In 1974, President Richard Nixon was close to a deal on universal health care with Sen. Ted Kennedy (D-Mass.).Their initial approaches were completely different: Kennedy favored a government-run single-payer system; Nixon wanted to extend the market-based system in which employers were mandated to provide coverage and those who had no coverage were enrolled in an HMO-style Family Health Care Plan.
Under their compromise, everyone would receive a national health care card to provide personal information and guarantee basic health care. A Comprehensive Health Insurance Plan would cover pre-existing conditions, mental illness, alcoholism and drug addiction.
{mosads}Kennedy and Nixon were close to a compromise solution when Watergate demolished Nixon and his presidency.
Flash forward 45 years, and the battle still goes on. But when I see Sen. Bernie Sanders’ (I-Vt.) “Medicare for all” plan — re-released this week with little change, and quickly endorsed by Sens. Kamala Harris (D-Calif.), Cory Booker (D-N.J.), Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.) and others on the far left — I can’t help but think that the lessons of the past have not been learned
Not to mention the fact that the 1970s lacked today’s innovative personalized solutions like cancer immunotherapy, robotics and genetically engineered treatments that one-size-fits-all insurance will never consistently cover.
Still, on the surface, Sanders’ plan sounds great: No co-pays or deductibles, no premiums, no private insurance whatsoever. Of course, when you mention the cost of transition to the taxpayer, it instantly becomes less popular. Not only that, but the term “Medicare” is a misnomer, since the process of expanding government-run health insurance to all means changing it, and the final restricted, rationed product will end up looking more like Medicaid than Medicare.
Sloganeering flame-throwers like Sanders are not considering that the private health insurance system is very powerful and deeply imbedded in the fabric of our capitalist society, and it won’t simply roll over and be replaced. Health insurance was initially devised in the 1930s to cover life-threatening, catastrophic illness. Unfortunately, over time, health insurance morphed into a fear- and slogan-driven monstrosity that is used by politicians and businessmen to garner votes and profits, respectively
Whereas Sanders seeks to reduce choice and heavily regulate or ration options, the Trump administration, under the guidance of Health and Human Services Secretary Alex Azar, seeks to capitalize on the removal of the individual mandate to add and extend insurance options (“skinny” plans and association plans) and, most importantly, to emphasize price transparency.
The health insurance system has deteriorated to the point where the consumer never knows what anything costs and whether there are less costly alternatives that work just as well or better — so price transparency is one important fix. Reducing the role of profit-seeking middlemen is another. A third is providing more generic alternatives to overpriced drugs while blocking pharmaceutical companies from charging other countries less than we pay.
A fourth needed fix is to reward or provide tax incentives for healthy behavior, like exercise or diet, which decrease health care costs. Prevention doesn’t occur in the doctor’s office; it occurs before you ever get there.
Sen. Sanders’ plan is outdated, expensive, colossal and doesn’t fit or financially support the innovative personalized solutions of the future.
Sanders’ rhetoric may get him attention, but if he or others like him are serious about health insurance reform, they need to take a page from Nixon and Kennedy’s playbook. Those two politicians, both deeply committed to a universal health care solution, came at it from opposite sides — Kennedy’s was socialized and Nixon’s market-based. Their compromise solution, if not for Watergate, would have worked far better in the U.S. than anything Sen. Sanders proposes. It would have worked within the current system by extending it, in a way, to plug the holes.
The best solution in health care will come from modifying, reforming and improving, not from demolishing or replacing. The removal of the mandate to buy overstuffed (those ten “essential” benefits), expensive ObamaCare policies with high-barrier deductibles and narrow networks that limit access, is an opportunity to actually expand the insurance pool by adding more options that work for more people.
A national health-care card still makes sense, but single-payer insurance does not.
Marc Siegel M.D. is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter: @drmarcsiegel.