In a letter published July 25, Ron Yezzi argued in response to Al DeKruif that it was OK for one family of two to pay 32 percent of its income for health insurance since there were some couples who would only pay 20 percent, and in addition they would enjoy the benefits of guaranteed and universal coverage and other benefits without any additional cost.
Let us pause for reflection, lest Socrates be right that none of us know anything. The cost of this plan is too high for everyone including those who would receive a subsidy from the government to buy insurance.
The Affordable Care Act does not reform anything about the payment for health care that makes it affordable, and actually adds to the cost by complicating the methods of payment and requiring expensive oversight and enforcement to make it happen.
We currently experience expenses of 40 percent or more of our health care dollar to handle the financial paperwork of privately insured care. This includes the profits and expenses of insurance companies/HMO’s plus the expenses of providers to collect the revenues they have earned. This diversion of the health care dollar stands to become worse, not better under the ACA.
The plan alleges controls on the cost of insurance by requiring a return of 80 percent of premiums to benefits and creating a competitive environment at the health insurance exchanges. Why do we need that kind of a hit when the Medicare plan accomplishes the same thing for 3 to 4 percent and other developed countries provide health care for 1 to 12 percent of GDP? We are at 16 percent and aimed at about 23 percent of GDP.
Another way to understand the problem is that the ACA does not address the new reality of the corporate dominance of health care which has occurred since about 1980. Big Business derisively referred to health care as a cottage industry ripe for a takeover, and they did it. Health care has become a large industrial group on Wall Street.
Much more of health care had been delivered privately or on a community level like other small businesses, but with the industry becoming corporate and publicly held, costs increased greatly; enter profits, even at the so-called non-profits; enter huge CEO pay; enter generous contracts for consultants; (many of these consultants being former executives of the corporations) enter advertising, outrageous commissions for landing contracts, extensive expensive mailings, big expenses for specialists who invest the float and the required reserves with banks; etc.
We don’t need all of this to accomplish the payment of our health bills. The ACA fails miserably by failing to address and reform these matters.
On Aug. 4, ObamaCare pro and con positions were discussed on the Free Press opinion page. The arguments reduced themselves down to the wisdom and folly of employers and young people gaming the system. It was truly disgusting. Do we know nothing about developing a plan for a terribly serious purpose that doesn’t resemble a game of chance at a casino? Forbid it that Socrates was totally correct. We obviously need mandatory basic coverage for everyone and the simplest payment system possible — one that can function with a mix of providers similar to Medicare. In this system as in Medicare and Medicaid, insurance companies have contracts with the government to handle the day-to-day business of payments. They might offer supplementary policies to those who make that choice.
Delmer C. Eggert is a retired medical doctor, he had a private practice in Mankato for 36 years and was a medical consultant to the security hospital in St. Peter and to social services agencies.