Friday, July 6, 2012

On the Supreme Court Ruling on the Affordable Care Act (AFA): An Integrative View

Usually “Integrative” means a middle of the road approach. In this case it means both Republicans and Democrats will be equally offended by reading this blog.

Since the main goal of any Health Care system should be to serve the public, let us start by contemplating the fact that the top 5 countries in health care outcomes do much better than the USA and at ½ the expense per person per year. How do they do it? They provide the most basic services through a SINGLE PAYER system. Doctors work for themselves, but are paid by a single insurer, thereby reducing overhead, paperwork, and exclusionary regulations. As bad as state-run programs are, keep in mind that Medicare-Medicaid have an overhead of < 5%; private insurance companies’ overhead costs are >20%. No doubt this is offensive to Republicans.

If you disagree with the statements above, could you compromise if each state regulated its own Single Payer program, thereby eliminating Federal intrusions while focusing on each State’s idiosyncrasies?[1] An integrative, middle-of-the-road solution is more likely to succeed in view of the changes being implemented in those aforementioned countries. For example, the English National Health Service Embarks on Controversial and Risky Market-Style Reforms in Health Care[2] as General Practitioners are making more decisions, patients choose who they see and local governments exercise more control.

Now, let’s offend Democrats: whether we call it a “penalty,” or a “tax,” I do not want to pay into a system that is rigged in favor of Pharmaceuticals, Insurance companies and other Big Business Corporations who have practically taken over Health Care. The whole thing has become big business with only peripheral platitudes about serving people. Sure, the system “does” a lot to people; unfortunately, only 80% of it has any validating scientific evidence and seem to be driven by profit only.[3]

The ACA only allows more people to have their “symptoms managed,” not the root of their health problems. The Act perpetuates a “Disease Care system” while doing very little for true primary prevention, or the factors that lead to disease, like nutrition, mind-body, and environmental issues.[4] Sure, secondary prevention, like mammograms and bone densitometries are covered, but, they only “prevent” disease after they have started. Besides, tests like those are not only overdone but unnecessary in many patients under 50 and under 65 years of age respectively.

For years I have lived without health insurance, refusing to cave in to fear and misinformation. I have felt fairly confident (knock on wood) that I am likely to avoid disease by eating a ton of vegetables, exercising and living a clean, relatively balanced lifestyle. Of course, not everyone may be able to do this: let them join any health plan THEY CHOOSE. Or, better yet, help them study this whole matter and vote for politicians who in the future may support a State-based Single Payer system. With savings from overhead, paperwork and those accrued from bulk drug purchases in other countries, which are not allowed in the USA presently, such a system would not force anyone to participate, yet allow anyone to buy up better coverage beyond the bare necessities provided to all.

The argument that such a system would be unfair competition to existing insurance companies is not backed up by history. Is not the US Post Office struggling against FedEx and UPS? And the argument that we need to force everyone to participate in order to lower cost by spreading it out is not valid, either: cost went up in Massachusetts with an approach similar to the ACA, because a significant number of those who joined were desperate to use services. Insurance companies were hoping for healthy, young patients to offset the additional burden, never mind the inherent unfairness. By the way, most doctors in Massachusetts preferred a single payer system.[5]

The 4 million Americans who feel robbed of any choice will likely pay that “penalty,” or “tax,” if getting Health Care coverage they do not believe in nor plan to use, is cheaper.

[1] State-Based Single-Payer Health Care? A solution for the USA? “ New England J. of Medicine 2011;364:1188
[2] NEJM 2011;364:1360
[3] J. Business Week, May 29th 2006, cover story. The article is written by David Eddy, a Heart Surgeon trained in Mathematics; he is the chairman of the Center for Health Policy Research & Education at Duke University
[4] Book “The health care mess: how we got into it, and what it will take to get out,” reviewed in JAMA 2006;295:331
[5] J. Archives of Internal Medicine 2004;291:164


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