In an unworkable market, health care is viewed as an entitlement
In “The left’s health care rhetoric is unhinged’’ (Opinion, June 28), Jeff Jacoby criticizes the Democratic response to the Senate health care plan, focusing on the reference to dire predictions of increased mortality. I would argue that there are more substantive issues to debate.
Let’s stipulate that both the liberal criticism of the Senate proposals to replace the Affordable Care Act and the conservative commentary on the existing program represent equally overheated, largely exaggerated rhetoric. Republicans argue largely on economic grounds, while Democrats focus on coverage and care. Unfortunately, neither approach is workable, or sustainable, under our present capitalistic model.
The forces of supply and demand should create an equilibrium. On one side, consumers weigh value and price in order to make choices; meanwhile, suppliers adjust to these demands to gain market share. But when it comes to health care, these forces don’t apply.
Over the last 55 years, health care has become an entitlement, and consumer attitudes on value are now fixed — only the best is acceptable. Furthermore, price is largely unknowable and, to a varying extent, an indirect burden. On the supply side, without the usual demand forces at work, there is no incentive to provide better value or lower prices.
As Elizabeth Rosenthal writes in “American Sickness,’’ “we, and our employers and insurers, are shopping for health care in a market where everything is monetized to the maximum, without much regard for the implications for patient health.’’
Either we revert to the pre-entitlement era of pay as you go, with charity or publicly funded hospitals and clinics as an alternative for the less affluent, or we opt for a hybrid system of standardized, and regulated, health care for all alongside a private, market-based system that competes for alternative or supplemental coverage.
The longer elected offiicials and pundits wallow in superficial rhetoric, the longer the public will remain without viable solutions.
Dr. Dean R. Wasserman
Plymouth
Data on Mass. health reform make strong case for Obamacare
Jeff Jacoby dismisses calls to save the Affordable Care Act, or Obamacare, because he asserts that expanding health coverage does not reduce the death rate (“The left’s health care rhetoric is unhinged’’).
But there’s strong evidence that health reform does save lives, and the Massachusetts experience is a prime example.
This month The New England Journal of Medicine collected research on the impact of expanding health insurance coverage. Many of the studies look at Massachusetts as the test case. Because we expanded our coverage four years before the ACA, Massachusetts provided a valid comparison with other states that are otherwise similar.
First, the studies show that expanding coverage leads to increased preventive care, which allows problems to be avoided or caught earlier. For example, in Massachusetts we had higher rates of potentially curative surgery for colon cancer. Fewer patients had more dangerous emergency surgery. Health reform also improved people’s perceptions of their own health.
And on death rates, the findings were clear that expanding coverage saves lives. Bay State counties were compared with demographically similar counties nationally, and it was found that Massachusetts’ 2006 reform led to significant reductions in both all-cause mortality and mortality responsive to health care. The effect was more pronounced when compared with counties with lower rates of insurance coverage.
After looking at all the evidence, one must conclude that expanding coverage through the ACA leads to improved health outcomes and better health. The repeal-and-replace movement, which would result in more than 20 million people losing coverage, really would lead to more deaths.
Brian Rosman
Policy director
Health Care for All
Boston
In creating policy void, Democrats missing the moment
I’m a lifelong Democrat. My father voted for Adlai Stevenson, and I resented Richard Nixon, labored as a precinct captain for George McGovern, and disrespected George W. Bush. Having said that, I now resent the Democratic Party for the policy void it has created, failing to take advantage of the Trump debacle and present cogent, persuasive policy ideas consistent with the proud legacy of the party.
The Democrats have simply vilified the Republican health care bills and failed to present alternatives that focus on rehabilitating Obamacare. Instead, they should focus on how to stem the departure of insurers from the exchanges; moderate premium increases; and address skyrocketing pharmacy costs, including negotiations with pharmacy manufacturers.
Personally, after more than 40 years in the health insurance industry, and as part of the baby boomer tidal wave, I feel stronger than ever that this Republican vs. Democratic policy debate is confusing, overly complex, demagogic, and inevitably futile in achieving the goals of universal access and sensible costs.
The Democratic idealist in me implores policy makers to look to Western Europe for answers; the Republican realist in me whispers: Not in my lifetime.
Tom Boyajy
Boston
Ahem, we have a gun-violence preexisting condition
Has anyone noticed that whenever there is talk of better gun control, the response from our leaders is that we don’t need gun control, we need better mental health care. And yet, mental health services are one area of the proposed new health care bill that is being cut.
Susan Suarez
Chelmsford
