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Nobody knew this could be so complicated

Ortbals Headshot 1 1 16By ALAN J. ORTBALS
    Recently President Trump exclaimed, “Nobody knew health care could be so complicated.” If what he meant by that was that everyone knew but him, he was right. Health care is complicated. At least in the United States, that is. In other countries, not so much.
    We all remember how gut wrenching it was when the Democrats were wrestling with it in 2009 and now we’re watching the Republicans suffer the same anguish.
    What makes it so difficult is that both parties insist on keeping the private, for-profit, health insurance model. Why? It’s certainly not because we have the best health-care system in the world. Consider the following.
    While the U.S. health-care system is the most expensive in the world, it ranks last on most standards of performance when compared with other advanced countries. Of 17 high-income countries, the United States is at or near the top in infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides and rates of disability. We’re also at the bottom of the list for life expectancy.
    The United States spends more on health care per capita and more on health care as a percentage of its GDP than any other nation — 50 percent more than the second-highest nation, France.
    Medical expenses are the leading cause of personal bankruptcy in the United States and the lack of health insurance causes roughly 18,000 unnecessary deaths every year here.
    So why are we fighting so hard to keep this dysfunctional private insurance model? We can only assume that it’s because insurance is an extremely profitable business and big money spells big political clout in America.
    Canada, on the other hand, has a very simple, publicly-funded, single-payer system in which every citizen is issued an insurance card and services are delivered by private providers.
    Our insistence on keeping the private insurance model creates big problems that are hard to resolve if you want to come anywhere close to universal coverage. Since health insurance is not going to be provided as a right, we have to create complicated systems to try to coerce individuals to buy it who either don’t want it or can’t afford it. Obamacare sought to maximize coverage through an expansion of Medicaid, levying penalties for those who were deemed financially capable of buying insurance but didn’t, providing subsidies for those in the middle and forcing businesses to cover their employees.
    Plus, you also have to force insurance companies to cover people they don’t want—older folks and those with pre-existing and chronic conditions. And, they have to provide it at affordable rates which means they lose their shirts on these folks. So, in order to make that work you have to go back to the first part and try to force young, healthy people to buy insurance at higher rates to help subsidize the older, sicker folks.
    The Republicans don’t like the individual mandate so their plan was to drop that and try to coerce the young and healthy into buying insurance by the threat that, if they don’t buy it when they’re healthy, it’ll cost more when they’re sick. That wasn’t going to work.
    But, at the same time, they don’t have the nerve to put people with expensive pre-existing conditions out on an ice floe in the Arctic (assuming there are any left), so the insurance company mandate would have remained. That was an entirely unworkable plan.
    A month or so ago, Presidential press secretary Sean Spicer held a press conference in which he demonstrated the difference between Obamacare and Trumpcare by displaying the two bills, stacked side by side. One was a foot high and the other about 3 inches but you know what, the Medicare for All bill is just 30 pages, double spaced. Maybe we should take a look at that.
    A single payer model would eliminate all the waste and inefficiencies involved with the myriad of private insurers and government programs like Medicaid, CHIP, and the VA. It would streamline administration and minimize overhead costs. And it would put the Department. of Health and Human Services in a position to negotiate the costs of care and drugs for everyone. Gone would be the days of hopping from one insurance program to another like Indiana Jones trying to maneuver his way to the Holy Grail. And, it would get the health insurance monkey off the backs of employers.
    In short, it would produce what Donald Trump promised: great health care for everyone at the lowest cost. Let’s stop trying to design a Rube Goldberg model that will never produce those outcomes. Medicare for All is the solution.
    Alan J. Ortbals is president and publisher of the Illinois Business Journal. He can be reached at or (618) 659-1977.

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