While the Affordable Care Act (ACA) may be annulled during the Trump Administration, it is important to review why health care is necessary and what may happen without it. The United States continues to lag behind the rest of the developed world in its health care system, with outcomes ranging between 37th and 70th among nations in the world. This, in spite of the fact that America spends over 16% of its GDP on health care, far above what most other countries spend, usually 5-10%.
There are several reasons for this. The most critical issue is that, in spite of reforms, many Americans are without access to affordable health care. President Obama, writing in the Journal of the American Medical Association in 2016, touted improvements in coverage that resulted from the institution of the ACA in the United States. He noted that the rate of uninsured declined from by 43% from 16% in 2010 to 9.1% in 2015. Viewed another way, however, this means that more than half of the people who were uninsured before Obamacare are still without health insurance. In 2015, 32.3 million people were still uninsured in the US.
Yet there are serious shortcomings under the ACA even for those who are unwilling to face the risk of a catastrophic illness or injury without insurance, especially for those who can only afford the high-deductible plans. Employers also increasingly impose these kinds of plans on their employees. Health care “experts” often rely on dogmatic economic theories which predict that these kinds of plans would lower health care spending, since people who spend their own money become more careful shoppers. Studies have shown that such plans are indeed linked to lower health care spending, but not because patients suddenly become more sophisticated in choosing providers or discerning what care is really necessary. Rather most of the savings are for precisely the wrong reason: people simply avoid getting the care they need because they can’t afford it.
Consumers of these plans become so fearful of accessing the health care system that they often do not even get the preventative care that they are entitled to —at no cost —under the plans. They have good cause to be concerned. A Kaiser Foundation/New York Times survey reported that 20% of insured Americans have difficulty paying their medical bills. Even after the badly-needed ACA reforms were implemented, the health care system has continued to fail in its essential functions of keeping people healthy and free from financial stress.
What is causing this economic inefficiency? In the past, insurance companies have sucked up 30% of each health care dollar for administrative overhead, including billing, scrutinizing claims (to deny them as often as possible), sales commissions, marketing and high CEO salaries. Such excessive costs are unrelated to the actual delivery of care.
Transferring to a government-sponsored fund like Medicare goes a long way toward providing adequate health insurance coverage for all Americans. There has been improvement under the ACA, which mandated that administrative costs must stay under 20% of the insurance bill. Yet this is still far from the administrative costs associated with Medicare or the Canadian single payer system, which have been estimated as low as 2%.
By contrast, PROUT calls for health care systems which emphasize healthy lifestyles and preventative care. In the US, preventive health care was not supported until recently, as Medicare and other insurances would not cover such services. Consequently, people would develop preventable severe diseases, leading to expensive hospital bills that could bankrupt them even if they had decent insurance. It has been argued that since customer turnover is high for insurers, they have little incentive to provide preventative care that will only pay off years after the customer leaves the plan. The ACA has addressed this problem with increased provision for screening visits and preventive care. Still, the practice of preventive care should be expanded much farther. The saying, “an ounce of prevention is worth a pound of cure,” still holds true.
An additional problem is that state and federal governments in the US have minimized access to alternative and natural methods of care. These include homeopathy, chiropractic, naturopathy, acupuncture, yoga postures, meditation, Ayurveda and the like. Fifty percent of Americans engage in alternative medicine of these types out of their own pockets, often with unlicensed practitioners, compared with European and Asian countries where people are kept healthy at much lower expense using these modalities.
Doctors are not commonly incentivized to render economically efficient care. Our fee-for-service system encourages maximum visits and high-technology care, even though low-tech approaches like counseling, diet and exercise are proven to be less expensive and more successful. Fortunately, some HMO’s have been getting engaged in these areas.
What is the solution? First, PROUT offers the notion that cooperatives work better than commercial institutions, whose profits are siphoned off by a few executives and also by shareholders who do not work there. When the entire focus of the company is on benefits for its participants, new synergies are created. Examples of this include the Medical Mutual Group in North Carolina, which provides liability insurance and other services to physicians and other health care practitioners. Their rates are a fraction of the commercially-owned insurers’ rates, they sponsor continuing education on a frequent basis, they recruit ideas and board members from all over the state, and they distribute rebates to the members when things are going well.
A second example is the Group Health Cooperative in Madison, Wisconsin. Practitioners are paid a flat salary, plus incentives for improving the health of their patients as measured by pre-set guidelines, instead of incentives for mass production. Practices include monitoring cholesterol and blood pressure levels, diabetic control, etc. Complementary and alternative medical practitioners are also supported, including yoga, naturopathy, acupuncture, and chiropractic. The board is elected from the membership itself, and the patients are the members. The premiums come from people’s pockets and employers’ payrolls, supplemented by Medicare, Medicaid and other insurances. This cooperative has received the Better Business Bureau rating of A+, and is ranked as the highest quality private health plan in Wisconsin.
Medicare for All, or a single payer system where a government agency pays all medical providers with revenue collected through taxes, would work also. It would cover 100% of the population with no increase in cost. This system works well in Canada and other countries. Some countries like Belgium and Israel do well by having several government-approved insurance plans and mandating that everyone has a policy. An alternative consistent with PROUT principles would be a system of health care provided by cooperatives of medical professionals, paid for either by patient cooperatives or a government-run single payer system.
Complementary and alternative systems hold great promise. For example, in Cuba, a 2010 study of 2.3 million people immunized with homeopathic medicines found an 84% reduction in leptospirosis cases compared with a 22% increase in an untreated region, and the cost was only one-tenth that of traditional immunizations. The Ornish program of yoga, low-fat vegan diet, meditation and exercise and stress management has been found to be far more effective than medications and surgery in preventing and treating heart disease, and costs only one-tenth as much as bypass surgery or stenting.
The future of health care coverage in the US is unclear. It is recommended that people contact their legislators to save Obamacare, Medicaid and Medicare, or perhaps provide a suitable alternative. If a new alternative is proposed, people should advocate a single-payer system with truly universal coverage. People can also join health care cooperatives or create them, offer their help at free clinics and stay healthy by following the natural laws of health. Generally speaking, our greatest life extenders are sanitation, immunizations, eating less, exercising more and being happy.