Doctor's In: ObamaCare vs. Ryan's Vouchers

Our health care system needs fixing. Few would argue that. Forty-nine million citizens have no health insurance and the number is growing. Those with insurance find co-pays increasing and coverage shrinking. Private sector companies are requiring increasing contributions from their employees if they do provide a health care plan. Many do not and that number is growing.  Physicians face frustration as managing increasing uninsured patients impacts their ability to provide quality care.   

It is ludicrous to claim the United States has the best health system in the world when so many are denied equitable care.  Efforts to accomplish universal health care can be traced back to President Harry Truman.

The Obama administration was the first to successfully pass a Health Care bill afecting all Americans known as the Affordable Health Care Act enacted by Congress in March 2010. Ryan’s “Pathway to Prosperity” (vouchers) is offered as an alternative to ObamaCare a continued target of derision by the Republican Party.

Enacted in 1965, government financed health care, Medicare, assured health care coverage to seniors who reached the age of 65. The Medicare Act was fiercely fought by conservative groups. Harry Truman received the first Medicare card presented to him by President Lyndon Johnson. 

After studying both ObamaCare and Ryan’s Vouchers, I would suggest that both plans leave much to be desired. Although ObamaCare addresses insurer abuses,  it still leaves millions uninsured and provides inadequate control of escalating health care and administrative costs.  

VoucherCare does not address insurer abuses and panders to private sector insurers. The result will be escalating costs to the insured, little to stem health care cost inflation, and no regulation concerning administrative costs.

Path To Prosperity (Ryan’s vouchers)

The government would no longer pay doctors to treat Medicare beneficiaries.  They would buy their own private insurance plans from a government approved list.

Everyone over 55 would be grandfathered into the current Medicare system. A revised provision would allow individuals to opt out and choose Medicare as it exists.

Critics have concluded that the Ryan plan would end Medicare as we know it. It is important to understand that plan details may change should Congress debate it for passage.

Concerns include that private insurers can tweak benefits to keep them actuarially sound based on the government’s voucher cost. Another fear is increasing costs to seniors which many can ill afford. Critics suggest the plan rests on the same rational as Medicare Advantage by allowing seniors to get their coverage through private insurance companies; it clearly did not work. 

Is the plan more fluff than stuff? I would suggest that it protects the private insurers and increases the burden of cost for seniors. There are no controls for profiteering as in the Obama plan or efforts to end insurer abuses. Much of the detail of how it provides advantages both as to savings and quality of care are obscure and ill defined.  Essentially we must rely on the insurer to structure coverage. There would be little or no interference from the government to assure benefits.

ObamaCare (Affordable Care Act)

The main elements of the plan include ending the denial of coverage for pre-existing conditions. Preventive care such as immunizations and other preventive services are covered with no co-payments. All plans are prevented from maximum lifetime benefits. Dependent coverage would be extended to age 26. Insurance companies cannot drop coverage should a person become sick. Administrative costs cannot exceed twenty percent. There are numerous provisions to reduce pharmacy costs and end the donut hole. ObamaCare has been passed and its provisions clear.

The largest criticism of ObamaCare involves costs and the suggestion that it will take resources from Medicare. To date there is no evidence to identify any services that would be lost to Medicare. It is clear that millions will still be left without coverage with ObamaCare. The Republicans have indicated they will repeal ObamaCare should they win the election.

ObamaCare addresses many insurer abuses. Administrative costs alone can reach 40 percent. There are unending complaints relating to denial of benefits, cherry picking, and uncontrolled premium escalation through private insurers.  Although most who are covered by private insurers will remain reasonably healthy and happy with their plans, those that get seriously ill may find their plans inadequate. Increasing co-pays, deductables, and shrinking benefits have made health insurance unaffordable to many.

Instead of working with ObamaCare to tweak concerns and allow needed health care system reform, Republicans wish to dump the plan completely and return to a market controlled by private insurers. Private insurers have failed the test of time to allow affordable health care to the American people. 

A wiser course of action would be to cooperate with the administration and strengthen ObamaCare so the desired goal of universal health care can be accomplished. The nation can and must afford it.