OPINION:
Back when I was a medical student in the 1980s, I spent several months working at a clinic in Tierra Amarilla, New Mexico (La Clinica Del Pueblo de Rio Arriba), which provided health care to the entire community (everything from treating gunshot wounds to sore throats). This clinic, now a Federally Qualified Health Center, was staffed back then by doctors, including one who was repaying a loan with service to the National Health Services Corp.
These days the clinic continues to shoulder on, part of a health care safety net that provides essential care for patients whether they have health insurance or not. A growing doctor shortage in rural areas is compensated for with nurse practitioners and physician assistants.
Grants from the Affordable Care Act and the Medicaid expansion have helped to keep these essential clinics afloat.
In contrast, the health care reform proposals offered by the current Democratic candidates for president won’t work in the real world. The rhetorical false promise of Medicare for All would compromise quality of care. Gallup’s yearly survey just reported that Americans prefer a private-based insurance system rather than public by 54 percent to 42 percent.
Down in the medical trenches, health care is all about access. Current Medicare and Medicaid provide less access to tests or treatments or the doctors providing them than private insurance does.
Critics of private insurance love to point to all the waste in the system, where health care expenditures are now close to 20 percent of the gross domestic product.
But the best solution to this waste is to squeeze out the parasitic middlemen, to restore the free market to health care with more transparency, expanded health savings accounts, expanded approvals of generic drugs, and direct care models. The extensive Henry Ford health system in Detroit has been offering direct care to all General Motor employees for more than a year, and Dr. Steve Kalkanis, chief of Neurosurgery at Henry Ford Hospital, told me it is working well and saving on cost.
Indeed, health care shouldn’t only be a matter of choosing between big private insurance and big public insurance when both are huge self-justifying bureaucratic interfaces that stand between the doctor and the patient. But if I have to choose, I, like my patients, will choose private, if for no other reason than that Medicare and Medicaid pay doctors and hospitals less to provide more care for a population of patients who are frequently sicker.
In fact, hospitals and medical centers rely heavily on the additional income provided by private insurance to fund research and high tech solutions for comfort and cures. The expansion of government-run (Medicaid) and government-subsidized (Obamacare) insurance with the Affordable Care Act was more than enough. The notion of destroying and replacing the employer-based system that provides a useful tax deduction incentive to employers and care for more than 180 million people is political posturing that reveals just how out of touch with health care realities many of our politicians are.
Health insurance was invented in the 1930s to protect people from bankruptcy, and even though the treatments and tests available have expanded astronomically, the purpose of insurance remains the same. Rather than upend or undermine the whole health care system to provide coverage for those 30 million who lack coverage, it makes much more sense to offer a scaled-back public option that covers the bare bones of catastrophic and severe illness along with preventive procedures such as mammography and colonoscopy.
Americans can tell a false promise when they see one. This is why millions of people a year chose to pay the tax penalty rather than opt for a high-deductible, narrow network heavily subsidized policy that promised much more than it could deliver.
Getting rid of the individual mandate was the best thing that ever happened to Obamacare, it opened the door for more options and more choices of coverage. Replacing the mandate with an overstuffed public option that is intended to compete with private insurance is another bad idea that won’t benefit patients as much as politicians.
• Marc Siegel, a physician, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.
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