Making A Decision On Health Care Reform: It’s Not Easy

Remember that post I wrote about health care reform, including my day long web research? None of that was easy. Well, I had a question about comparing the Federal Employees Health Benefits Program (FEHBP) to H.R 676. I asked the Physicians for a National Health Program (PNHP) about it. They debunked the FEHBP. At least that’s my opinion.

Then I wrote my congressman, D-Dave Loebsack. I don’t delude myself that H.R. 676 has a ghost of a chance of becoming law anytime soon, especially in this time of Republican control of congress and the White House. The substance of my letter is below. You can also write your congressman through this link. For anyone from Iowa who has a stake in this issue, it just so happens you can meet with Dave Loebsack, Democrat for a town hall meeting on Valentine’s Day, February 14, 2017, starting at 8:00 a.m. at 121 Cannon House Office Building, 27 Independence Avenue S.E., Washington D.C. There will be many town hall meeting like this scheduled around the country where citizens will be confronting members of Congress who propose to repeal the Affordable Care Act without having a better plan to replace it.

I’m a psychiatrist at The University of Iowa Hospitals and Clinics in Iowa City (UIHC) and I have a couple of comments about why I’ve chosen to support single payer funding of health care as it relates to Iowans and mental health. The usual talking points from the Physicians for a National Health Program (PHNP) are below and I imagine you’ll get dozens of these.

I’ve been on staff at UIHC for 21 years and I’m on the path to retirement. Part of what drives my decision is the deplorable politicized battle over the fragmented health care system in our state and in our nation. Privatizing Medicaid in Iowa is a disaster so far on many accounts as you’ve no doubt read in Iowa newspapers. Governor Branstad just dumped $33M more into the managed care companies who are already demanding more money.

Private insurance greed and administrative waste are the main barriers to Iowans getting the mental health care they need and getting physicians and hospitals paid for providing it. Private insurance problems are one of the main reasons for the rising costs in terms of deductibles and premiums of Obamacare and Republicans don’t have to work that hard to persuade anyone that it must change or it must go.

Branstad got around the Medicaid expansion issue under Obamacare by getting the waiver for privatization. CMS approved it, but not without a good deal of criticism about how it was being rolled out.

I watched the CNN debate on health care reform broadcast recently and the most interesting feature of it was that Bernie Sanders at every turn had to sidestep defending Obamacare and often pointed out the advantages of single payer systems as structured in many industrialized nations other than our own. Ted Cruz detailed the usual arguments against it in the usual Republican fashion, frequently and predictably mischaracterizing it as “socialized medicine.” The conservative plan would likely produce the “race to the bottom” flight of the managed care industry to insure Iowans, with inadequate medical and mental health coverage offered with unaffordable premiums and astronomical deductibles.

There have been many blows against mental health care in Iowa, a trend that has been visible for many years and most recently emphasized in the closing of two of our state mental hospitals without a vision for replacing the fragmented system with subacute facilities which would relieve the bottlenecks in our acute psychiatric units.

Obviously, a single payer system will not solve every problem in mental health care access in Iowa. But trusting private insurance companies to play a pivotal role has been costly in every possible way and, according to some experts, may include loss of life if we don’t change direction.

Speaker R-Paul Ryan praised the Federal Employees Health Benefit Plan (FEHBP) as an alternative to Obamacare in another televised Town Hall presentation on health care reform a little over a month ago. You can even find a Wikipedia article on line claiming it has been proposed as a model for national health insurance. PHNHP debunked this long ago, largely because it’s controlled by private insurance carriers. Just a few of the problems with are: 1) It won’t provide health care for all; not even all government employees are covered, 2) It would likely be less affordable if offered to the public because most government employees are younger and healthier than average, 3) It would probably be offered at very high premiums, coverage would be bare-bones, and fewer insurance companies would participate because they would lose money. I’m sure you know much more about this than I ever will.

H.R. 676 is not identical to that. It’s been reintroduced by its sponsor, Representative John Conyers, D-Michigan. It has picked up several new co-sponsors this year and I hope you’ll be one of them.

It probably won’t be easy for Dave, either.