by Sandor Stern

Dear Republican Friends,

Regarding your stand on healthcare…

This country spends more on health care than any other country in the world. One would expect that fact to translate into the best medical care. I know you believe it does, and you are correct when it comes to medical advances and facilities, but we are not even close to the best when it comes to the medical care of our population. According to statistics from the World Health Organization, we spend almost twice as much per capita than any other nation – $7290 in 2007 and it has increased since then. That amounts to 16% of our GDP. 18.5% of government revenue is spent on health care. And what do we get for that money? Our life expectancy is lower and our infant mortality rate is higher than every other industrial nation. Our system is ranked 37th in the world among 191 nations. And your reaction to those facts is a pledge to repeal the 2010 Affordable Care Act – the most comprehensive health care reform in 45 years.

You brand it with an Obamacare label in your effort to denigrate it. That is laughable; firstly because it mirrors Romney's Massachusetts Health Care Plan of 2006 (framed by the Republican conservative think tank's Heritage Foundation) and secondly because it does not reflect the single payer plan that Obama would have liked. Though Democrats held a majority in the senate, they fell short of the sixty votes needed to pass a bill unpalatable to the Republican senators. The Affordable Care Act was obviously a compromise. Given its auspices it seemed a safe direction. It's basis is insurance coverage through private companies. Who would have guessed that the Republican party and its presidential nominee would disown a plan like that? In hindsight, considering the Republican about face on so many of your previous legislative bills, this should not have come as a surprise.

What baffles me is your disregard for Romney's turn around. He initially touted his plan (that included mandatory insurance for all) as a model for the nation. Then he waffled by saying his plan was good for his state but not for the nation. Now he avoids the subject. My question to you is: if the plan is good for the state why not for the nation? All this hue and cry goes on about the Romney plan, but nobody seems to ask the pertinent question – is it working for the people of Massachusetts? 98% of Massachusetts residence now have insurance, including 99.8% of children. Two out of three adults in the state support the law and 88% of doctors say it improved or did not affect the quality of care. It seems the proof is in the pudding.

To this date, the Affordable Care Act has improved health insurance coverage in many ways. Children can stay on their parents’ policies until the age of 26. Individuals with existing insurance policies no longer have to pay deductibles and other out-of-pocket expenses for certain preventive care services. Children under 19 cannot be denied insurance because of a pre-existing condition. Insurance companies cannot drop your coverage if you become sick, nor can they place lifetime limits or arbitrary annual limits on coverage. Insurance companies are required to spend more of the premium dollars they receive on health care services and quality. It becomes easier to file complaints about the quality of care in a nursing home. Better access to information on nursing home quality and resident rights is available. Seniors who reach the Medicare doughnut hole receive a 50 percent discount on brand-name prescription drugs and a 14 percent discount on generic prescription drugs. Medicare benefits have expanded to include free coverage for wellness and preventive care. Hospitals that improve the quality of care for people with Medicare can qualify for new payments.

But that’s not all. Yet to come in 2013: Those who reach the Medicare doughnut hole receive a 52.5 percent discount on brand-name prescription drugs and a 21 percent discount on generic prescription drugs. Increased funding will be available to help families and children get coverage through Medicaid and the Children's Health Insurance program (CHIP). Hospitals and doctors can qualify to receive a new type of payment (called a "bundle") to coordinate with each other as they care for patients. Yet to come in 2014: Insurance companies cannot deny anyone health coverage because of a pre-existing condition. Those who reach the Medicare doughnut hole receive a 52.5 percent discount on brand-name prescription drugs and a 28 percent discount on generic prescription drugs. Subsidies are available for those with limited incomes who purchase health insurance through an exchange. Children, parents and adults without children who do not have Medicare and who have a limited income are able to apply for Medicaid. Spouses of people on Medicaid who receive care services at home get the same protections for income and other resources as spouses of those on Medicaid who live in nursing homes. Yet to come in 2020: after continuing yearly declines in doughnut hole costs, the Medicare Part D coverage gap or "doughnut hole" will be completely closed.

These are the present and future benefits of the Affordable Care Act that you want to repeal. Why? You claim multiple reasons. You rail against the mandatory coverage. You consider it socialism. Under your definition of socialism that would make mandatory withholding taxes for social security, Medicare, and Unemployment insurance socialism. It would make mandatory driver's licenses socialism. In fact, mandatory income tax would have to be listed under your definition. Yet, there are no socialist aspects to the Affordable Care Act. Individuals purchase their coverage in an open market from private insurance companies. The physicians who provide services work on a fee for service basis. Hospitals and laboratories remain in the hands of private enterprise. So where is the socialism you love to scream about?

You claim that the costs of insurance will go up. Without doubt if there is no mandatory coverage that will be true. That was true before the ACA and was one of the prime reasons to institute the act. When healthy young people are not buying insurance, the price goes up for those older and in poor health. Mandatory coverage keeps the costs down. And before grumbling over that, how many people paying into social security and Medicare die too young to ever collect a dime? How many people pay unemployment insurance and never need to collect a check in return? That's why it's called insurance. It's a necessary price one pays today just in case the day arrives when the need arises.

