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ALAN TURNER: Clouding the real issues in health care


After the hullabaloo in Congress over the effort to “repeal and replace” the Affordable Care Act, it still seems obvious that the real and underlying issues surrounding health care in America are somehow not coming to the forefront.

Here are a few basics: 1) We all want quality health care; 2) We all want to live longer and healthier lives; and 3) We want somebody to come up with ways to deliver #1 and #2 in ways that won’t bankrupt our companies and ourselves. Whether we are poor folks, middle class, or affluent wage-earners, these things are important to all of us.

That’s where the agreement begins and ends, however. It’s clear that the word “affordable” in the Affordable Care Act is anything but. With all of the horror stories of families facing huge premium increases for high deductible insurance, and with the premium levels outstripping the ability of average middle class folks to cover, it’s obvious that the Affordable Care Act has not achieved its objectives. Where it HAS achieved its objectives was in extending health care to millions of poor people through the Medicaid expansions which the majority of states (but not Mississippi) chose to take. Whether you agree with the Medicaid expansion or hate it, it has extended health care to millions of families whose only option before was to show up at an Emergency Room for care that they could never, ever pay for.

Looking at the bill which failed in Congress, would it really have “fixed” the whole issue of how to provide health care for Americans that they can actually afford? The answer is almost certainly “no”.

Many believe the Affordable Care Act will collapse under its own weight in the not too distant future, and they may be right. It’s a simple fact that most of the “exchanges” that were set up at the onset of the ACA have failed. It’s another simple fact that several of the biggest insurance companies have pulled out of the list of providers, because they were losing tons of money, despite large and frequent premium increases. So, one wonders whether the Republicans were really all that disappointed that their bill did not pass, because it wouldn’t have addressed the needs of all parties in any meaningful way, and thus, they may not have been that anxious to own something with a lose-lose scenario.

So, leaving politics aside, what’s the real problem? And does it have any solution?

The one thing that so many on all sides of the health care debate seem to want to ignore is a simple but undeniable fact: that health care is consuming an ever-increasing share of the Gross Domestic Product of the United States, and that continuing that trend is simply not sustainable under any reasonable scenario, even in the mid-term, let alone the long-term.

I have reported here before that the thing which is at the heart of the problem is the fact that in 1960, health care accounted for only 4 percent of our GDP. Today, it’s gobbling up close to 18 percent of our GDP. Compared to other Western nations, we are spending an average of 50% more on health care as a percentage of GDP. And yet, life expectancies in most of those nations are equal to, or greater than those in the United States.

So, were we getting terrible health care in 1960? I think not. In 1960, as today, we had many wonderful, caring doctors and health care professionals. We had many great clinics and hospitals. Our health care was regarded as the best in the world.

Today, all of us in the business world know the pain and burden of providing health care benefits to our employees, a burden which increases without respite. It is to the credit of business that most have hung in there and provided the best benefits they could under the circumstances. But there is a limit. There is a place beyond which we cannot go.

My objective here is NOT to point the finger or play the blame game. It’s simply to state the facts, and ask what can be done about them. If our health care system collapses, it should be painfully clear that that’s not going to benefit any of us at any level.

Is the only solution to switch everything to the single-payer option? Should the Federal government then “own” health care and essentially manage the whole thing? Should we set a “boundary” for how much we can afford to pay for health care as a nation? Would that mean rationed care? These are thorny issues.

Perhaps the only realistic way to maintain some sort of balance would be to have a two-tiered system. The first tier would be the private option, for all who get their health care benefits through an employer who can negotiate rates with insurance companies and providers, and gets tax benefits for providing those benefits. The second tier would be the public option, for EVERYONE ELSE. For this to work, it’s clear that things would need to function as they do now with Medicare….namely, that the government sets reimbursement rates for all health care procedures, and insurance companies are free to sell “supplements” which cover costs that the basic coverage does not provide. And perhaps those standards are maintained for the private tier as well. This might indeed upset the apple cart in many ways, and it might well lead to much less availability of care (or call that rationed care if you will). But given the seemingly grim alternatives, do we really have much choice?

Contact Mississippi Business Journal publisher Alan Turner at alan.turner@msbusiness.com or (601) 364-1021.


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