Sickness for All or Medicare for all! Either You Choose S4A or M4A?
Original: Oct. 28, 2019; Update: Nov. 18, 2019.
To Continue...
It all started with Senator Bernie Sanders advocating the Medicare for all back in 2016! Guided by the ideology that Americans have the right to healthcare, Bernie supports the Medicare for all (M4A) program as the safety net that would best guarantee medical coverage and access to all. In turn, the Medicare expansion will insure Americans against "the profits of the insurance and pharmaceutical companies." Senator Sanders contends that providing healthcare to all Americans is economically viable. With less Americans filing bankruptcy (due to their unpaid medical bills), the M4A will contribute to "an economy and a government that works for all - not just the 1%." (Not Me. Us. Bernie, 2019).
Sickness for All (S4A): Before delving into the M4A ideology and policy, an observation about our bodily structure is prudent. "No matter who we are or where we come from," we are all inherently structured similarly. From early young age, we are compelled to believe in "Self-Reliance" - a concept or ideology that underpins our American values. Through a combination of nature and nurture, we begin to define our world through "toughness, stoicism, and self-sufficient" - all within the context of absent emotional IQ. As a result, we go through life all skeptical of authority - preferring "dissent and independence of thought" over connectedness. We cumber ourselves in being independent, irresponsible, and judging others according to our own socio-economic terms. Meanwhile, we live and grow into our own tribes of "warring and servile" conformists (Sartwell, 2019).
While being self-reliant, growing signs of continued struggle between God and US over our values and beliefs began to show in the background. Without notice, however, we become sick - astonishingly underscoring our inter-dependence on each other. More challenging is how our values toward God have suddenly changed. Flabbergasted, we become "disabled from resisting" God's mercy, as our body gives out over the course of our illness from symptoms, diagnoses, and prognoses, to treatments and maintenance (hopefully).
Diseases are expectedly known to impair our functions as well as our dignity. For our worsening medical conditions, our days become full of "physical pain for the patient and emotional pain for the family." Along with the overwhelming sense of desperation & fear of the unknown, the logistics of providing and/or affording care more likely will become helplessly cumbersome. As we fall into different stages of "anticipatory grief," we will perpetually struggle with "risky medical procedures, prescription drugs with serious or unknown side effects, as well as financial anxiety" - until our "mighty brain decided it had enough"(Harris, 2018).
Train Voyage Illustration: One's journey of sickness over the course of the disease is like traveling through time along the rails of life aboard our own train. A few of us might be fortunate to ride their own but slow train from cradle to grave with no stops in between. For most of us, however, our train voyage from start to finish could be as fast as riding a high speed rail with little if no stops in between. Or our travel could be a long, treacherous journey with so many excruciating S4A train stops along the voyage. Unbeknownst to us, these train stops are typically untimely and unpredictable, since we never know when it will be time to step off the train - our final stop to mortality.
The uncertainty of these stops can/will take their toll on our sanity. If nothing else, the "complexities of grief will continue to bewilder us (Harris, 2018)." As we get closer to our final stop, our life begins to feel as we are riding "a freight train gaining speed by the day (Strassel, 2019)." Faced with such reality, we become "timorous and desponding", as we become afraid of truth and death." As we got closer to our final train stop, we all start praising God. Regardless of our personal vertigo-induced tracks, mortality will certainly take care of the rest (Firestone, 2018). Fortunately, those who may believe in the after-life will conform to what God has waiting for us - facing our end with courage (Sartwell, 2019).
Medicare for all: Nevertheless, there should be "nothing partisan" about building the healthcare system for all. Regardless of income, gender, age, and ethnicity, it should provide coverage and care for all Americans. Since the Affordable Care Act was signed into law back in 2010, debates* have been raging on whether healthcare is a right or a privilege. Heretofore, health insurance companies could deny coverage for pre-existing conditions. Since then, both parties have remained steadfast in their opinion. Some asserted that the ACA is unconstitutional - hence it should be repealed. A federal district judge in Texas has ruled in support of a group of Republican governors and state attorneys general (Harris, 2018).
For others, the ACA was hailed as the 'holy grail' in fight against being uninsured and sick. They point to the ill-effects of repealing the ACA. Without its provisions, they fear, Americans with pre-existing conditions would be denied health insurance - discriminated based on their age and gender. As a result, over 50 million Americans could lose their healthcare coverage, according to the Kaiser Family Foundation. At the same time, individuals in their mid-20s would lose healthcare coverage from their parents' health insurance plans. Both lifetime caps and out-of-pocket costs are no longer capped. Hundreds of thousands of insured individuals would lose their health insurance, if the Medicaid expansion in dozens of states could be reversed (Harris, 2018).
The Exacting Maladies of the US Healthcare System: Before assessing the feasibility of the M4A and its provisions, it is probably prudent first to illustrate the current US healthcare system ever-growing maladies (Binder, 2018).
First - Unnecessary Care in billions of dollars: The U.S. healthcare system is best described as the system of "overuse and unnecessary care." According to the Institute of Medicine Health, nearly $500bn in healthcare expenditures are unnecessary. Coupled with another $500bn in lost productivity and disability, the country spends nearly one-trillion dollars annually in waste.
