On the occasion of Medicare’s 47th birthday, we urge the immediate expansion of Medicare to everyone in the United States. We need a health care system that provides access to every one of us, no matter how sick, poor, old or unemployed we may be. We need reduced costs. We need improved health outcomes.
The Affordable Care Act is not the solution. At its best, the ACA will leave 75,000 Maine people without health coverage. Another 110,000 or more will be underinsured and at risk for financial catastrophe or death when they get sick.
The ACA will not slow the soaring costs of health care. Maine’s health care costs, currently $8500 per capita per year, will remain among the highest in the country. With no restriction on prices charged by insurance companies, many people will find even the lowest-tier policies unaffordable. Others will be unable to afford deductibles and necessary care. Still more will be bankrupted by out-of-pocket expenses when they get sick. Patients will be compelled to defer health care until they are desperately ill, further eroding public health in Maine and the rest of the nation.
The ACA entrenches the worst aspects of our health care system:
- Private health insurance companies remain the dominant portal through which most patients can access health care. Because of our current system of more than a thousand insurance plans, associated administrative waste consumes 31 percent of total health care spending. If this administrative loss were invested in health care, we could provide comprehensive care to every person with no additional funding.
- The ACA reduces Medicare costs by paying providers less, a tactic which encourages providers to avoid Medicare patients.
- The Supreme Court decision on the ACA struck down the provision which penalized states that refused to expand their Medicaid programs. In Maine, Gov. LePage proposes not only to refuse to expand MaineCare, but to curtail existing enrollment and services without penalty. If allowed by the federal government, this would further increase Maine’s numbers of uninsured residents.
- The ACA encourages cost-shifting to patients in the form of compulsory purchase of expensive policies, higher deductibles and higher co-pays.
No other nation uses our unique private insurance system, which penalizes the sick by charging them more, by reducing their benefits or by denying care altogether. None allow private insurance companies to place profit over coverage. Yet, all of them provide better care to more people for less money than we do.
Instead of further privatization of our health care system, we implore Congress to immediately extend Medicare to every person in the United States and then to work to improve it. Making Medicare universal would:
- Insure health care access to every American regardless of health, wealth, age or employment.
- Allow patients to choose their physicians, rather than having insurance companies choose for them.
- Reduce fraud by using a single set of consistent rules, regulations and forms throughout Maine and the rest of the country.
- Reduce costs of health care by eliminating administrative waste generated by the private health insurance industry. Harvard economist Dr. William Hsiao estimates that under a single system such as improved Medicare for all, Mainers would save 10 percent of total health care spending, or $1 billion in the first year alone. This is not speculation, but is based on the demonstrated performance in many other countries around the world.
Improving Medicare would:
- Include everyone, giving each person equal access and benefits.
- Cover all necessary medical, dental, vision, mental health and long-term care with little or no patient cost-sharing.
- Negotiate fair prices for pharmaceuticals, medical devices and health services.
- Determine benefits and payments based on need and evidence, not on politics.
- Assure guaranteed access to health care for all communities by defining global operating budgets for health facilities with separate capital budgets to facilitate better health planning.
We can no longer tolerate having the highest health care costs with the worst outcomes in the industrialized world. We cannot rely on our private insurance industry or on the ACA to remedy our crisis. We implore our congressional leaders to immediately protect, improve and expand Medicare. Every person in the Maine and in the United States needs and deserves access to health care.
Doctors Julie Pease and Edward Pontius are physicians who practice psychiatry in Brunswick. Dr. Philip Caper is a retired internist who lives in Brooklin. All three are members of Physicians for a National Health Program, a nonprofit research and education organization of 18,000 physicians, medical students and health professionals who support single-payer national health insurance.