EDITORIAL: Sen. Bennet’s health plan won’t help

Dec. 14--The political class still does not get it. We cannot solve the health care crisis by printing more coupons.

The latest noncreative, think-inside-the-box idea for fixing health care comes from our friend, U.S. Sen. Michael Bennet -- with whom The Gazette's editorial board has discussed health care on several occasions.

Bennet, D-Colorado, explained his idea for "Medicare-X" at the Colorado Health Institute's annual Hot Issues in Health conference last week in Englewood. He said it is "the best name I ever came up with."

As explained by John Ingold in The Colorado Sun, Medicare-X would be another health care policy on the open market. Consumers could buy into it regardless of age. Traditional Medicare covers Americans 65 and older who have paid into the system throughout their working years.

Politicians are jumping on a bandwagon of advocating Medicare expansion because the program has a better reputation than Medicaid, which expanded in Colorado and most other states as part of the Affordable Care Act.

Medicare generally pays higher reimbursement rates than Medicaid, the program for low-income individuals and families.

If Medicare-X does everything Bennet anticipates, it won't do much. Most Americans, including those with private insurance, have problems affording health care. The system can't meet demand, which will only grow as the massive baby boomer generation ages.

In Colorado, Ingold reports, private health care procured through employers covers about half the population. Medicare and Medicaid cover about one-third of residents. Only 8 percent buy insurance on the open market, where they could consider Medicare-X among options. The 6.5 percent of Coloradans who are uninsured might also consider the plan, though this demographic has forgone previous options.

Sen. Bennet cannot consider this a substantive approach to lowering prices and improving access to care.

Politicians usually talk about "coverage" instead of "care." Anyone can promise coverage, and therefore a façade of care, by merely talking and introducing a bill. Even a bad idea says "at least I'm trying."

Most insurance plans, public and private, are glorified coupons. Typically, the insurance holder waits in line and pays money out-of-pocket. If the consumer spends enough, an invisible third party pays a percentage of costs that exceed a high arbitrary threshold. Buy two and get a third one free.

The arrangement incentivizes higher prices, as providers collect from patients and third-party payers only when deductibles and co-pays are met.

Establishing another third-party payer scheme -- a coupon with a really good name -- stands to make a dysfunctional system worse. It will do nothing to expand the supply of care, which is the only outcome that will make health care more accessible and affordable.

As politicians waste time devising coupon schemes, demand increases on a decreasing supply of care. The Association of American Medical Colleges anticipates a nationwide shortage of 120,000 physicians in 11 years.

Rural communities are devastated by the shortage, getting by with 13 doctors for every 10,000 residents. That compares to 31 doctors for every 10,000 urban residents.

Alarmed by the doctor shortage, administrators at the New York University School of Medicine recently eliminated tuition.

The global health care staffing agency Mercer projects a shortage of 98,700 medical and lab technologists and technicians within 6 years. The company's research projects a shortage of 95,000 nursing assistants and 29,400 nurse practitioners by 2025.

CNN Business reports "nurses are retiring at a rapid clip, but there aren't enough new graduates to replenish the workforce."

This is not an insurance problem. It is a shortage of care, in which the health care industry can charge absurd prices and third-party payers can avoid them with insane deductibles.

Americans hear about the possibility of health care "rationing," as if it belongs in a future dystopia. We have rationing today, and it goes by the name of "rising deductibles," "rising co-pays," "rising premiums," "we don't accept Medicaid," and "uncovered procedures."

Given this trajectory, the public might expect politicians to address the health care shortage. They could start by undoing regulations that have physicians so miserable they are retiring early in record numbers, while discouraging others from joining the field.

The Annals of Internal Medicine reports physicians spend more than half their time on paper work, including the Affordable Care Act's requirement they convert patient files to "electronic health records." A Medscape survey finds two-thirds of physicians are "burned out," and 15 percent are depressed.

We need a plan that addresses all components of the health care shortage, so our economy can provide a robust and competitive market that serves everyone. We need our health care sector competing for patients, not pricing them away.

This country continues enduring inadequate health care, despite a booming economy. Politicians offer one approach to fixing it: coupons, with great sounding names.

The Gazette Editorial Board

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