“Another Really Dumb Plan for Health Care Reform”

September 20, 2017

The Graham-Cassidy bill to replace Obamacare is making the rounds in Washington, DC.  While the nation’s attention is focused on recovery efforts for Hurricane Harvey in Texas and surrounds, recovery from Hurricane Irma in Florida and Hurricane Maria tearing up Puerto Rica and the Caribbean, with President Trump threatening to wipe North Korea  (and Iran?) off the face of the earth, even while providing the strangest speech ever delivered in the body of the UN since it’s foundation (although President Kaddafi of Libya tearing up the UN charter is a close second), the conservative Republicans, led by Senator Lindsey Graham, SC, and Senator Bill Cassidy, LA ( who is called a liar on national TV by the father of baby Kimmel), are moving under the cover of darkness and haste in an attempt to offer one last attempt to overturn the Obamacare (The Affordable Care Act of 2010) and its “creeping socialism.”(Graham)

The arch conservative Republicans, led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana are feverishly working to obtain the 50 votes to pass this last gasp bill, before September 30^th.  It is so hurried, even the Congressional Budget Office has not had time to analyze it fully, nor predict either the overall cost to the consumers, or how the removal of the mandate to exclude pre-existing conditions will affect the cost of coverage for the poorest consumers of health care.

The Republicans senators, claiming the mantle of conservatism are so philosophically blinded by their own ideology, they no longer see the constituents as persons worthy to represent.  Their own constituents are weighed and measured not as human beings, but as consumers of health care who present too large an expense to the federal budget.  Never mind that the combined sums of the wars which the United States propagated in Iraq and Afghanistan amount to $2.4 trillion, much more than the amount spent on health care, nor the fact that our bloated military establishment spends $640 billion dollars on defense each year, not counting our various wars, which are kept “off budget.”  The spending on military defense for the USA is more than the combined totals of Japan, Germany, United Kingdom, France, Saudi Arabia, Russia and China!  So when President Trump decides to “wipe North Korea and its 27 million people off the face of the earth”, he has plenty of firepower with which to do it.

Excluding the cost of Social Security, which is a separate item relating to retirement benefits, the Federal government subsidizes private health insurance to the cost in 2016 of $300 billion.  The projected cost of major health care programs for 2017 year, as of June 2017 show Medicare (including part D) at $590billion (net of offsetting receipts), Medicaid $385 billion, Health insurance subsidies $51 billion and Children’s Health Insurance program $15 billion.  Much of the rise in spending is due to the aging of the population, the expansion of federal programs and the rising health care spending of enrollees.

The different calculations sometimes do not agree, as persons tend to quote whatever statistics happen to support their current argument.  The figures I have stated above should be easily confirmed as they are from the Congressional Budget Office.  The total US budget is about $3.7 trillion dollars, and in 2015 $3.2 trillion was financed by revenues, with $438 billion financed by borrowing.  To balance the federal budget will require a reduction of total spending, or an increase of federal taxes, or a combination of both.

The current divide in this nation is a philosophical one, causing deep division among us.  On the one hand, some as Senator Bernie Sanders view health care for all citizens as a fundamental right, and quote studies which show European nations spending per capita around the world.  The United Kingdom spends $3192 per person on health care, Switzerland spends $6289 per person, and the United States spends $8423 per person, per year. The United States spends more per capita than either Austria, Canada, Germany, Switzerland or the United Kingdom.  The argument can be effectively made that Universal Health Care for all citizens, properly managed and controlled with a one payer system (which would be financed by all taxpaying citizens) will actually save the government money over the current system which is a hodgepodge of public and private plans, not including the VA.

Could it be that Bernie Sanders is right?  We know that the Canadian and the British systems pay less for health care by paying less for medications, less for treatment plans, less for physician salaries, and cut out the need for the so called “middleman” of private insurance, which effectively eliminates the need for health insurance companies to perform as profit producing corporations in order to preserve their wealth on Wall Street.

I expect, as a primary care physician, the real reason the Republicans strongly opposed any federal mandate to have health care for all citizens is really more about the profit being made by insurance and pharmaceuticals companies, who both have a strong interest to maintain the status quo, as well as persons like the Koch brothers, who also oppose for similar reasons.  Real reform of health care in the United States has not been possible because those who provide health care and those who profit from it are far more concerned about the profit lining their own pockets than they are about the health care consumer, our patients!

The budget figures I have quoted above do not lie.  Our current spending in the United States under the current model for both military defense and health care (excluding social security, which is another discussion entirely) is unsustainable.  We need a reform of both areas.  However, as long as the Republicans protect the military as a “sacred cow” and call for more defense spending and the Democrats do not offer a realistic proposal to fix which is clearly broken as to cost vs real health returns, we will continue to be stymied in any real budgetary reform.

The current health care reform bill proposed by Graham-Cassidy is stupid and short-sighted, as it will result is an even greater hodgepodge of plans and political agendas varying from state to state.  With no consistent mandate for patient care, the whole system will be in danger of collapsing on itself.  Patients with preexisting conditions and those with special needs will be forced to migrate or move to the states with better health care coverage and leave the states with poorer coverage.  As a person who has lived all my life in South Carolina, I expect we will see a vast migration out of the state to whichever state more wisely uses its piece of the federal pie.  I hope the Graham-Cassidy bill fails as miserably as all the other attempts to replace Obamacare (the Affordable Care Act of 2010).  It is not a bi-partisan effort at all, but only another attempt to impose a conservative agenda on the population of the United States.  It is a piecemeal and not a comprehensive reform of health care in our country.

If the profit motive is removed from health care and it is considered in the United States to be a right of every citizen, we could begin to have a meaningful discussion of reform.  It will likely be greeted by some with great anguish, rending of garments and gnashing of teeth.  We will know then who makes the most profit from not changing.  For the rest of us, we will be happy simply to move on with our lives and talk about something else, as for example what my neighbor’s name is down the street and whether we have taken the time to get to know him or her or their extended family.

As Christians, we are led by the words of Jesus Christ our Savior, “As you have done it unto one of the little ones (“the least of these”), you have also done it unto me (The Gospel of Matthew, chapter 25, verse 40—the words of Jesus Christ!)  Simply human decency and compassion for our fellow human beings should remind us that all of us, from the least to the greatest deserve to have compassionate health care.  As for myself, in my practice, we welcome everyone who comes through the door.  Our mandate is simply to provide care for all, even for those who cannot pay and have no insurance.  It just makes common sense.  As I have done it unto one of the least of these my brethren, I have also done it unto me.  Even if Jesus had never came to earth, it would still be the right thing to do! Compassion is never a wasted commodity.  It bears many fruits and prepares us to inherit eternal life.  The profit motive is eliminated, if we choose to lay up treasure before God in heaven.

BW, MD, AAFP-Fellow

“The voice of one crying in this wilderness, make straight in this desert a highway for our God!”

“Amen and Amen!”