An Iowan’s Plea for Honesty to Democratic Presidential Candidates
I last wrote to you regarding health care in Cuba after a cruise there earlier this year. Interestingly, that cruise has now been banned by our president. Now, six years to the month since I started this blog regarding health-care reform in Iowa, we have 24 Democratic presidential candidates crisscrossing the state and most of them on a national debate stage raising their hands regarding whether the country should eliminate private insurance in lieu of a Medicare for All proposal.
Iowans and Americans need — more than anything else in this upcoming presidential election — honesty regarding various policy debates, especially the debate on the future of U.S. health care.
For the issues of climate change, immigration, and income inequality, as well as health care, we will each give our support to the candidate we believe is telling us the truth and who then has an appropriate vision for the future based on that truth.
In the spirit of that demand for honesty, I wish to discuss the simplistic question posed to the national debate participants regarding the wisdom of eliminating private health insurance.
All of those 20 presidential candidates should have protested because of the absurdity of that question. They should have said that private insurance exists for current Medicare recipients as a supplement; it exists for countries that supposedly have universal health-care coverage, such as the United Kingdom and Germany; and, given the reality of a world where both the rich and the poor will forever co-exist, private insurance will always be available to help the not-poor feel more secure about their health-care future.
A quick aside: I have no love for private insurance, which I believe has thwarted health-care reform for decades much the way the auto industry stymied electric cars for decades. Most recently, private insurance has created Health Savings Accounts and high-deductable plans, which take money from the health-care system while not providing for the health-care needs of the premium holders. I agree with Sen. Elizabeth Warren that the additional money spent on administration for private health insurance should be spent on health care.
Thus said, despite bemoaning the existence of private insurance, after decades in the health-care system as a family physician, I believe that private insurance to some extent shall never be eliminated entirely in the health-care system.
The correct question should have been: “How do we move to a country that has universal health-care coverage for the not-rich with the understanding that private insurance will always be available for those wanting additional peace of mind regarding their health-care future?”
The obvious tension in this question is that the resources, presumably taxes, necessary to pay for universal coverage offered in a governmental system such as Medicare for All will by necessity take away resources from individuals who want to pay additionally for the security presumably provided by private insurance. Seems an impossible task, but I think not. My optimism is based on the success of Medicare for individuals who are 65 years and older. It is a system that has low overhead, near universal acceptance and support, and an increasingly positive track record of supporting improved health care.
Moderate Republicans, Independents, and Democrats are fertile ground for allowing the idea of expanding Medicare to grow. This is the honest approach Democratic presidential candidates should be touting.
I have argued in earlier blog entries that Medicare should expand, beginning with individuals from 55 to 65 years of age. Please see those discussions from May 2016, March 2017, and April 2017. I look forward to future debates and thoughts from the candidates.
I have received calls regarding my preference for the Democratic candidate on caucus night. I plan to list my top three choices every month till January.
This month my choices are:
- Joe Biden
- Elizabeth Warren
- Kamala Harris