LEANING RIGHT--While it's entirely fair to blame the GOP-led Congress for not having a plan or consensus to replace or improve ObamaCare after years of running for election/re-election against it, it isn't fair to not place the blame that belongs to so many Americans who want their health care for free. Particularly because so much of the "free" health care that we believe works so preciously well in Europe and Canada is being paid for indirectly by US, the American people. (Graphic above.)
Much of the reason why Europe's leaders are unhappy with President Trump's demands that all nations pay their fair share of NATO and defense costs is because anywhere from 0.5% to over 1.0% of their GDP is being spent on domestic costs such as infrastructure and health care instead of defense. Only the U.S., Greece, Britain, Estonia, and Poland pay their promised share of defense/NATO costs.
Add to that the fact that these countries have capped/lowered costs of prescription medications compared to the U.S. (Americans pay 2-3 times the amount that Canadians and Europeans do for the same medications), and it's not hard to conclude that we're indirectly subsidizing large amounts of their prescription costs. Subsidizing the Third World is both kind and moral ... but subsidizing the rest of the industrialized world is unacceptable.
What IS a fair statement is that these nations have decided to make everyone pay for a powerful, extensive safety net meant to cover the costs of health care...although the arguments about how everyone pays, and how the health care is distributed, and the growing burden of refugees not choosing to pay proportionately into their national health care, are both uncomfortable but timely, and also "fair" to discuss and debate:
1) Fiscal literacy among Americans is frighteningly low, as is the willingness to pay for their health care even when one is young and healthy. However, what counters this reality is that it's become an "all or none" during the era of the "Affordable Care Act", which is one of the greatest misnomers of American legislative history.
Having young, healthy adults all be required to pay for such far-flung oddities as pediatric psychiatry was and is a ploy to make these young and healthy adults pay for the insurance needs of those who either will not, or cannot, pay into the system. One can dislike Senator Ted Cruz of Texas all one wants, but his urging the options of "barebones" plans is both timely and a way to ensure that all Americans have access to a safety net of their own choosing.
2) The individual mandate can and should mean different things to different people of different values and means. In other words, requiring one to have catastrophic insurance only, while educating that person as to what his/her health care costs will skyrocket to should true medical needs occur, emphasizes BOTH freedom AND responsibility (something that the utopians in our society cannot fathom, but need to start wrapping their heads around).
3) Like it or not, the more health care is "free", the more that market forces (some of which most Americans find amoral and disgusting) will allow for INCREASED, not AFFORDABLE, costs. If prescriptions are covered, then costs for those prescriptions go up. If office visits are covered, then costs for those visits go up, and so on. In other words, the MORE we're covered, then sooner or later we'll see our deductibles go up and we'll discover that we're LESS covered.
4) There is virtually NO incentive for doctors, hospitals, and pharmaceutical companies to cater to individuals and families willing to pay cash. To be blunt, we treat cash-paying patients like dirt--we're forced by law to charge them as much as insured individuals, although many doctors find innovative ways to allow them to pay less (usually out of compassion, not greed). "Boutique" clinics, makeshift clinics adjacent to pharmacies, and the like have their roles for both ACCESS and AFFORDABLE health care.
5) Most of organized medicine got on board with the Affordable Care Act, but did so against the opposition of its main membership, in large part because the American Medical Association and much of academia lives in a utopian bubble. However, they CAN start helping to make health care more affordable by finding their moral compass and put their money where their collective mouth is:
a) Yes, it's "socialist" but stating which drugs should cost patients $10, $25, $50, and so on based on consensus/specialty opinion would establish a bully pulpit that would drive the greatest violators of overcharging pharmaceutical companies--generic companies--to work with governmental and political leaders (who've also been cowards to the pharmaceutical industry) and make dirt-cheap medications plummet in cost. And stop blaming health plans who are just doing their jobs by keeping premium costs down by step-therapy policies.
b) If academic institutions started working more with state Medicaid programs, health plans, the pharmaceutical industry, and the FDA, more cost-effective mechanisms to establish and verify new treatments could be established. Consensus statements based on costs and quality evidence (placebo-controlled trials) help drive health plans to cover certain medications more than others. High-risk pools suddenly become more cost-effective.
c) Academia and medical societies can also decry monopolistic and predatory pharmaceutical companies, and take them on when anti-trust actions are indicated. The best method to reduce costs is through capitalistic, and not socialistic, mechanisms--this isn't just political jingoism...rather this is basic economics, both time-tested and yet to be disproved. Anti-trust actions should encourage capitalism, not discourage it. Requiring choice and competition usually brings costs down.
d) It's time that the academic gurus speak the truth and emphasize what medications should be over the counter. Recently, Differin gel, a topical retinoid, was allowed to be over the counter. Before, the medication was prescription only and a triple-digit cost, and now it's anywhere from $15-30 depending on the tube size. All primary and specialty societies should urge more treatments to be over the counter, accessible, and cheaper for patients ... and that CERTAINLY includes oral contraceptive agents (birth-control pills).
Keeping costs down encourages health, a better economy, and a better quality of life. For health care, cracking open the door to creating more choices, demanding individual and societal responsibility, and not demonizing those fighting to keep costs down (like health plans, presuming they're run well) is the best way for a society to achieve affordable health care.
Certainly, those courses of action establish the best way for a FREE society to achieve affordable health care, and allow citizens to take care of their own health needs ... while also allowing Americans to best pay for those who truly, medically cannot access and afford life-saving and life-improving health care.
(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud father and husband to two cherished children and a wonderful wife. He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition, and can be reached at email@example.com. He also co-chairs the grassroots Friends of the Green Line at www.fogl.us. The views expressed in this article are solely those of Dr. Alpern.)