LOSE OBAMACARE AND WE ALL SUFFER

Although Trump’s food policy agenda is unclear, his anti-regularity, anti-science leanings in general should be a major cause of concern to all of us.

If the Affordable Care Act (“Obamacare”) is repealed, not only could 22 million Americans face the devastating prospect of losing their health insurance, but all of us would lose several other health benefits as well.

First we would lose the opportunity to see how many calories are in thousands of foods, for, starting May 1st, 2017, we could lose the ACA rule that requires the listing of calories on menu boards of chain restaurants, movie theaters, supermarkets, delis, and convenience stores. The new administration could scrap the whole effort—as some in the food industry have urged. Moreover, the Federal Drug Administration (FDA) has told companies to disclose added sugars on Nutrition Facts labels by 2018. Since the new administration will likely sack the current physician FDA leader (Robert Califf, MD) in favor of a politically motivated layman, this regulation also could well be eliminated or delayed for years.

Second, the Obama administration proposed voluntary targets for cutting sodium (salt) in foods, which, as I have explained, would save tens of thousands of lives every year (http://www.mortontavel.com/2014/10/06/). Again, the present administration could scrap the whole effort—as some in the food industry have urged.

With regard to our children, two members of the Trump campaign’s agriculture advisory committee have worked to roll back the progress we’ve made in improving school lunches and removing junk foods from school vending machines. Can anyone doubt the potential damage of this measure?

The new administration may be inclined to grant the food industry’s request to continue to use heart-damaging trans fat (http://www.mortontavel.com/2014/) in many processed foods.

What about safe food protections? Who knows what to expect from a president whose campaign accused the “food police”—the FDA—of inspection “overkill.”

All these threats, as noted above, serve as a potential detriment—if not an outright danger—to the health of the general population. We should all follow these issues closely and become engaged, whenever possible, in the political process itself.

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SHOULD WE OPT FOR A SINGLE PAYER SYSTEM FOR MEDICAL CARE?

When considering the best way to solve our country’s medical care woes, I am reminded of Winston Churchill’s famous statement about democracy as a form of government, in which he stated in effect: It’s a terrible system, but everything else is worse. This same statement might apply to a single payer system in medical care, for it probably beats everything else, as I explain below.

First, a truly effective system will not be achieved unless we solve the many associated issues that include tort reform—to control the exorbitant costs of physician medical malpractice insurance in many states—excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. But all these issues can be solved, given the desire and, hopefully, willingness of our legislative bodies to work together for the benefit of all.

Although the Affordable Care Act (ACA) represents a step forward for this country, it does not address the problem of waste and complexity in the system in the way that a single-payer system would.  James Burdick, MD, a transplant surgeon at Johns Hopkins University School of Medicine and author of the forthcoming book Talking About SINGLE PAYER!, argued that a single-payer system is “a more economical way to use healthcare resources. You could reduce expenses and still improve quality. That’s a tremendous opportunity that you don’t have in many other fields.”  Of course, as he pointed out, this would virtually eliminate the entire commercial insurance industry—with $730 billion in revenues and a workforce of 470,000. (Maybe these same workers could be involved in more productive work such as restoring our nation’s wobbly infrastructure!) But Dr Burdick also maintains that a single payer system would likely restore doctors’ authority. And those who favor this system say that for all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments would be eliminated.

There also appears to be evidence of growing physician support for a single-payer system. For instance, a 2014 survey of Maine physicians disclosed that nearly 65% of respondents preferred the single-payer option over trying to fix the current system—up from 52% in a 2008 survey. Physicians in general now seem more open to a single-payer system.

Americans are warming up to the idea too. Notwithstanding the Republicans constant calls for abandoning the ACA, a majority of the population (51%) now supports Medicare for all, according to a national poll released this past year. Many experts believe that the movement for a single-payer system may start at the state level, since much of the public continues to mistrust Washington. But a firm judgment about this issue probably awaits the results of the next national election.

One way to reduce medical expenses would be to shift at least some costs to the recipients themselves. Medical insurance might be best reserved only for big ticket items, such as catastrophic events. Using the analogy of automobile insurance, would Americans buy insurance to pay for routine maintenance and fuel for their cars? This would suggest that one should only be provided with very high-deductible forms of insurance. For instance, emergency rooms should be best reserved for broken bones, gushing wounds, and other genuine emergencies, not sniffles and sprains. A full medicine chest and a bit of common sense would comprise a more effective strategy.

In reality, a government-run single-payer system is the only way to provide effective basic medical health therapy and management, but for those who desire a higher level of care—and can afford it—there should be a private-pay system, contrasting with the Canadian system. This would, de facto, constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a “one size fits all” system, but would be the most pragmatic approach.

Usually those against single payer system trot out the usual vague objections that we are becoming “socialistic.”  But what about our current Medicare system, is that not socialistic? I might add further that I personally have worked at a VA hospital, and, despite all the current noise, found that once patients were able to access the system, the care is quite good. Its main problem seems to be gaining initial entry into an overburdened system in a timely manner. By contrast, it is highly unlikely that a random assortment of for-profit HMOs would do a better job serving the high-utilization health needs of our veterans.

Whether we like it or not, basic healthcare is like a utility—something everyone needs, and in the best interest of our society, everyone should receive. Although there are many variations of the general theme as I have enumerated above, we are moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including the Republicans!

Interestingly, under rules provided by the ACA, which most Republican lawmakers are determined to repeal, all members of Congress and their staffers must purchase coverage through an online exchange, just like everyone else who doesn’t receive insurance from an employer. But Senator Ted Cruz, for instance, can opt out of the system, for he obtains his health insurance from his wife’s employer, Wall Street powerhouse Goldman Sachs. That means that if Cruz is successful in overturning the ACA, he’ll still be covered even as 11 million others lose their insurance. That, apparently, is their problem, not his!