The inadequate, shoddy debate over health care reform

What does the recent election cycle portend for health care in America? Not good, if we go by the recent debate over further reform of our dysfunctional system. The non-debate has been shallow, barely covered by the mainstream media, and uninformative at this important juncture in deciding where to go next in U.S. health care.

In reality, we have three basic alternatives in how we finance health care: (1) continuation of the Affordable Care Act with changes as needed; (2) repeal of the ACA and replacement by a GOP “plan”; and (3) enactment of a single-payer Medicare-for-All system of national health insurance (NHI). But you would never know that from the debate, which is sketchy on the first two options and remains silent on the third.


Now that “conservatives” run the government in a new Trump administration, what can we anticipate? We are already seeing alarming evidence of racism, misogyny, bigotry, and authoritarianism at the highest levels of appointments in the White House and among some members of Congress.

In health care, we can expect efforts to dismantle the ACA, leaving more millions uninsured; to cut Medicaid through block grants to states; and to further the privatization of Medicare and Medicaid. We can also expect the easing of regulations on – and the protection of profits of – the big insurers, drug companies and other corporate stakeholders in our medical-industrial complex.

The GOP’s claims that “competition will work” have been repeatedly discredited over the last two-plus decades. Under its plan or the status quo, health care costs will continue to soar as health care becomes even less affordable, choice more restricted, coverage more skimpy, and as medical outcomes continue to worsen.

What we all want and need now is an honest and substantial debate over our three major options to reform U.S. health care. Debate over these alternatives should be nonpartisan, not a left-right or top-down issue.

For example, in the aftermath of the 2016 elections, conservatives now largely run the government at both the federal and state levels. If we were to base our future health policies on conservative principles, what would they be?

Donald Light, professor of comparative health care at the University of Medicine and Dentistry of New Jersey and researcher at Harvard’s Edmond J. Safra Center for Ethics, offers one answer. He notes that conservatives and business interests in every other industrialized country have endorsed these four conservative moral principles: anti-free-riding, personal integrity, equal opportunity, and just sharing. He proposes these 10 guidelines for conservatives to stay true to these principles in health care today:

1. Everyone is covered, and everyone contributes in proportion to his or her income.

2. Decisions about all matters are open and publicly debated. Accountability for costs, quality and value of providers, suppliers, and administrators is public.

3. Contributions do not discriminate by type of illness or ability to pay.

4. Coverage does not discriminate by type of illness or ability to pay.

5. Coverage responds first to medical need and suffering.

6. Nonfinancial barriers by class, language, education and geography are to be minimized.

7. Providers are paid fairly and equitably, taking into account their local circumstances.

8. Clinical waste is minimized through public health, self-care, strong primary care, and identification of unnecessary procedures.

9. Financial waste is minimized through simplified administrative arrangements and strong bargaining for good value.

10. Choice is maximized in a common playing field where 90-95 percent of payments go toward necessary and efficient health services and only 5-10 percent to administration.

Surprisingly, perhaps, if we were to reform health care financing along the lines of these conservative principles and hold so-called conservative lawmakers to them, our third option, single-payer NHI, would be the only alternative to meet these criteria.

Let’s have a thorough-going debate in the name of democracy and fairness, working toward the common good.

A just-completed Reuters poll puts health care at the top of what Americans want the new administration to address in its first 100 days, above the economy and immigration. Let’s demand more transparency and accountability for factual media coverage during and beyond this critical period.

John Geyman, M.D., is professor emeritus of family medicine at the University of Washington, Seattle, and author of “The Human Face of ObamaCare: Promises vs. Reality and What Comes Next.” He is past president of Physicians for a National Health Program.

The views expressed by authors are their own and not the views of The Hill.