June 25, 2018
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Government, health care go together

By Dr. Erik Steele

Ahhh, springtime! Warm breezes waft the scent of cut grass, bright blossoms and cow manure past our nostrils. But wait — sniff more carefully. That’s not cow manure, that’s some of the national debate over health care reform. The two are easily confused, especially the scent surrounding the question of whether the federal government should offer a health insurance product to compete with private insurers in an effort to insure all Americans.

Frankly, I don’t care who insures whom, as long as everyone has health insurance. If private insurers can do the job in a cost-effective, patient-friendly manner, great. If it takes the feds to do that job, fine with me. But no one should fear a federal government role in health insurance just because it’s the federal government, any more than they should fear a role for commercial insurance companies just because they have to make a profit.

Let’s look at some of the reasons cited to “keep government out of our health care.” First, government should not be in the health insurance business as a matter of principle. Wrong and too late; the government is already in the insurance business in a big way, and has to be. Otherwise, about 100 million Americans — those who are over age 65 and those who are poor — would probably not have health insurance. These two groups are insured by the government through Medicare and Medicaid respectively. That’s in large part because the private insurance market has been unable to insure these and other expensive populations that cannot afford the cost of insurance premiums high enough to make it economically viable to insure them. Even government-subsidized private Medicare plans have struggled to survive. So the government already has to be the biggest insurance company in America.

Second, the argument continues, federal government cannot run anything well, so don’t let it run health insurance. But the feds run Medicare, one of the most popular and efficient health insurance programs in America. It covers 35 million-plus Americans at a lower administrative-overhead cost than most private insurance plans. Medicare works well enough that many health policy experts think the best and easiest way to insure all Americans is to enroll everyone in Medicare. So the idea that the federal government is not capable of managing a health insurance plan is, well, good on vegetable gardens but not for much else.

Finally, controls, mandates, rationing and the boogeyman of Big Government managing your health care; get used to it, because insurance for all of us without more control of how we spend our insurance dollars is unaffordable. The idea that government as an insurer will be more controlling than commercial insurance is a fantasy because none of us can afford freedom from controls in health care anymore.

Freedom for doctors and hospitals to waste care? Forget it. Freedom for you as a patient to get tests or treatments you can do well without? Come on! Freedom for medical device companies to market their wares to doctors and patients for conditions that barely justify the use of their expensive products? No other modern country is dumb enough to do that.

So get used to the idea of controls and mandates in our health insurance. Whether brought to us by Anthem Blue Cross or Cigna, or by Medicare and Big Brother, those controls are not only coming, but you actually want them. Every time you complain about health care costs you are actually asking for them. Otherwise, you can forget universal insurance that is affordable for this nation. You can just keep paying 10 percent to 12 percent more for your employer-based insurance each year to the point it is eating half your pay, or $18,000 out of pocket for your daughter’s appendectomy because you could not afford health insurance.

Get real, America. Stop believing the rhetoric that government in our health insurance is automatically a bad idea; there is no solving this mess without some government role. Stop believing that some kind of control over how we consume health care is a bad thing, or that any insurance — governmental or commercial — can succeed without controls over our collective and individual health care decisions.

Otherwise, the idea we are going to reform health care is also getting spread over the farm.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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