Doctors from across the nation have put forth a resounding call for profound health care reform; 2,231 physicians nationwide have endorsed a proposal advocating the renunciation of the current profit-driven private insurance model in favor of a universally accessible single-payer system.
The passage of the Affordable Care Act (ACA) in 2010 was an enormous step towards significant health reform. Unfortunately, frustrations still abound in our current health care system. Many Americans remain uninsured or underinsured, health care costs are spiraling, and the marketplace continues to favor private insurance companies and massive hospital conglomerations driven by profit.
The physicians who drafted the recent proposal believe more dramatic changes are required to provide affordable, quality health care to all Americans. They’ve proposed a single-payer model as the next step forward.
Although single-payer health reform, often dubbed “Medicare for All,” has been a hot topic in this year’s presidential primary battles, the proposal is strictly non-partisan. It calls for a publicly financed national health program (NHP) in which each and every American would be covered for all medically necessary care.
The proposal, entitled “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform,” was drafted by 39 physicians and announced in an editorial published May 5, 2016 in the American Journal of Public Health.
“Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb,” said Adam Gaffney, MD, a Boston-based pulmonary disease and critical care specialist and lead author of the editorial, in a news release. “Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma. Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests.”
The editorial, entitled “Moving Forward from the Affordable Care Act to a Single-Payer System,” outlines the shortcomings of the current system and explains how a publicly funded, single-payer NHP could improve upon our current system.
The problem: current health coverage is neither universal nor comprehensive.
Fewer than half of uninsured Americans have gained access to coverage under the ACA. For those who have, underinsurance remains a problem. Prohibitively high deductibles and co-payments discourage those who have insurance from getting the care they need. According to the editorial, in 2014, 36 percent of non-elderly adults chose not to receive medical care they needed due to cost and more than half of all overdue debts on credit reports were medically related.
The proposed solution:
An NHP would offer comprehensive coverage requiring neither co-payments nor deductibles. ALL medically necessary services – inpatient, outpatient, prescription drugs, long-term care, and dental – would be 100% covered.
The problem: health care costs are rising.
As implied by its name, the Affordable Care Act was intended to rein in increasingly out-of-control health care costs. The past few years of slow spending growth on health care might appear to be cause for celebration. However, the slowdown in spending began even before the ACA was implemented. This indicates that the recession was the cause of the slackening, not the ACA. Recent data supports this theory: as the economy has slowly improved, health inflation has begun to creep up once again. There’s little evidence that the ACA’s cost-controlling measures are having the intended effect.
The proposed solution:
The simplicity and efficiency of a streamlined NHP would control health care inflation. It would eliminate many of the unnecessary and wasteful administrative costs inherent in our current system. Cutting administrative costs alone would save $500 billion per year, according to the editorial. The NHP would also be allowed to negotiate prices with drug companies, creating another opportunity to save money. The billions of dollars saved would be pumped back into the system to expand and improve coverage.
The problem: A market-driven health care system complicates issues of payment.
In a system where the profit-incentive is paramount, it’s a formidable challenge to create a payment system that lowers health spending while improving quality of care simultaneously. According to the editorial’s authors, “any method of payment can create perverse incentives in a market-based system when an ethos of professionalism and commitment is lacking.”
The proposed solution:
An NHP would do away with the profit motive. At the same time, it would offer providers flexible payment arrangements, such as a simplified fee-for-service schedule or salaries at not-for-profit health care facilities. Institutional providers like hospitals and nursing homes would receive funds for their operating expenses from the government. Eliminating per-patient billing in these ways would save a huge amount of money. These funds could then be poured back into patient care and community needs rather than enhancing profitability.
The problem: Limited networks of health care providers restrict patients from freely choosing a provider and endanger the doctor-patient relationship.
When the enrollment cycle rolls around each year under the ACA, patients who change jobs or seek lower premiums frequently must switch to a new insurer. Since each insurer offers a different network of providers, patients often have no choice but to “break-up” with their current doctors when they move to a new insurer.
The proposed solution:
A national health program would offer one large network of health care providers from which patients could freely choose a doctor or hospital. Patients wouldn’t be forced to sever a relationship with a doctor for financial reasons, which would foster longer-lasting therapeutic relationships between doctors and patients.
The authors of the proposal and the physicians who have raised their voices in support believe that a single-payer national health program would at long last make the universal right to health care a reality.
Christine Malossi is a freelance writer based in New York City. Her work focuses on public health and sustainable living. A certified yoga teacher, she also writes about the practices of yoga, meditation, and mindfulness. Find her at www.christinemalossi.com and follow her on Twitter: @cmalossi.