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Stronger Rx than Obamacare needed to cover everyone and control costs: physician leader
Citing Census Bureau report that 29 million people were uninsured last year, and noting that rising deductibles and other out-of-pocket expenses are deterring millions of insured Americans from seeking needed care, Dr. Robert Zarr says moving to a single-payer, improved-Medicare-for-all program has never been more urgent.
“The Census Bureau’s official estimate that 29 million Americans, including 3.7 million children, still lacked health insurance in 2015, five years after the passage of the Affordable Care Act, starkly illustrates how our inefficient, private-insurance-based system of financing care is fundamentally incapable of providing universal coverage,” said Dr. Robert Zarr, a Washington-based pediatrician who is president of Physicians for a National Health Program.
“The fact that 29 million people remain uninsured – a figure that won’t change much over the next decade, according to the Congressional Budget Office – is totally unacceptable to me as a physician,” he said. “Studies show that lack of insurance is linked to a higher mortality rate. Being uninsured is lethal, and currently leads to tens of thousands of deaths annually.”
Zarr noted that since the ACA’s passage the number of uninsured has fallen by about 41 percent – from about 49 million people in 2010 to 29 million in 2015, with the largest gains among the poor, near-poor, and minorities. He said such gains “can only be welcomed, since research shows that having some kind of coverage is better than none.”
But he said the Census Bureau report shows that new sign-ups dramatically slowed last year, with a decrease in the uninsured rate of only 1.3 percentage points from 2014. Zarr said other research shows that even if all the states that opted out of the ACA’s Medicaid expansion program were to opt in, the overall picture would largely remain the same.
“That tens of millions of people will remain uninsured under our current arrangements is perhaps the most compelling argument for why our nation needs to swiftly adopt a single-payer system, where everyone, without exception, would be covered and get first-dollar coverage for all medically necessary care,” he said. “But it’s by no means the only argument.”
Zarr pointed out that, once again, the Census Bureau report leaves unmentioned the declining quality of health insurance in the United States, or the “hollowing out” of already inadequate insurance, which takes the form of very high deductibles and copays, rising coinsurance rates, and narrow provider networks that restrict patients’ access to care.
“Too many people have skimpy policies that deter them from seeking care when they should get treatment, and that leave them unprotected against financial hardship when illness or injury strikes,” he said. “And their number is growing.”
He said that a 2014 study by the Commonwealth Fund shows that about 31 million people who have health insurance – nearly a quarter of all non-elderly adults – are “underinsured,” or have inadequate coverage based on their income. That’s nearly double the rate in 2003. Of these, 44 percent went without a doctor’s visit, medical test, or prescription due to cost, while 51 percent had problems paying off medical bills.
“For example, today a 40-year-old man earning $25,000 who signed up for a silver plan on the exchange would be eligible for government subsidies, but would still be at risk for $5,000 in copayments and deductibles,” he said. “Or a family of four with an income of about $60,600 could face out-of-pocket costs for copayments and deductibles – after premium payments – as high as $13,700. And these numbers apply to ‘in network’ services only. Out-of-network costs can go much, much higher. Such financial barriers are untenable, economically and morally.”
“The problem has only gotten worse over the past several years,” Zarr said. “Last week the National Center for Health Statistics reported that the percentage of persons under age 65 with private insurance enrolled in a high-deductible health plan increased to 40 percent in the first quarter of 2016, up from 25.3 percent in 2010. This is an alarming proliferation of an insurance model that discourages care-seeking, a model that will lead to much suffering and in too many cases, early death.”
Zarr said the recent announcement by Aetna, UnitedHealth Group, and other insurers of their withdrawals ACA’s marketplaces in many U.S. counties because the enrollees there were unprofitably ill – even as the insurers’ overall profits and stock prices have soared to record highs – shows they cannot be relied upon to fulfill the basic function of protecting patients’ financial security in time of need.
“Whether it be the big private insurers’ increases in premiums, deductibles, and copays, or the skyrocketing costs of medications by Big Pharma – the recent EpiPen price hike is a glaring example, although dramatic increases in the costs of insulin and other life-saving medications have also occurred – it’s clear that our corporatized health industry is bent on maximizing their profits at the expense of our patients’ health,” he said.
“Only a nonprofit, single-payer health care program will cut out the huge bureaucratic waste in our system, freeing up the funds to provide everyone with quality coverage. And a single payer will give us the tools we need to rein in rising costs. That’s why I and thousands of other physicians earlier this year issued a statement calling for a single-payer system.
“Our patients and our economy can’t wait any longer for an effective remedy to our health care woes. The stakes are too high. We need to swiftly move beyond the ACA to a single-payer national health insurance program.”
Historical state-by-state data on the uninsured from 2012-2015, compiled by PNHP staff from the Census Bureau’s newly published data, can be found here