The United States spends more per person on health care than any other country, but our health outcomes are far from the best.
Simply put, the challenge facing Congress is how to get more value for all that money.
Yes, the details are complex, but we’re a big, complex country with a big, complex economy. Our elected leaders should engage that complexity and produce practical reforms and solutions that inspire confidence in the future. That is a reasonable expectation.
But Sen. Rand Paul was having none of it during a recent meeting with physicians in Ashland.
Speaking to health-care providers in an economically depressed region where life expectancy is declining — a region that he represents in the U.S. Senate — Paul basically said we can’t afford to take care of the people there.
Dr. Richard Ford, the chief medical officer of King’s Daughters Health System, had cautioned Paul that Republican proposals to cut the government’s Medicaid program would put the hospital’s future at risk.
Before President Barack Obama’s Affordable Care Act, Medicaid paid for 17 percent of King’s Daughters’ patients, now it’s 23 percent. Medicare, the government program for the elderly and disabled, covers half of King’s Daughters’ patients. Two percent are “self-pay.” The remaining 25 percent have private insurance, through their employers or by buying it in the individual market.
Paul, an eye doctor who dislikes government and has presidential aspirations, responded with a diatribe about the national debt. “I call it the big-hearted, small-brain syndrome, which is very, very prevalent in Washington,” he said. “They are sympathetic, they want to help people. We all do. But the thing is, if you destroy the country helping people, would you be better off or worse off?”
So, Paul thinks that, unlike the rest of the industrialized world, the United States can’t afford hospitals and health care, especially in depressed areas, without self-destructing as a nation? What an absurd, defeatist view. Remember, lack of money is not the problem. We spent the most per person on health care long before Obama. The challenge is getting more value for all that money. It’s fantasy to think that government won’t have to spur efforts to do that.
Also remember: The repeal bill that emerged from the House with President Donald Trump’s support is, more than anything, a tax cut for the rich.
The Affordable Care Act signed by Obama in 2018 delivered coverage to a half-million Kentuckians. Congress paid for it by raising taxes on individuals who make more than $200,000 a year ($250,000 for couples) and through new taxes on health insurance, drug and medical device companies; all of them are prospering nicely. The House repeal bill ends those tax increases.
Rising profits have pushed up health insurers’ market value nearly 300 percent, more than double the increase in the Standard & Poor’s stock index since 2010.
Though some insurers are losing money on individual health policies in some places, profits are surging, in part because insurers make money managing Medicaid and Medicare for governments.
Interviewed Wednesday, Ford, the chief medical officer, said it’s unlikely that King’s Daughters would go under, but some smaller hospitals that provide vital services in rural Kentucky would not survive Medicaid cuts.
Like most Americans, Ford understands that the ACA helped millions of people and that it also has flaws. The region desperately needs more primary-care doctors, for example. In the world’s No. 1 per capita spender on health care, that also is a reasonable expectation.
Congress could fix the flaws if — rather than dishing up tax cuts to wealthy political donors — the priority became making health care more affordable by getting more value from the money we’re already spending.