsidizing employers and employees. This subsidy is enormous, hundreds of billions of dollars per year. In 1965 Congress established the publicly funded Medicare program for the elderly, and the Medicaid program for the poor and disabled. The Affordable Care Act (aka Obamacare) passed in 2010, with opposition from Republicans from the outset that never diminished.
So now that Obamacare apparently is going to be repealed, where do we go from here? As Americans, do we really believe in “life, liberty and the pursuit of happiness” for all of our citizens? Isn’t it appropriate to expect everyone to contribute in the support of a health care financing system? Have I ever, in fit of passion, forgot to use a condom; have I ever taken a ride on the back of a motorcycle without a helmet; have I ever gotten behind the steering wheel of a car after drinking too much? Unfortunately, yes, I have done a lot of stupid things in my life, which could have impacted not only my health but also the health of others. Fortunately, there were no long-term adverse consequences. I try to live a healthy lifestyle (eat properly, exercise, don’t smoke, etc.) but I have also needed treatment for conditions that I was not responsible for: medications to treat my asthma; contact lens to treat my eye condition called Keratoconus; surgery to treat my low-grade cancer. The question is not if we will need health care, but when will we need health care.
Seeing patients in our free clinic in White River Junction, I find myself wondering why I, a second-generation Italian-American, should have access to affordable health care, while other citizens whose ancestors go way back do not. As an example, one of our local farmers, who couldn’t afford a colonoscopy, was seen because of rectal bleeding; he was found to have an incurable colon cancer. He came to us too late for effective treatment. A local school custodian, who couldn’t afford his antihypertensive medications, subsequently suffered a stroke. What makes me special? Should health care be determined by who your parents are, by what part of town you live in, or by whether or not your chosen profession is reimbursed adequately? Is it really acceptable in the United States today to designate some of our citizens as being in a lower caste?
Again, where can we go from here? For starters, make Medicare available for everyone. That’s what I have. When I was working, I paid a payroll tax into Medicare; now I pay premiums based on my income. Am I happy with it? You bet, and by the way, don’t ever touch my Medicare! I have not seen a survey of Medicare recipients who overall are not happy with the program. One can choose between the traditional Medicare plan, which I chose, or a privately insured managed health care plan, Medicare Advantage, which can substitute for Parts A and B of traditional Medicare. With the traditional Medicare, I can see whoever I want to see and go to the hospital of my choice.
But I can hear the wail, “how will we ever be able to pay for it”? The answer is we already are, and we are not getting great “value” (great outcomes for what we are paying). An estimated $3.2 trillion is spent on American health care annually. If you were to enroll those in Medicaid, our veterans, our workers and their dependents into Medicare, you would see enormous, even “yuge,” administrative savings. From such a large patient database, we would be able to perform outcome research on which treatments are more effective and reduce costs even further. With every worker eligible for Medicare, Congress could get rid of the employer’s deduction for supplying their employees with insurance. Also, Congress could decide that all those contributing to their insurance could be eligible to receive a tax deduction toward the cost of their Medicare premiums.
What the Republicans are proposing will not bring about a healthy health care system, but a dysfunctional health care system. We will regress to having more uninsured, and again have “job lock,” people stuck in jobs because they need insurance. Hospitals will shift costs, and businesses will become less competitive because of the increasing cost of offering insurance to employees. We all need to be in the same boat, and pulling in the same direction; the time has come for publicly funded, universal health care.
Paul D. Manganiello is the medical director of the Good Neighbor Health Clinic in White River Junction.