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    Friday, January 27, 2023

    Health care a big issue that got little attention

    It is an issue on which Americans agree, which is a rarity, yet it hardly made an appearance in the debates leading up to the Nov. 8 election.

    Americans overwhelmingly agree the health care system is too expensive and not working well for many. But while Americans agree it needs fixing, there is no consensus as to how.

    Consensus can build around policy proposals, but to a significant extent, proposals were lacking. Politicians focused on other issues.

    Democrats wanted to remind voters that a group of Republican Supreme Court appointees had stripped women of their constitutional protection to access abortions and that election deniers, which have become a major piece of the GOP brand, threatened the foundation of our democracy and self-governance.

    Republicans wanted to keep reminding voters of the rising costs of filling their car tanks, heating their homes, and buying the groceries. And they pointed the blame at Democrats as the party in power in Washington, without offering any genuine solutions for fixing inflation.

    Trying to repair the health care system is complex, with any solutions offered certain to generate controversy. It does not have the us-against-them attraction of those other issues. Few candidates tried to make the issue central to their campaigns, despite the polls showing Americans are concerned about it.

    In passing the Inflation Reduction Act of 2022, signed into law by President Biden in August, the Democratic majorities in the House and Senate did for the first time give the federal government the authority to negotiate prices for widely used drugs covered under Medicare Part B and Part D. But that doesn’t begin until 2026. The law also caps monthly insulin costs at $35 for people with Medicare, beginning next year.

    While polls show these moves were popular, they didn’t seem to generate much traction for Democratic candidates, perhaps in large part because the party did not try very hard to make them an issue, instead aiming fire at Republicans on the abortion and anti-democracy topics. And perhaps the strategy was the right one politically, given that Democrats over performed expectations in retaining Senate control and seeing Republicans capture the House only by a narrow margin.

    The proposals in the Inflation Reduction Act (that was a bogus name, by the way, the act really focused on renewable energy initiatives and health care) were the first significant steps taken on health care since approval of the Affordable Care Act in 2010. Labeled Obamacare, it vastly expanded access to health insurance through Medicaid, set up health exchanges to provide subsidized insurance to individuals who could not otherwise afford it, and required that preventive procedures be made available at no cost, such as physicals and breast and colon screenings for cancer.

    In the years that followed, Republicans ran on a platform to undermine and repeal the ACA, without offering any serious proposals to replace it or make things better. It is a wonder that the GOP’s failure to have any policies to address problems with health care has not hurt the party more. Democrats have done a lousy job of making them pay.

    The polls are clear Americans are not happy when it comes to health care. Asked how well they think health care is managed in the United States, only 12% respond extremely well and 32% somewhat well, while 56% find it is not working at all well for them. The numbers get grimmer when it comes to the cost and ability to afford prescription medications, with only 6% responding the system is working extremely well and 74% saying it is not working at all well, according to Associated Press-NORC Center for Public Affairs Research polling.

    But you don’t need a poll to know the system is broken, you just have to talk with friends and family, or experience it yourself.

    People are tired of getting stuck in the middle with health care providers trying to “up code” their way to getting higher payments from insurance companies and the insurance companies pushing to negotiate rock-bottom prices from the providers. Most everything else we buy has a price and provides a clear understanding of what we get for our dollars. But good luck trying to find logic in what is charged for health services or having any control over pricing.

    By most measures, the U.S. health care system is under performing when assessed against comparable countries. A study by Johns Hopkins estimated that medical errors are to blame for more than 250,000 deaths in the U.S. That accounts for 10% of all deaths in a typical, non-pandemic year, making it the third leading cause of death after heart disease and cancer.

    And U.S. care is expensive, more expensive than all other industrialized nations. In just one example, the average cost of a C-section is twice as much in the United States than anywhere else.

    Ever-rising drug costs, excessive diagnostic testing on expensive equipment for fear of being sued, and poor coordination of care, leading to diagnostic redundancy, all contribute to high health care costs. Insurers pass those costs onto consumers through higher premiums.

    Add in physician and nursing shortages, the difficulty folks often face in finding a doctor, and it is no wonder so many Americans are dissatisfied with the management and providing of health care.

    With control of Congress now divided, don’t expect major changes at the federal level in the next couple of years. States should fill the gap by experimenting with solutions. Democrats will have an issue to run on if they can coalesce around initiatives that build on their pharmaceutical and insulin price controls. It is hard to imagine Republicans offering solutions, given their do-nothing record.

    Percentagewise, Americans will be getting older, which means Americans will be getting sicker. The nation needs a healthier health system to meet that challenge.

    Paul Choiniere is the former editorial page editor of The Day, now retired. He can be reached at p.choiniere@yahoo.com.

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