As surely as Beto speaking Spanish and Bernie inveighing in Brooklynese, healthcare will take center stage during Round 2 of the Democratic debates on July 30 and July 31. And, judging by the avalanche of new healthcare proposals, viewers will almost certainly be left with the impression that the U.S. healthcare system barely covers anybody (except, of course, the “millionaire and billionaire class”). But recent data isn’t kind to the assumptions of socialized medicine crusaders such as Sen. Bernie Sanders (I-VT).
Despite millions of Americans being tossed off their healthcare plans after the Affordable Care Act (aka “Obamacare”) was signed into law, current government studies estimate that about 9 out of 10 Americans have coverage, and according to Gallup, more than three-quarters of Americans rate their quality of care as “excellent” or “good.” Wannabee healthcare “reformers” such as Sanders and former vice president Joe Biden must acknowledge that most Americans like their care and would like to keep it (for real!). Instead of reinventing the wheel, policymakers should work to reduce costs and bureaucracy within the current system.
Unlike Obamacare, Americans won’t have to read the full text of Sen. Sanders’ “Medicare for All” proposal to find out what’s in the plan. The architects of Medicare for All have been very upfront: any “comprehensive” new system of government insurance would come at the expense of private plans. Americans would have to pay higher taxes to support health insurance plans with features they would not need, including access to rare, expensive drugs and dubious dental treatments.
Other proposals, such as Bidencare, don’t seem as bad; private insurance would remain intact, coupled with greater federal subsidies to purchase individual marketplace plans and a federal Medicaid public option for low-income Americans. Like his former boss, Biden assures voters that they can hold onto the plans that they like. But this didn’t happen under Obamacare when strict regulations defining what “good enough” insurance is led to mass cancellations of existing coverage. President Obama’s infamous promise that “if you like your plan, you can keep it” proved hollow when more than 2 million Americans were told by the government that they would not be able to renew their plans. It is, of course, possible to grandfather in plans already held by Americans while insisting that new plan enrollments meet the nonsensically high standards demanded by Washington bureaucrats. But that begs the question: why are plans so highly regarded by the American public not good enough for the currently-uninsured population?
Presidential hopefuls (and most politicians) trying to win over the trust of voters should stay away from tinkering and dictating what healthcare plans should look like. Instead, they should address the 800-lb gorilla in the room: rising costs. Despite large majorities of Americans approving of their quality of care, Gallup finds that just over half (54 percent) find costs to be acceptable. Fortunately, there are plenty of ways to increase affordability in medicine without compromising current plans. Federal officials can work with states to expand scope-of-practice to nurse practitioners (NPs), ensuring that a steady supply of medical professionals is able to prescribe low-stakes medication such as antibiotics if the doctor is unavailable or simply too expensive. According to the American Association of Nurse Practitioners, only 22 states and the District of Columbia allow NPs to use their full training to diagnose and treat patients.
Medicare’s lack of data on NPs makes it difficult for the government to identify practitioners and set up appropriate billing procedures. The Medicare Payment Advisory Commission (MedPAC) notes that the, “lack of specialty data create several problems, including obscuring important information on the clinicians who treat beneficiaries and inhibiting Medicare’s ability to identify and support clinicians furnishing primary care.” MedPAC recommends that Medicare strengthens its data collection on NPs, and allow practitioners to bill the Department of Health and Human Services directly instead of current, indirect billing practices that cost the agency–and taxpayers–billions of dollars in roundabout reimbursements.
The White House should identify ways to work with states to expand NPs’ responsibilities, as the resulting lower costs would slow the growth in spending for programs such as Medicare and Medicaid. This may not be as exciting as a radically new system of socialized medicine, but these cost savings can keep the vast majority of insured Americans content while helping that remaining 10 percent get the affordable care they deserve.
Joe, Bernie, and everybody else should set aside their posturing and grapple with reality instead of pipe-dreams that would make everybody worse off.
Catalyst articles by Ross Marchand