One example of such futility is the early-elective deliveries without medical or obstetrical indications. Per the American College of Obstetricians and Gynecologists, the Childbirth Connection, the March of Dimes and the Association of Women's Health, and the Obstetric & Neonatal Nurses (AWHONN), and along with all the national health plans, all have constructed the dramatic effects of these deliveries since 1990s. Early elective deliveries (EED) do equally harm women and newborns. Babies born at 37-39 weeks of gestation carry significant increased risk compared to early term births of 39-41 weeks. These infants will have a much higher risk of death as well as a higher risk of harm like respiratory problems & admissions to the NICU. Therefore, limiting the rate of these deliveries will definitely decrease these unnecessary admissions by as many as one-half million NICU days.
Second - Do not harm to Patients: The US healthcare system, regardless of its advanced medical technologies and skills, continue to exact harm on its patients. One in four Medicare recipients report some form of physical or mental impairment during their hospital stay. To bring such issue into focus, a good analogy might be the 1-to 4 odds of being injured every time you get "behind the wheels."
Third - Perverse Incentives in How We Pay for Care: Over time, health plans, Medicare and Medicaid paid FFS for medical services, regardless of their utility to the patient. It is an epidemic of perverse incentives, as such payment system encourage the provision of additional services. Changing the reimbursement methodology to the value-based model will lower healthcare costs.
Fourth - Lack of Transparency: In simple terms, "transparency galvanizes change like nothing else." Posted healthcare services (costs & negotiated rates) will more likely depict a better symmetry between providers and healthcare purchasers. According to Leapfrog Group (purchaser-driven organization), transparency would enable patients to be better consumers of healthcare services.
More important still is the public outrage of payors (Medicare, Medicaid, & Insurers) as well as the private outrage of consumer advocates (patients & employers). Calling upon the drug & medical device manufacturers and PBMs) for more patient-centered services might bend their cost curve. Pharmaceutical pricing & inefficiency of their supply chain has become more threatening malady next to providers' delivery functions. The key point here is "not to financially reward complacency of the healthcare access & delivery functions."
Pros M4A: Despite the generous benefits of the ACA that are bestowed upon millions of individuals, the US healthcare system is far from fixed. There are about 30 million Americans w/o health insurance, as well as millions of other Americans w/ insurance but unable to afford the rising cost of health care. Therefore, the U.S. needs a healthcare system of good outcomes rather than one of high profits. Recent studies noted a trim of $5 trillion in healthcare costs over the next 10 years, along with countless saved lives (Harris, 2018).
Con M4A: For others, however, the M4A New Deal epitomizes what governments are all about. For starters, it will be a behemoth government-driven plan that will control a third ($3.5 trillions) of the US economy. Buried in the details, this New Deal will yield to more government control of Americans' private life. The M4A would dictate all aspects of healthcare access and delivery - from the who, what, where, when, why and how. More ominous is the M4A diabolical fuzzy math as it doesn't delve much into the additional costs, e.g., the trillions of dollars in additional taxes. Its opponents cite the Federal Reserve "extending credit" patriarchal role as one reason not to support the M4A (Strassel, 2019).
M4A Buyers Beware?: This is one of the latest efforts to combat those aforementioned maladies. On the surface, one approach may be to uproot the current system which will require nearly Hercules efforts. No malady does our healthcare system suffer the most then its inefficient administrative one.
As we construct and operationalize the M4A program, we must stay in tune to the following questions: What are its mission and objectives? Should we remain a private system financed more and more by a public one? How do we implemented? Along what time line? What are the benefits as well as the costs - whether tangible or intangible - associated with the M4A program?
Final Note: Will the M4A improve the US healthcare system or not? This is a prudential question, given all the pertinent costs and barriers (accounting and economic basis).
Despite all the acquisitively, incompatible values, we're now on the cusp of public/private accountability for an all public/private healthcare coverage. Unfortunately, our past may contain certain precedents and may serve as an ominous guide to constructing & implementing the M4A program. It's no coincidence that since the 1930s we've had presidents with good intentions. Nor is it coincidence that states have also tried.
Time and time again, the U.S. healthcare 'unnecessary costs and services" were thought to be a malady in need of curing. Nonetheless, the fear now is these government-driven programs have none other than cultivated rather ill-defined maladies of more bureaucracy. Nowadays, what makes the conundrum of the current healthcare systems is not the medical-based maladies, considered difficult to diagnose. Rather, it is the unwillingness of the government to take bold actions to tame the beast within all the sectors of the US healthcare system.
Two final thoughts to direct our debate are as follows:
Will we force the machineries of medicine to endure all strategies and policy changes - "if only for the sake of enduring."
The M4A may be an additional sign that Americans - for better and worse - are now like the opposite of what they used to be? (Sartwell, 2019).
* These debates - some are explicit and open while others are muted but real - can be classified into the categories of who, what, where, when, why and how.
References:
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