Blog | Thursday, June 1, 2017

Back to health care reform


While Washington now seems consumed with the mess swirling around the White House that was triggered by the abrupt firing of the FBI director, I want to get back to the mess swirling around the latest effort to “repeal and replace” the Affordable Care Act.

Although the President stated that nobody knew that health care could be so complicated, his apparent surprise is surely based on his own profound, willful ignorance. Anyone who has paid even the most cursory attention to American health care delivery and financing knows that our “system” is uniquely complicated (actually, it is complex). The complexity has been driven by many forces including, among others, the historical accident of employer-based health insurance, a mythic belief in “the market” to improve everything it touches, a corresponding skepticism that government can do anything effectively, and a lack of national consensus about what we, as citizens, owe each other to “promote the general welfare.”

The net result has been well documented. Health care in America is characterized by huge disparities in access to care, major failures of quality and safety, and unsustainable costs. It is, of course, also characterized by amazing life-saving and life-sustaining technology and millions of dedicated, compassionate people who struggle daily to overcome the dysfunction to deliver great care. So how to fix the bad without destroying the good?

I am convinced that the “reforms” being floated in Washington are taking us in the wrong direction. In fact, I believe that the whole idea of tinkering with the current system is fundamentally flawed. It reminds me of the endless addition of Ptolemaic epicycles in the failed attempt to preserve a geocentric model of the universe, instead of the embrace of the more simple (and accurate!) Copernican heliocentric model. Why not just acknowledge that more incentives, more subsidies, more exceptions, more complexity, more inequity, more pieces to this puzzle are not the answer, and move to a model that has worked in other economically developed countries?

I believe the time has come for government sponsored, tax-supported, national health insurance—Medicare for all. It could be phased in by gradually lowering the age of eligibility, and converting patients now covered by Medicaid. It could be paid for, in part, by corporate taxes in lieu of paying for employer-based insurance, as well as general government funds based on progressive taxation. It could lower costs the same way costs are managed everywhere else, by limiting what providers, pharmaceutical companies, device manufacturers and everyone else can charge, and by continuing the transition, already well underway, to convert Medicare from a fee-for-service based system to a value-based system.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.