Waldman: Nine Narratives Explain Persistent Healthcare Failure

Editor’s Note: This Op-Ed was submitted to Breitbart Texas by the Texas Public Policy Foundation and was written by Dr. Deane Waldman, MD, MBA.

So many narratives about healthcare abound, it is hard to understand why no one seems able to fix healthcare. Here are nine examples of commonly accepted wisdom: eight are false; one is true.

 

Washington must stabilize insurance market

The latest talk in Washington is a need to stabilize the insurance market with additional, cost-sharing subsidies. The market is unstable because of the costs of Obamacare bureaucracy and regulations. Obamacare has made selling health insurance a money-losing proposition and has made policies even less affordable.

The cause of market instability is Washington. Let the market stabilize itself. Let it be free — Washington should stop controlling the health insurance market.

Obamacare is working

One online author recently wrote, “Trump can’t repeal Obamacare because it is working.” Others urge we build on ACA success: a drop in the U.S. uninsured rate from 17.1 percent to the current 8.8 percent, representing 17.7 million newly insured Americans.

President Obama started healthcare reform in order to bend down the national healthcare spending curve and to make insurance affordable. Hence, the law’s name, yet, the annual cost of health insurance for an average family has jumped from $12,680 in 2008 to $18,142 in 2016. Obamacare will expend an additional $2.6 trillion dollars and has nearly doubled the national debt.

This is first false narrative: Obama’s financing scheme for healthcare certainly isn’t working.

Trump caused Obamacare to fail

Some blame President Trump for his threat to de-fund insurance subsidies saying he has destabilized the insurance market. Not so.

Though President Trump has threatened to use the executive pen to cut down Obamacare, he has not done so yet. The decline of the ACA started long before he took office.

Insurers such as UnitedHeath, Humana, Aetna and Anthem all stopped selling Obamacare insurance long before January 2017. A central element of the ACA— the individual mandate—was declared unconstitutional in 2012. The cost of insurance skyrocketed in 2014, 2015, and 2016, long before Mr. Trump entered the oval office.

Obamacare is failing because it is conceptually flawed, not because of anything President Trump did or did not do.

GOP will repeal and replace

From 2014 to 2016, when the GOP had a majority in the House of Representatives, they voted to repeal parts of Obamacare 48 times and the entire bill six times.

The GOP had seven years to consider, debate, test, and revise an effective alternative to Obamacare, one they could convince the American people to support. Instead, they waited till 2017. Then, in a rush, they created hastily, ill-conceived political compromise plans—American Health Care Act and Better Care Reconciliation Act—that failed.

Insurance coverage is what matters

Whether you pay attention to CBO scores, newspaper headlines, talking heads on TV, or online articles, you hear that millions will lose their insurance if Obamacare is repealed. Insuring people seems to be the top, possibly the only, priority of people in Washington.

The most important outcome of an effective healthcare system is not insurance—it is access to care, which should always be the first item for consideration, not an afterthought. Neither Democrats with Obamacare nor the GOP’s two failed reform schemes offer any evidence that their plans will improve access.

Gaining coverage is the key to care

There is solid proof that people who GAIN insurance LOSE access to care. New Mexico expanded Medicaid under Obamacare, and close to 400,000 additional New Mexicans signed up. Nearly half of the state population is now dependent on federally supported insurance. Despite an infusion of $3 billion additional federal dollars, the cost of Obamacare mandates created a shortfall of $417 million. To balance their state budget, NM Medicaid had to reduce an already low physician payment schedule even lower. This made medical services even less available.

Increasing the number of government-insured individuals reduces the availability of care.

Single payer is the only option left

With Obamacare failing and the GOP offering nothing new, some assert that the only option remaining is single payer.  This is false, and ironic.

The ACA increased the amount of federal control within the healthcare system. Obamacare is quite obviously failing.

Single payer is total government control of healthcare. Why should you believe that more government control — single payer — would save us from the excessive government control — Obamacare — that is currently destroying healthcare?

Health care must come from Washington

Some people reason as follows. Americans have a right to health care. Washington ensures and protects our rights. Therefore, Washington must create a healthcare system that gives all Americans timely, high-quality care.

Falsehood piled on top of falsehood.

Health care is a provider’s work product and therefore, it cannot be a right (unless you believe in slavery.) Specially trained providers, not federal bureaucrats, deliver care. Washington politicians have been “fixing” our healthcare system for fifty years. Look what that has gotten us.

Most people cannot conceive of any healthcare system that doesn’t come from Washington. That is precisely what the U.S. needs.

“StatesCare” can fix healthcare

Since Washington is the root cause of healthcare system failure, the cure is simple: remove Washington from healthcare. What does “removing Washington” mean?

It means more than $1 trillion a year will no longer be wasted on federal bureaucracy. This money can be used to pay for care.

It means Washington can no longer impose its one-size-fits-all solution on 323 million Americans.  Residents of inner Detroit have radically different medical needs from Texans on the Panhandle.

The individuals who understand local needs best, who know local resources, and who are most responsive to local concerns—namely state legislators—will be making healthcare system decisions.

And it means instead of federal mandates, states should decide for themselves. We call this solution, StatesCare.

California wants a single payer — 39 million people should have what they want. Texas wants a free market and who is Washington to say no to 29 million Texans? If groups of smaller, less populous states want to form regional coalitions, they should be free to do so.

Here is a true narrative: The cure for our sick healthcare system is replacing federal control with StatesCare.

Dr. Deane Waldman, MD, MBA, is a retired pediatric cardiologist and Director of the Center for Health Care Policy at the Texas Public Policy Foundation. Dr. Deane can be reached at dwaldman@texaspolicy.com or follow him on Twitter at @SystemMD.


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