Last week I accepted an invitation to serve as an observer at the Democratic caucus in Bonner County, Idaho. Bernie Sanders won by a landslide.
“Bernie prevailed because North Idahoans are a fiercely independent people,” exclaimed one of the caucus participants. But Bernie’s plan for health care, “Medicare for All,” will result in the homogenization of American medicine. His one-size-fits-all strategy is contrary to anyone wishing to be fiercely independent.
All three Republican candidates left standing have promised to repeal the Affordable Care Act, while Hillary Clinton has pledged to refine and build upon the program, now in its sixth year. Sanders’ plan for a single-payer, national health care program is a radical departure from any of the other candidates. He argues that while the ACA has resulted in health insurance for 17 million more Americans, 29 million remain uninsured. Sanders claims that his plan for national health care will cover inpatient and outpatient care, preventive and primary care, emergency and specialty services as well as drug, vision, dental, mental health care, equipment and supplies without a deductible or copay. He proposes to do all this while saving the American people $6 trillion over the next 10 years.
How would it be paid for? First, the plan calls for de-linking health care
from employment and replacing it with a 6.2 percent income-based health care premium paid by employers and a 2.2 percent income-
based premium paid by households. Second, taxes would be increased by making income tax still more progressive, putting capital gains tax on par with personal income tax, limiting deductions and tightening the provisions for inheritance tax. Finally, he would remove tax breaks for health-related expenditures.
Sander’s health plan for the U.S., like the ACA, is driven by the conscionable motivation to ensure access to health care for more Americans. Better access is the right thing. So is lowering costs. The annual costs for health care are approaching $3 trillion annually and are head and shoulders above other industrialized nations by any measure. Yes, there is waste. Yes, there is too much profit going into the coffers of Big Pharma, but a single-payer system is not the right choice for the U.S.
The quality of health care will suffer under a single-payer national health care program. The biggest complaint among citizens of countries with national health care is that the care is rationed. Too many essential services for diagnostics, treatment and specialists are unavailable, deferred or delayed because they are deemed too costly. Candidates for joint replacement surgery must bear their pain while they wait in line, while those in need of heart surgery wait until, sometimes, it is simply too late. Others must wind their way through the gauntlet of approvals until a cancer diagnosis is made, only to learn that while they were waiting the cancer spread.
Patients, providers and plans already have begun to experience how efforts to curtail costs also can curtail the ability to provide individualized care. Few Americans wish to treat their body like they treat their car. Just bring it in for a generic, mechanical service, hook it up to the computer, rotate the tires, change the oil and render standard maintenance. Fine. On one level we are just biological machines. Weight, cholesterol, blood sugar and blood pressure must be checked and managed. Yet, while many standard evaluations are broadly applicable to the majority of patients, inattention to the greater complexities of the human condition would be a painful sacrifice, one difficult to justify.
The practice of medicine is not just a science. It is also an art. The delicate fabric woven by the two is what creates the possibility for authentic wellness. When patients come to Manakai o Malama for health care, they are not looking for a mechanic. They come to engage in an integrative, collaborative approach to health through balance.
Between the Prepaid Health Care Act of 1974, Quest (developed in the 1990s) and the ACA (in place since 2010), Hawaii has a track record for providing access to health care for a larger percentage of its residents than almost any other state. The health care system in Hawaii is far from perfect, but it is dynamic and continuously evolving. Many problems remain and much remains to be done, but national health care is not the right solution for Hawaii. It is not the right solution for the U.S.
Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