You seem to prefer remaining with the old "free enterprise" system – which has never been free or even enterprising. In that system, 40% of U.S. citizens did not have adequate health insurance, if any at all. The cost to these people has been that they’ve been avoiding medical care, sometimes until it was too late for a cure, often to the detriment of preventive steps, and for some a cost in dollars that led to bankruptcy. The cost to the nation has been a crush of patients inundating emergency rooms – paid for by the taxpayers. Is that the trade off you really want? Medical costs paid for others through your income tax rather than a small bite out of every citizen's pocket?

There is no doubt that the Affordable Care Act is flawed and that flaw is the same one that exists in the Massachusetts Plan. In Massachusetts, though 97% of taxpayers are complying with the law, the cost of premiums rose 12.2% between 2006 and 2008. One of the main reasons for cost increases is due to the administrative overhead, and that will apply to Affordable care. An apples to apples comparison of plan overheads is best seen in administrative costs for Medicare and Medicare Advantage. According to the Congressional Budget Office, expenses under the public Medicare plan are less than 2% compared with 11% expenditures under the private plans of Medicare Advantage. Meanwhile the General Accounting Office reported that in 2006, Medicare Advantage plans spent 83.3% of their revenue on medical expenses and 16.7% for non-medical expenses and profits. That makes sense. Private Insurance companies are in business for profit and they must spend money on sales and advertising to compete with each other. Why do we need them in the health care business? That is why a single payer system gets you the most bang for the buck. We only have to look to our northern neighbor, Canada, for comparison.

In the mid sixties Canada and the USA faced the same issue in health care. As citizens aged, private insurance companies either denied them insurance coverage or asked exorbitant rates. This was an overwhelming humanitarian problem. The USA decided to alleviate the problem through Medicare, a plan that insured citizens above the age of 65 years. Canada decided to institute a Medicare plan that covered every citizen from cradle to grave. This is a system similar to those in almost every industrial nation in the world. There are only two exceptions: the USA and Turkey. Good company, right?

Before you start shouting "socialism" look at the facts. The Canadian system is no more socialist than our own Medicare. Patients choose their own doctors and those doctors are paid on a fee for service basis. Though federally funded, each province and territory maintains and oversees its own separate plan. Spurred, I suspect, by profit seeking private insurance, pharmaceutical and medical supply companies, a mythology about the Canadian Health Plan has taken root in this country.

Myth: taxes in Canada are extremely high. Fact: the average after-tax income of Canadian workers is equal to about 82% of their gross pay. In the USA that average is 81.9%. Myth: Canada's health care system is a cumbersome bureaucracy. Fact: the provincial single-payer system in Canada operates with a 1% overhead. That's even better than our own Medicare operating costs. Myth: the Canadian system is significantly more expensive than the USA system. Fact: 10% of Canada's GDP is spent on health care for 100% of the population. The USA spends 17% of it's GDP but 15% of its population has no coverage, and millions of others have inadequate coverage.

Myth: Canada's government decides who gets health care and when they get it. Fact: the government has absolutely no say in who gets care and how they get it. Those decisions are left entirely to doctors. In the USA HMO's and private insurers make medical decisions all the time. If they decide they won't pay for a medical procedure like an MRI you won't get it no matter what your doctor thinks – unless you pay out of pocket for it.

Myth: there are long waits for care. Fact: there are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care and longer waits for elective surgery. Despite the waits, Canada is ranked 7 points above the USA in patient care by the World Health Organization. Canada boast lower incident and mortality rates than the USA for all cancers. Life expectancy in Canada is 81.3 compared to 78.1 in the USA. The infant mortality rate in Canada is 4.5 and in the USA 6.9. Per capita expenditure in Canada is 3,895 dollars per year and in the USA it is 7,290 dollars per year. Fewer Canadians (11.3%) than Americans (14.4%) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the USA for medical care. Fact: If a Canadian goes outside the country to get services deemed medically necessary, not experimental or are not available at home for whatever reason, the provincial government where they live fully funds their care. Those patients who do come to the USA for care and pay out of their own pocket are those who perceive their care to be more urgent than their Canadian doctors believe. In a Canadian National Population Health Survey of 17,276 Canadian residents it was reported that 0.5% sought medical care in the USA in the previous year. Of these, less than a quarter had traveled to the USA expressly to get care.

Perhaps the best example of furthering the myth is that of an Ontario resident, Shona Holmes, who traveled to the Mayo Clinic after deciding she could not wait for medical care at home. She characterized her condition as an emergency; she was losing her eyesight and portrayed her condition as a life-threatening brain cancer. Her Ontario insurance refused to reimburse her for medical expenses and she sued – and lost. In 2009, at the peak of the Republican fight against the Affordable Care Act, she appeared in ads on American TV warning of the dangers of the USA adopting a Canadian style health plan. After the ads appeared critics pointed out discrepancies in her story: the Rathke's cleft cyst for which she was treated was not a form of cancer and was not life-threatening. In fact, the mortality rate for patients with a Rathke's cleft cyst is zero percent.

The facts are available to anyone with the inclination to pursue them. In the face of those facts, how can you take a stand to repeal The Affordable Care Act? If anything, you should be working to improve it. I don't find evidence of that in the Republican Party Platform.

Just asking

Your friend

Sandy

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