EDITORIAL: Cost is the real culprit in health care

Oct. 03--Medicare for all is the newest Democratic Party talking point.

Gubernatorial candidate Andrew Gillum has adopted the favorite line of democratic socialist Sen. Bernie Sanders.

But it's wildly unrealistic and would do little to deal with the high costs of health care without rationing.

The first reason that Medicare for All is unrealistic is that it would have to scrap the entire health insurance system in the country.

The fact is that most Americans are satisfied with the health insurance they receive from their employers. They don't want to be transferred to some Canadian-style system.

The Patient Protection and Affordable Care Act, Obamacare, was designed to deal with those uninsured Americans who are not covered by employer health insurance, Medicare or Medicaid. It's a relatively small number of Americans but under the previous system, some uninsured Americans were threatened by bankruptcy with high health care bills. This is the segment that needs affordable health insurance.

There are reasonable proposals in Congress to deal with the uninsured and make Obamacare work better. But they haven't been able to gain wide support.

At issue is the incredible complexity of U.S. health care. It forces physicians to spend too much time on billing. Yet Switzerland and Germany use third party providers like the U.S. employer-based system but with far less complexity.

The United States actually has several different health insurance systems:

--Employer-provided insurance, funded in part with federal tax incentives.

--Medicare for those 65 and older.

--Medicaid, which covers certain low-income people, in Florida but not single adults.

--Military systems, including the Veterans Administration and TriCare for active military.

--Individual policies in which people often don't receive the advantages of mass discounts and negotiation.

A Medicare for All proposal was considered in Sanders' home state of Vermont but dropped because it was too expensive.

The flaws with Medicare for All were listed in an opinion column by Richard Kocur, assistant professor of business at Grove City College (Pennsylvania).

The cost of Medicare for All has been estimated at $30 trillion over 10 years, which would require a doubling of federal taxes.

Beyond the gigantic tax increase, proposals resume a drop in expenses. For instance, reducing provider fees would cause a drop in access as providers drop out.

The real problem with the U.S. health care is that high prices are baked into the system. Cutting prices means a cut in someone's profits.

Here are some facts from The Wall Street Journal:

--Health care overtook retail as America's largest industry. That equates to a powerful lobbying force for the status quo. Health care companies have doubled lobbying spending since 1998. The only segment big enough to challenge the health care industry is business itself.

--Prices for health care started rising faster than inflation in 1960s. Drug prices have risen the fastest. In response, some large companies have started their own insurance networks and drug providers.

--Lack of transparency frustrates the effort to control prices. A consumer, faced with a diagnosis of appendicitis, does not have time to solicit bids and analyze treatment alternatives.

However, as much as 40 percent of care could allow for shopping, such as joint replacements or nonemergency MRIs. So how are consumers supposed to compare price and quality?

The average cost of a hospital MRI is more than double the cost at an imaging center, reports The New York Times.

Yet patients are not shopping for medical care. What seems more practical is to give physicians the price and quality information and give them bonuses for recommending tests and procedures that save money.

High drug prices

The Trump administration has protested high prescription drug prices and taken some action.

One example is exploring the importation of prescription drugs, reports Kaiser Health News. This would be limited to cases in which one company makes a high-priced drug that is off its patent.

There are many bad examples, such as a pill that once cost $13.50 and now costs $750.

It's just a start toward reining in many outrageous examples of unaffordable drug prices.

The real issue with health care in America is simple: high prices. Until they are reined in, no system will work, especially not Medicare for all.

___

(c)2018 The Florida Times-Union (Jacksonville, Fla.)

Visit The Florida Times-Union (Jacksonville, Fla.) at www.jacksonville.com

Distributed by Tribune Content Agency, LLC.