A Physician’s Plea: Fix Our Health Care System

The second presidential debate touched on Obamacare only briefly, but the candidates’ potential solutions to the Affordable Care Act mess deserve further scrutiny. It is critical, actually, as the day of reckoning approaches for Obamacare. 

Obama’s failed promise to the American public that they would not pay more for their coverage and could keep the doctor of their choice was apparent from the start. Skyrocketing costs for coverage in 2017 ranging anywhere from 20 to 60 percent have driven the point home — just as they have with each new enrollment period since the ACA’s inception.

Addressing health care coverage must be a top priority and not just campaign rhetoric.

And Obama’s bypass now of the Department of Justice — and using federal funds not delegated for health care to reimburse insurers for the billions they’ve lost over the past three years — will do little to stop the bleeding from a critically injured system. 

Many of the private insurance carriers that are participants in the Obamacare market have given their notice. Either they raise their rates to cover their losses or they can no longer offer coverage.

Obamacare assumed that the employer and individual mandate provisions, along with the expansion of the state-run Medicaid programs, would fund the millions of newly covered lives. It didn’t — for several reasons. For starters, 19 states didn’t buy into the president’s plan. Employers then cut back the number of their employees or reduced their hours, making them part-time because they couldn’t afford to provide coverage. And Obamacare’s individual mandate clause was not severe enough to force younger, healthy individuals into obtaining coverage rather than paying the relatively innocuous fine.  

For the victor of the upcoming election, addressing health care coverage must be a top priority and not just campaign rhetoric.

Related: Obamacare 2017: Higher Prices, Fewer Choices

Hillary Clinton, years ago as the first lady and throughout her political career since, attempted and failed to put through a complex revision of our health care delivery system. Her take on the increasing problems with Obama’s current program is to expand it to a Medicare-for-all system that in reality is a modified single-payer system. The flaw in single payer is the lack of choices it creates, the lack of competition that exists, and even more government mandates that dictate allocation of resources.

Donald Trump’s solution is to repeal Obamacare and start over. Since 10 million to 12 million additional individuals have coverage under the current program, Trump’s proposal may not be doable and would at least temporarily leave millions of potential patients without coverage. Trump’s proposal otherwise is for insurance companies to compete for patients across state lines with further emphasis on Medical Savings Accounts and vouchers for those who can’t afford to buy coverage.

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It is probably too late to totally repeal all of Obamacare. A Medicare-for-all system that turns over our health care system to the federal government is equally as bad. This country has come so far in addressing health care coverage for our uncovered and under-covered citizens.

Now is not the time to go back, but to build on what we have already accomplished.

As voters align with their candidate, it is important to remember the comments of one of the main architects of the original legislation, liberal MIT professor Jonathan Gruber: “Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter,” he said during a panel discussion at the University of Pennsylvania in 2013.

The majority of the voters trusted the Democrats once. I’m not sure they have earned our trust again.

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Robert Tenery, M.D., is a Dallas-based ophthalmologist and writer, and the third in three generations of physicians.