"Georgians need better options - reduced costs, enhanced access, and improved quality of care''— Gov. Brian Kemp
I recently read a piece by an M.D. (The Hill, May 17), which advocated abolishing insurance and going back to a direct contracting model. A decade ago, I had an op-ed in the AJC opposite the head of the Georgia Medical Association who was making a similar case.
Frankly, I have also heard this argument made before by physicians I know. I agree that we cannot continue on the present path. But I disagree on the corrective course of action.
We simply cannot go back to the fantasized “good old days” when physicians negotiated prices with each patient. Trading chickens for an office visit is just not feasible in 2019.
I’ve been in healthcare for decades, as Georgia Director of Health Planning, SVP/VP at national healthcare firms, a state Board of Health member and as a health reform columnist. I was also a Republican chairman of a county commission, responsible for obtaining healthcare insurance for our employees.
During my career, the healthcare proportion of the GNP for the U.S.A. has more than doubled, to 17%. The proportion of GNP spent on healthcare for other nations is much lower, for example: Israel, 7%; Italy, 9%; and Canada/UK/Netherlands, 10%.
Per OECD statistics, all these developed nations have universal access while spending much less per capita than the U.S. And, their mortality/morbidity stats are better, not worse.
I’m a capitalist, not a socialist. But if the current multi-payer, for-profit insurance system doesn’t work, there’s an obvious solution: single-payer. It’s one of the few instances where government intervention is not only effective in achieving the goal of universal coverage, it is more efficient.
The only thing lacking is political will. We can thank the healthcare-industrial complex, their lobbyists and bought politicos in both parties for this frustrating situation.
President Trump came into office stating that Obamacare was a “disaster” and that he would provide lower-cost, high-quality healthcare for all Americans. In March 2017, he tweeted “healthcare is coming along great” and last March that the GOP “will soon be known as the party of healthcare.”
Despite these promises, he and the GOP have produced nothing of real value, succeeding only in eliminating the unpopular “individual mandate” which incentivized uncovered people to get coverage. His current “reform” efforts are merely aimed at reducing insurance policy coverage so that people can get cheaper bare-bones policies.
Meanwhile, Trump’s moves have increased the number of uninsured people by 1.3 million from 2016 to 2018 while the number of Americans having access and cost issues has gone up considerably in every category surveyed, according to the Commonwealth Fund.
During Trump’s term, due to cost considerations, more Americans did not fill needed prescriptions, get recommended tests, visit doctors when ill, or get needed dental work.
Further, the number of citizens contacted by a medical collection agency for unpaid bills increased from 25 million to 30 million.
Unfortunately, improving access while restraining cost increases and improving quality (per Gov. Kemp) is virtually impossible under the current scenario. In the meantime, we must live with what we have in our healthcare financing world and attempt to improve upon it.
Gov. Nathan Deal refused to take federal funding to expand Medicaid, even though the first 3 years would have cost the state nothing. Despite his shortsightedness, 450,000 Georgians are now covered by the ACA. Georgia still has one of the highest uninsured populations in the nation.
Kemp is more open to expansion (90% paid for by the Feds, if approved by them) but is apparently planning to make expansion limited, restricting coverage for the poor via cost sharing or work requirements, while increasing paperwork. Other states (Kentucky, Arkansas) attempting to utilize similar federal waiver approaches have had rough waters.
A consulting firm is drafting a federal Section 1115 waiver for Kemp’s consideration. After a comment period, the waiver would then go to the feds before year’s end.
We can only hope that Georgia’s waiver is designed to help more Georgians obtain coverage rather than furthering ideological and political goals.
If not, please make your feelings known.
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