Assuming it is not overturned by a very highly politicized Supreme Court (“In the balance,” April 2, p. 6), millions of the uninsured will eventually receive coverage under the Patient Protection and Affordable Care Act. It is a first step. But the reforms did not go nearly far enough in cost containment. Or, we believe, in coverage. We are building on a shaky foundation: expansion of private insurance companies. Political opponents warn that the ACA's healthcare reforms will result in rationing. There is already tremendous rationing of care in America despite the fact that our nation has by far the world's highest per capita healthcare expenditures. Why? Because we have chosen to administer our system through private insurance companies. Their goal is to benefit shareholders and employees—particularly top executives, many of whom have seven-figure incomes. To turn a profit, they must exclude those individuals who are the most likely to require expensive care. This is the way that the healthcare free-market works, maximizing returns for shareholders, not helping patients. If you don't believe we have rationing, talk to the demoralized doctors who spend so much of their time trying to persuade insurance companies to provide their recommended care to sick patients. A majority, or 58%, of physician respondents in a survey published in the New England Journal of Medicine support an expansion of Medicare to Americans ages 55 to 64. This route was proposed, but then quickly dropped during the debates over health reform. At a minimum, Congress should have made this interim move toward universal coverage. Then, we could have expanded Medicare each year to cover more of the population until truly universal coverage was achieved and costs contained. Along these lines, the organization Physicians for a National Health Program has determined that the most cost-effective route is Medicare for all. Medicare's administrative costs are 3%, whereas private insurance runs 31%. The additional funds could be utilized to cover the uninsured. Yes, there are some waiting lines in Canada for elective procedures, but Canada spends about half what we do per capita on healthcare. With our current spending level, we need not have lines here. In any case, under universal Medicare, any rationing that might someday be required would be based on medical need as determined by your physician, not by insurance companies. The only way to get a handle on both costs and access is universal Medicare. That is the solution, not privatization and placing the burden directly on a powerless consumer/patient with little information and even less clout relative to providers. Because of the meekness shown by Congress in its reform efforts, we suspect that the situation will be much worse in another 15 or 20 years when it is next addressed by our children.
Jack BernardRetired healthcare executiveMonticello, Ga.
Evan WeismanRetired cardiologistAtlanta