In an editorial published by the Huffington Post on January 24, 2013, John Geyman, M.D., Professor Emeritus of Family Medicine at the University of Washington School of Medicine, makes a case that the Affordable Care Act (ACA) only goes part of the way to improve our broken health care system, and in the end will not be able to fix the continuing problems of rising health care costs, lack of access to health care for millions of Americans, and variable quality with worse outcomes than in other developed nations of the world.
Dr. Geyman advocates a Medicare-For-All insurance program with a continuation of our private health care delivery systems, which he maintains will be the only effective way to control rising health care costs and provide quality health care for all.
In the editorial, “The Affordable Care Act: What to Expect in 2013,” Dr. Geyman predicts that the Affordable Care Act (ACA) “will fail to control costs or prices, will not provide universal access to care, and at best will provide low value, high premium “insurance” that will still make essential health care unaffordable for many millions of patients and families.”
According to Dr. Geyman, “The ACA’s fundamental flaw is that it props up an inefficient and exploitative private health insurance industry while not recognizing that deregulated markets can’t fix systemic problems of access, costs, quality, equity, accountability and sustainability.” In Dr. Geyman’s view, this flows from the political fact that the Affordable Care Act (ACA) was “crafted in large part by corporate stakeholders who are themselves responsible for the high costs of U.S. health care.”
Dr. Geyman maintains that the ACA does not contain provisions that would be able to stop the following trends, which he predicts will continue to raise costs, deny access to care, and negatively affect quality of care for millions of Americans – for all but the most wealthy, that is:
- Mergers among major insurance companies, hospitals, medical groups and others — which Dr. Geyman predicts “will end up increasing costs and prices while limiting patients’ choices of physician and hospital.”
- “Continued lobbying by the insurance industry to mold accountable care organizations and insurance exchanges in their interests (i.e. cherry pick enrollees and pass along sicker patients to public programs).”
- Efforts toward “further privatization and exploitation of Medicare and Medicaid.”
- “Efforts by insurers to limit definitions of minimal essential benefits.”
- “Further fragmentation and increasing bureaucracy of our market-based health care system with worse health outcomes.”
What is the Solution?
Dr. Geyman makes the case that “Health care reform needs to be more progressive than how it ended up with the ACA. The only real fix for our problems is single-payer, improved Medicare for All, a proposal introduced by Rep. John Conyers (D-MI) (H.R. 676), coupled with a private delivery system.”
H.R.676 — The Expanded & Improved Medicare For All Act — was introduced by Rep. John Conyers (with at least 33 other Co-Sponsoring Members of Congress) in the 112th Congress (2011 – 2012). The Bill was slightly expanded from similar legislation introduced by Rep. Conyers with 83 Co-Sponsoring Members of Congress in previous Congressional Sessions.
According to Physicians for a National Health Program (PNHP), a non-profit organization of more than 18,000 physician members nationwide, which advocates for a universal, comprehensive single-payer national health program, “HR 676 would institute a single payer health care system by expanding a greatly improved Medicare system to everyone residing in the U. S.”
“HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care,” PNHP explains.
“HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs,” PNHP states.
“Millions of Americans are frustrated with rising health care costs, and have a deep mistrust of private health insurance companies. The for-profit medicine model has resulted in rationed care and created undue stress and financial hardships for millions of Americans across the nation,” Congressman Conyers stated in a news release issued by PNHP.
“Americans … know that our own Medicare program, although not perfect, is a proven and efficient method for providing health care to America’s seniors,” said Congressman Conyers.
“It is time for Congress, other elected officials, the medical community, health care policy experts, and the national media to begin to seriously examine how a Medicare For All program in America could contain growing health care costs, and provide quality and affordable health care for all. Our current health care system is simply not financially sustainable over the long run. The time has come for deep systemic change in our health care system, and a large dose of common sense,” Rep. Conyers concluded.
“Despite what we are being told by politicians on both sides of the aisle, our deregulated health care marketplace is not sustainable, and there is no real fix short of single-payer financing reform coupled with a more accountable private delivery system,” Dr. Geyman opines.
Dr. Geyman has long been an advocate of a single-payer financing system for medical care (Medicare-for-All financing), coupled with a private health care delivery system (meaning, you could keep your private doctors, hospitals, clinics, and health care providers).
In an opinion article published by The Seattle Times in 2009, he wrote: “Single-payer financing (public financing coupled with a private delivery system, a reformed “Medicare for All”), as embodied in Rep. John Conyers’ bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of some $400 billion a year. That’s enough to assure universal coverage for all Americans while eliminating all co-pays and deductibles — the ultimate pay-go. Single-payer will give us far more efficient, affordable, effective and reliable health care than our present multipayer system. Health insurers have known for years that they can’t compete on a level playing field with single-payer, and have only been surviving by favorable tax policies and other subsidies from the government.”
“Many studies over the past two decades, including those by the CBO, the Government Accountability Office (GAO) and the nonpartisan Economic Policy Institute, have concluded that single-payer can assure universal coverage and still save money. HR 676 needs to be brought out of the closet and put on the table for CBO scoring against other options being considered in Congress, all of which cost much more and fail to provide universal coverage.”
What Can We Learn from Other Developed Countries?
“Other advanced nations around the world learned many years ago that one or another form of public financing is fundamental to a good health care system,” states Dr. Geyman in his editorial. “The U.S. remains an outlier among these nations in having the most expensive system that still does not provide universal access to essential health care — even at that we have variable quality and worse outcomes. It is long overdue to learn from the experience of other countries that have coped more successfully with the same health policy issues that we face in this country.”
“Improved and Expanded Medicare for All is inevitable in America– it is just a matter of when it will happen. Single-payer health care systems have successfully contained health care costs and provided high quality health care in countries in Europe, Taiwan, Japan, and Canada. We can no longer continue to embrace the idea that private insurance companies and corporate-owned hospitals and clinics will bring down the costs of health care on their own,” said Congressman Conyers.
What Can Americans Do to Help Improve our Health Care System?
Following are Dr. Geyman’s proposals. He says, “These are some of the directions that we, the citizens of this great country, can take in restoring hope that all Americans can gain their rightful access to the health care that they deserve:
- “Speaking out, individually and collectively, at community, state and federal levels to expose the abuses and cruelty of what passes for health care in its under-regulated state.
- Fighting for a defined benefit program that covers all Americans in a single risk pool with full choice of physicians, other health professionals and institutions. (H.R. 676)
- Supporting efforts at the state level for single-payer financing in the event that reform may first need to be demonstrated at the state level before a national program can be passed by Congress.
- Pushing for a more responsible government oversight of health care at state and federal levels to oversee health care, including an independent, well funded national institute to deal with coverage and cost-effectiveness issues on the basis of scientific evidence, not upon which profit-based interest group can scream the loudest.
- Supporting and participating in divestiture efforts against abusive insurers and other stakeholders in the health care marketplace.”
Dr. Geyman’s editorial was published in its entirety on January 24, 2013, by the Huffington Post.
As summarized by the Huffington Post, “John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington, author of Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, past president of Physicians for a National Health Program (PNHP), and a member of the Institute of Medicine.” “As a family physician with over 25 years in academic medicine, [Dr. Geyman] has also practiced in rural communities for 13 years. He was the founding editor of The Journal of Family Practice (1973 to 1990) and the editor of The Journal of the American Board of Family Practice from 1990 to 2003.”
For more information about Dr. Geyman, see his full biography at the Huffington Post.
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