Medicare-for-All, not Medicaid-for-less

With the passage of Measure 101, many Oregonians can count again on some degree of healthcare security. At the national level however, the president and Congress can dismantle Obamacare without major legislative actions, simply by withholding funding, not implementing regulations, and gutting the insurance mandate clause. Another battleground yet is shaping up in courtrooms over arguments and decisions about how states can implement their own versions of Medicaid waivers that redefine and attach stricter conditions to coverage eligibility, benefits and access to healthcare. 

The recent Kentucky Medicaid “expansion” bill – soon to be followed by nine other, mostly Republican-led states – is a case in point. It calls for a program that includes work requirements for “able-bodied” adults and income verification, as well as cost-sharing provisions like premiums and copayments. Sounds fair enough, if our concern is mainly to restrict “abusers” from taking advantage of a “safety net” most of us don’t use but are paying for with our taxes.

Let’s step-back a moment and look at the whole picture. The vast majority of current Medicaid beneficiaries are children, working adults already employed in low paying jobs, and people with health conditions that prevent them from working, including the elderly poor. Many un-employed are often already in school or job training, or have a hard time finding jobs. Linking each eligibility case to work requirements would force health and social service personnel to identify and match “able-bodied” Medicaid applicants to jobs that are “appropriate” for them. With people moving in an out of poverty and/or fluctuating levels of physical or mental disability, the red tape is never ending, piling more bureaucratic workload on already limited resources - just to weed out a few “free loaders”.

Cost-sharing provisions – used as a way to prevent people from seeking medical care for minor illnesses and to make them more responsible in their healthcare decisions - are seen as tools to hold down insurance costs. But erecting hurdles can mean care delayed, care denied, and ultimately can increase financial and human costs – not just to the individual, but to society as a whole. More importantly, they ignore a much greater source of healthcare waste: providers prescribing marginally beneficial tests and treatments.  

Liberals and conservatives generally agree on the need for job creation, cutting wasteful spending and upgrading infrastructure. But controversies around healthcare reform epitomize our political polarization. If we can put divisive moral and ideological arguments aside (“who deserves what?”) and agree on the need to correct our social inequities to achieve better health outcomes (“what program is more cost-effective in the long run?”), then perhaps we could together build bridges, rather than dams, over our troubled waters.

Despite some flaws in the system (all fixable), our Medicare program has proven to be fundamentally cost-effective, highly popular and vital to our elderly. Why not offer Medicare eligibility and benefits to all individuals, from womb to tomb, regardless of income, employment status and health conditions? It would be administratively simpler, medically just, and financially achievable in a country as rich as ours.

Chinh Le, MD

Corvallis

(Published in the Gazette Times, Feb 8, 2018)