Commentary: America’s healthcare system


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I’m 84 years old. Until now my health has been excellent. But in the last two months, I’ve had numerous healthcare visits. I’m very critical of America’s healthcare system. It’s not because of the care I’ve gotten: it’s been superb. Was I just lucky? I doubt it. So “where’s the beef?”

Regardless of your political beliefs can we agree we’re drowning in paperwork? During these visits, the forms I’ve filled out would supply a NY Times Sunday edition. I’ve filled out my “DOB” over 100 times. (It hasn’t changed in 84 years.)

Sophisticated AI allows better diagnoses of some diseases than humans. Surely, it’s possible to create a health card that shares and updates medical information. Taiwan has implemented such a card. [1]

But here’s the deeper problem: I have Medicare, secondary insurance and drug coverage. But millions in the US don’t. They suffer from unmet health needs, often accompanied by catastrophic emotional and financial distress.

Can we do better? Emphatically yes. Some advocate returning to the pre-Obamacare era. Really? Denied coverage because of pre-existing conditions? Denied treatment because you’ve exceeded coverage limits? No expanded Medicare if you are low income? Declaring bankruptcy because of huge medical bills? (The leading cause of personal bankruptcy.)  [2] As tennis legend McEnroe said, “You cannot be serious!”

We need publically funded universal health care which takes many forms as in Canada, England, France, Germany, Taiwan and New Zealand, so it needn’t necessarily be “Medicare for all.” [3]

Regardless of which model is adopted, I hear the following objections:

“Its socialism’”. (Look up the definition of “socialism”; the only model that comes remotely close is that of the UK.) Also, “We can’t afford it” and “It will degrade the quality of care.” Baloney.

We have huge CEO salaries, high overheads and scandals like the recent pharmaceutical collusion [4] along with Big Pharma’s huge lobbying clout. Pharmaceuticals spend far more on advertising than research while lobbying doctors and justifying outrageous drug prices on the cost of research. [5]

Numerous studies establish that developed countries rank higher than the U.S. in health care outcomes and at half our costs. [6]

Nevertheless, healthcare costs are rising globally and must be controlled. Among the causes in developed nations are the increasing portions of the elderly, adoption of the US’s poor nutritional habits, and slowing economies. [7] In the U.S. a leading cause is rising obesity. [8]

The U.S. should move towards publically funded universal health care by first including Medicare as a public option in the ACA and correcting ACA defects. In 2017, healthcare expert Steven Brill listed nine “fixes”, especially in the area of cost-cutting. Among these are: tighter controls of prescription drug prices, with Medicare negotiating prices with pharmaceuticals; fully implementing competitive bidding for medical equipment and devices; antitrust action against rampant hospital mergers, and reinstating the excise tax on medical devices [9].

We must move toward the goal of publically funded universal healthcare “with all deliberate speed”. But unless we elect progressives in 2020, that goal will not be achieved. I am therefore switching topics to comment on the Presidential candidates:

Donald J. Trump: see the McEnroe quote above.

Among the Democrats, there are several who are excellent:  Steve Bullock, Governor of Montana, whose record in that very red state is amazing, and who would win middle class white voters while still being very progressive on all major issues. Three excellent young candidates are Tulsi Gabbard, Julian Castro and especially Pete Buttigieg, who is articulate and whose intellect and depth of thought are extremely impressive.  Regardless of your opinion of Buttigieg, read his story: “Shortest Way Home.” He writes beautifully and one day he will be President. Wouldn’t it be wonderful to have a President who actually writes literate English sentences?

Buttigieg, especially, recognizes the need for two fundamental democratic reforms: First, the filibuster:  It is now used to obstruct nearly all legislation. I favor the Harkins “sliding filibuster” proposal. [10]) Second, restructuring of the Supreme Court. Several proposals have been made.  [11] That Court now functions mainly as Mitch McConnell’s auxiliary arm of his Republican caucus. Both reforms are essential to saving our Democracy. Without them, even if Democrats retain the House, win the White House, and take back the Senate, it will profiteth us nothing.

However, these excellent candidates lack name recognition. Currently, the person having the best chance of defeating Trump, which I consider imperative, is Biden.  Biden has serious flaws I needn’t dwell on, but if he has the sense to listen to the ideas of these and other excellent candidates then he should be elected. I have no tolerance for those purists who say he isn’t progressive enough and ‘I will sit this one out.’ We saw what happened with Bernie and Hillary in 2016 and our country and the planet will continue to suffer the consequences for decades.

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