Medicare 50th Anniversary Presentation
By Harry Sparks
Photo: Allen Saxe
On Thursday July 23 Dr. Andrew Coates, immediate past-president of Physicians for a National Health Program, spoke about the history of Medicare and the benefits of moving to a single payer health care model. Dr. Coates was invited by Health Care Justice - North Carolina the Charlotte chapter of Physicians for a National Health Program.
When Medicare began in 1965 there was no internet. Enrollment was accomplished with paper, delivered by the Post Office. 18.9 million people were enrolled within 11 months. This was a big improvement in health care access for the elderly.
Dr. Coates informed the audience that currently the U.S. health care system spends more per person in public (taxpayer) money than any other nation spends in total, public plus private spending. Yet we have poor results for this expenditure. U.S. life expectancy is lower than other developed countries and the U.S. leads the industrial nations in preventable deaths and infant mortality rates. Maternal mortality in the U.S. has increased in recent years, and Coates emphasized this lamentable fact.
The Affordable Care Act (ACA) has reduced the number of uninsured. But when fully implemented, it will still leave 26-30 million uninsured people in the United States. In addition many millions of people are underinsured due to high deductibles and co-pays. Plans that require deductible spending amounts greater than $1000 per year are becoming the rule rather than the exception. As a result, costs for chronic and serious illness fall more heavily upon those in fair/poor health. Uninsured and underinsured people will often skip or delay necessary and vital care, something that ultimately increases costs and worsen outcomes, when (or if!) they do finally seek care.
Medical bankruptcies remain a problem in our current system in spite of the expansion of insurance under the Affordable Care Act. 78% of people with medical bankruptcies had insurance at the start of their illness. 60% of those had private insurance.
Dr. Coates presented a brief history of health reform beginning with President Truman and continuing through efforts of presidents Kennedy, Johnson, Nixon, and Clinton. These efforts culminated with Governor Romney in Massachusetts developing a plan that was the model for the ACA passed by President Obama.
According to Dr. Coates the ACA has no proven cost savings. The information technology requirements have been expensive to implement and there is evidence that it is contributing to over-testing. The payment reforms are tending to add costs. In addition the mandate did not reduce premiums in Massachusetts and is not likely to on a national level. Finally, while chronic disease management may be good for patients, it does not save money.
In summary the ACA may make underinsurance the norm as many of the policies have high deductibles and co-pays. The ACA did not implement any fundamental reforms to the current U.S. health care system, except to touch off a mounting wave of corporate mergers and conglomeration among insurers and hospitals alike.
Dr. Coates spent a few minutes discussing the Canadian single payer system. The system in Canada is portable; it brought down the cost curve of total, and improved outcomes, including life expectancy and infant mortality. Overall administrative costs in Canada are about 16% compared to more than 30% in the United States.
National health insurance should be universal when it comes to necessary medical care, with no “user fees” - no deductibles, premiums, co-insurance and co-pays. A national health insurance system should prohibit investor-owned institutions such as HMOs, hospitals, radiology centers, labs, etc. Implementing a single payer system would emphasize primary care, allow for controls on capital spending, and create purchasing power to negotiate with pharmaceutical companies and medical equipment suppliers.
Dr. Coates believes we have what it takes to implement a single payer, universal health care system that will be less expensive and produce better outcomes than our current model.