r Sen. Kamala Harris, who
is seeking the Democratic presidential nomination, veered away from
President Obama’s famous line – “if you like your doctor you get to keep your
doctor” – Monday night when she called private health insurance “inhumane” and
proposed a government-run alternative.
Speaking at a CNN town hall event, Harris, D-Calif., touted her
“Medicare-for-All” plan. But in doing so, she clearly took aim at the
employer-based health insurance system and at private health insurance purchased
by individuals and families in the United States.
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When CNN host Jake Tapper asked Harris if people could keep
their current health insurance under her plan, she indicated they couldn't. So
rather than simply expanding Medicare, she clearly wants to move toward a
single-payer government health insurance system.
According to a Census Bureau report published
in September, 56 percent of the U.S. population is covered by employer-based
health insurance and another 16 percent of the population is covered by health
insurance they have purchased on their own. In all, that amounts to 217 million
people who could lose their current health insurance coverage under the Harris
plan.
In advocating for the elimination of private health insurance
altogether, Harris said it is the insurance companies that stand in the way of
access to health care.
As practicing physician, I strongly disagree with the senator’s
ideas.
For one thing, private insurance is deeply imbedded in our
health care system. It isn’t going away no matter what a politician says to
garner support.
Private health insurance expenditures reached $1.19 trillion in
2017 and accounted for 34 percent of total national health care spending.
And even our public insurance plans are intertwined with private
insurance. Some 33 percent of Medicare beneficiaries were enrolled in Medicare
Advantage plans run by private health insurance carriers as of 2017.
Among traditional Medicare beneficiaries, about 25 percent have
Medigap plans purchased from private health insurance carriers.
And
beyond the monetary concerns and the threat to innovation and the
employer-based health insurance system, Medicare-for-All poses another problem:
the system would require the hiring of a huge government bureaucracy enforcing
numerous rules and regulations getting in the way of doctors providing the best
and most suitable care for their patients.
And that’s just Medicare. A total of 39 states have Medicaid
managed care contracts with private carriers to cover some or all of their
Medicaid enrollees.
Current Medicare provides health insurance for people 65 and
older, while Medicaid provides health insurance for people with low incomes.
Both provide care for people with disabilities.
The private health insurance system is the best fit for many of
our latest and greatest new health care solutions. Genetics-driven, the new
worlds of immunotherapy and robotics offer emerging tests and treatments that
are personalized, and work best with a free-market system that stresses
competition, choice and price transparency.
The Trump administration has made gains in these areas by
introducing more choice into the insurance market with skinny plans – meaning
plans that provide basic coverage at a relatively low cost designed to meet the
needs of people without serious health problems. The administration has also
enabled faith-based health insurance plans to cover more people and added
association plans that also work across state lines.
The goal is to have more Americans getting the health care they
actually need at a lower cost.
This is the opposite of what expanding government-run health
care offers us. Heavy government regulation – as with ObamaCare – stifles
innovation. It provide dysfunctional coverage that doesn’t work for doctors
(offering narrow networks of doctors and hospitals), patients (requiring high
insurance premiums and prohibitive deductibles) and insurers (severely limiting
or eliminating profits and incentivizing healthy people to go without
insurance).
The Medicare-for-All plan being touted by Sens. Bernie Sanders,
I-Vt., and Harris would cost $32 trillion in taxpayer funds to transition to –
and that’s without counting the inevitable jobs lost from an entitlement taking
the place of a hard-earned benefit with the destruction of the enormous
employer-based health system.
So while Medicare-for-All may sound good at first glance, the
enormous price tag and its other disadvantages show it comes at a great cost.
In addition, there is simply no way that this type of insurance
is geared to handle the latest immunotherapies or genetic-based personalized
treatments. There is already prohibitive rationing of care and waiting times to
receive health care in Canada, our single-payer health insurance model to the
north.
And beyond the monetary concerns and the threat to innovation
and the employer-based health insurance system, Medicare-for-All poses another
problem: the system would require the hiring of a huge government bureaucracy
enforcing numerous rules and regulations getting in the way of doctors
providing the best and most suitable care for their patients.
The more time doctors have to spend filling out forms and
appealing decisions by far-off bureaucrats, the less time they have to provide the
best individualized medical care catered to meeting each patient’s needs. Keep
in mind that Medicare today already fails to adequately compensate health care
professionals for many of the services they provide.
Before changing and ballooning Medicare in a way that will
significantly diminish its quality and functionality further, I wish Sen.
Harris would consider that 28 percent of primary care physicians already don’t
accept the Medicare we have now.
I wish that we physicians were more a fundamental part of health
reform, since most of dedicate our lives to providing the best care we can to
our patients. That’s an important fact that is too easily overlooked.
I wish I was more hopeful that this important message will reach
and affect Sen. Harris and others who are proposing a radical overhaul of our
current health care system. The last thing we doctors and our patients need is
another enormous government-run bureaucracy of the kind that is too often
plagued with problems and woefully inadequate for patients in other nations
around the world.
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