As Likely as Donald Trump being elected the President of the United States

By Dwight Michael M.D.

Those of us who have advocated for “Improved Medicare for All”, not at all like the present Affordable Care Act (ACA), were quickly shut out of the 2009 negotiations that led to eventual passage of the ACA in 2010.  President Obama and others in power at that time stated that this form of provision of healthcare, a version of a one payer system, was “politically not feasible”.  In every day terms, this meant and means that the present power-brokers in healthcare, the health insurance industry, the pharmaceutical industry, the medical device industry, the healthcare systems industry, and even some physician groups would use all of their clout, money and public information campaigns, to swell public opposition to a one-payer system with the ultimate goal of defeating this type of system.  These groups believe that they would have their profits significantly reduced.   Therefore, they have done everything possible to convince the American public that any form of a single payer system would be bad for everyone, especially patients, us.  I disagree.

Donald Trump is now president, the Republican Party which has sworn many times to repeal and replace the ACA now have majorities in the House and the Senate of our government, and so it is presumed that they do now have the power to repeal and replace the ACA.

Those of us who advocate for “Improved Medicare for All” were never terribly happy with the ACA.  However, the ACA did provide healthcare for about 20 million more Americans.  Prior to ACA, it was estimated that up to 50 million Americans were uninsured at any one time.

What else good came out of the ACA?  The insurance industry was no longer allowed to exclude costly, high-risk patients, they were no longer able to cap the total amount of what they would pay out for a patient’s care.  Insurance companies were no longer allowed to rescind care.   ACA allowed young adults up to 26 years of age to remain on their parents’ health insurance policies.  Essential health benefits have been covered from dollar one.  In most states, ACA dramatically expanded those eligible for Medical Assistance.  It provided tax subsidies towards health insurance premiums in a tapered fashion for those who made between 133% and 400% of the federal poverty level.  It prevented the insurance industry for increasing their rates for any reason other than age, zip code, and smoking status.

What has not been good about ACA?  It has caused an expanding epidemic of underinsurance.  Even if you can afford your premiums minus subsidies, can you afford your deductibles and co-pays?  I hear several patients a week bemoan their latest difficulties with dramatic increases in their health insurance premiums, their higher co-pays and deductibles, and their narrow networks of providers.  They have found out that if they go out of network for their care, they may face unlimited out of pocket costs.  Several of them have told me that they cannot afford the higher premiums despite the subsidies, and that they will be forced to go without insurance and face the penalty for not buying insurance on their tax return.  This was certainly not the intent of ACA or was it?

Drew Altman, president and CEO of Kaiser Family Foundation, in a recent article in the Wall Street Journal, states, “Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the ACA, Medicaid and Medicare–all three of health care’s major programs–and in the process, fundamentally alter the direction of the federal role in health and core elements of the social contract.”

All of us need to pay attention to what they want to accomplish.

Mr. Altman states that Republicans want to further privatize and change Medicare into a voucher system, which would result in less protection and increased out-of-pocket costs for all Medicare patients, making care less affordable to our aging population.  The Republicans want to change Medicaid to block grants to the states which will then force the states to take on the responsibility of deciding how they spend that money to provide care to those low-income individuals who qualify.  Mr. Altman states that although the laws have not yet been passed, “Republican plans are likely to shift costs to individuals and states as well as reduce consumer protections–and result in a significant increase in the number of uninsured.”

Based on what I see in my practice, I believe that these ideas will cause greater financial hardship for practically all Americans, except for the extremely affluent.

I understand that those who read this op-ed will believe that I am criticizing Republicans and may even stop reading this piece.  Please read to the end.  I do not agree with the Republicans’ solutions to these issues as they presently stated.

Why do we want to make it more difficult for aging America (Medicare), for poor America (Medicaid), and for the rest of us (ACA)?

“Improved Medicare for All” makes it easier on nearly all of us.  Based on a funding formula that would cost 98% of Americans much less than we presently pay for our premiums, deductibles, and co-pays, we would receive all healthcare proven to be medically beneficial including doctor and hospital care, prescriptions, therapies, eye and dental care, mental health, addiction health, and even long-term care.

Since I have advocated for “Improved Medicare for All” beginning in 2008, I have been told by others many times, “It will never happen here”.  Well, for the last 2 years, I have heard many times, “we will never elect Donald Trump president of the United States”.  The nearly unthinkable happened.  I believe that “Improved Medicare for All” can also happen in our country.   I will continue to advocate for “Improved Medicare for All” because I truly believe that it is the best way to provide affordable, accessible, high quality healthcare to all.

You can read more about our efforts at healthcare4allPa.org and pnhp.org. 

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