Improving affordable health care of all

It’s nice to be out in the fresh air again after two total knee replacements. Still, the time spent in hospital and rehabilitation was not a complete loss. It gave me time to think about our national health care system, and listen to the comments and experiences of fellow “inmates” on what’s right and wrong about the Affordable Care Act (ACA) or “Obamacare.”

For some patients, particularly those facing serious conditions and costs of treatment, Obamacare has been a life-saver. They could not have survived without Obamacare. For others, certain aspects of Obamacare were inadequate, or over-costly. To be sure, Obamacare is a work in progress. It can be improved. But the notion that “We need to repeal every last word of Obamacare” is as cynical as it is ignorant, heartless and absurd.

Back in December of 2008, I sent to President-elect Barack Obama’s newly formed health-planning team some materials on the World Health Organization’s own international staff health insurance system, which has been working successfully and “in the black” in more than 200 countries, including the U.S., with better coverage and at lower cost than virtually any insurance policy available in this country. I wrote: Here’s a working model to adapt and build on.

In the covering letter I suggested that a “single provider” system is probably not right for America, but a “single payer” system linking government and private insurance partners (as the WHO plan does) is highly feasible. Finally, short of that, the plan could be formulated as a “voluntary public option,” operating alongside other qualifying private policies in the competitive insurance exchange marketplace. As it turned out, none of these three options, (1) single provider, (2) single payer or (3) public option, got a hearing in the U.S. Congress — not one minute of debate.

The number one weakness of “Obamacare” is its failure adequately to deal with and regulate costs, prices, premiums, co-pays and deductibles. Pharmaceutical companies are free to charge high prices, through the roof, for their medicinal drugs, without a word of cost explanation or justification. For those on the plan, Medicare tries to screen health provider treatments and charges, but in reality what Medicare does is routinely reduce health provider claims by roughly the same percentage, even though one hospital may charge more than 10 times that of another hospital for the exact same procedure, days in hospital and outcome.

One of the most frequent complaints about U.S. insurance policies is that they impose up-front deductibles of as much as $10,000 a year before any insurance coverage kicks in. For a healthy young person, this seems like having no insurance coverage at all. So, why sign up and pay all these premiums, except to avoid the mandated penalty “tax”? Arguably, consideration should be given to abolishing up-front deductibles entirely.

Unlike the WHO model, most U.S. health insurance plans do not cover dental work, teenage tooth braces, subscription eyeglasses or even mental health services. Those all cost extra. Also unlike the WHO model, most U.S. plans are geographically limited to services provided within the USA, the state, the county, the district or even a more limited area covered by an HMO or particular provider. Individual providers are free to “opt out” of the national health scheme. 

Why such limitation? Expensive supplementary insurance coverage must be obtained for travel abroad. Why? If an American falls off a cliff in the Himalayas, and is treated in hospital in Kathmandu, his health care costs should be covered by the U.S. plan (as it is in the WHO plan). He simply could pay the Nepalese hospital directly and submit the claim for full reimbursement by the plan. 

So, what’s the solution? It lies in the third option. The advantage of the voluntary public option is that it provides a comprehensive norm against which all other policies in the insurance exchange have to measure up. Thus, if citizens find their existing premium rates or co-pays too high, or their coverage inadequate, they can voluntarily switch over to the public option. There’s nothing like “free” competition to bring prices down and push range and quality of service up. 

There’s plenty of work to be done to save and improve Affordable Health Care in the U.S. But the initiation of that work begins in the voting booth in the November 2016 elections, when we have the opportunity to put into office leaders who will put partisan politics and self-interest aside, explore options, seek practical solutions, and work for the health of all the American people.

Sharon resident Anthony Piel is a former director and general legal counsel of the World Health Organization.