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By Dr. Brad Cotton 

Representative Paul Ryan’s federal budget plan provides yet another way for Republicans to shovel tax dollars to their health insurance corporate buddies while putting your safety at risk. Firstly, the Medicare Modernization Act of 2003 (MMA) authorized the Medicare Advantage plans that cost the taxpayer 14% more than traditional Medicare while introducing all the bad side-effects of private insurance: restrictions on physicians, hospitals, increased bureaucratic paperwork, denials and reduced care. Secondly , the MMA created the Medicare drug program wherein perversely the government is actively prohibited from negotiating drug prices. The MMA thus consummated the illicit three-way marriage of Republicans with the health insurance and pharmaceutical companies. You, the taxpayer, were shoved out of the back door. 

Now, thirdly, Rep. Ryan proposes to replace Medicare with a voucher program forcing seniors back into the shark-infested private health insurance market. The Los Angeles Times 8 April notes: “When the House Budget Committee Chairman Paul D. Ryan unveiled his blueprint this week for cutting federal spending by $5.8 trillion over the next decade he argued that a revamping of the governments health safety net would rein in skyrocketing costs. Yet, because commercial insurers cost more to run than government plans, the Wisconsin Republican’s proposal to privatize Medicare starting in 2022 would actually spark a dramatic increase in how much the nation spends on healthcare for the elderly, according to the nonpartisan Congressional Budget Office which says that seniors would end up paying almost twice as much out of their own pockets--- or more than $12,510 a year under Ryan’s plan. Therefore the total cost of insurance would be higher.” The only cash flow guaranteed to increase under Rep. Ryan’s giveaway to America’s Health Insurance Plans (AHIP) is that torrent that streams from health insurers boardroom’s to Republican campaign offices. 

I support the Patient Protection and Affordable Care Act (PPACA) as it does provide a number of patient-friendly provisions and does cover more, about half, of the uninsured but the bill stinks badly compared to the single payer reform we should have gotten. While opponents deride the PPACA  as “Obamacare” it should  more appropriately named  “Romneycare” as it is the same blueprint the Republican Governor of Massachusetts’  signed into law in 2006. In any case, “Romneycare” or “Obamacare”, the bill wastes federal funds propping up costly and useless middlemen: the health insurance industry. Overall our private health insurance industry wastes 31% of every dollar on profit, overhead, advertising, paperwork and buying of legislators. Federal Medicare spends fully 97 cents of every dollar directly on patient care. 

Noted  conservative columnist Charles Krauthammer commented on the waste and inefficiency of our  U.S. healthcare non-system  as well as “Obamacare” , which is, after all, simply taxpayer support of the health insurance industry. Susan Taylor Martin of the St. Petersburg Times 20 February 2011 asked  Dr. Krauthammer : “…. You are a medical doctor who criticized healthcare reform as a ‘2,000 page bill that will generate tens of thousands of pages of regulations.’ Isn’t that a great argument for the simplicity of Canadian-style universal health care?” Dr. Krauthammer responded: “ It is. But it seems to me we have two choices. We have the best medical care in the world but it is the most expensive and we waste a lot. What you need to do is reduce the complexity and inefficiency. If we can’t get it right, we’re eventually going to a single-payer system. At least it (single-payer) doesn’t have this incredible absurd complexity of Obamacare.” 

For  real simplicity, economy and compassion, let’s take the current Medicare legislation and erase all references to Americans over 65 years old. While we’re there, erase all passages establishing the privately administered Medicare Advantage plans that cost us more. Now we have the basis for real healthcare reform at half the cost. Rep. Ryan and his party know this, if they were but able to admit it. Ideology blinds them. Even uber-conservative free-market ideologue Friederich Hayek notes in his tome “The Road to Serfdom”—“Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.” 

Ultimately it is a question of faith and values. Do we believe that healthcare is a commodity like flat screen televisions or luxury sedans? If  healthcare is just a market commodity this means it is OK that many of our neighbors suffer and die, or go bankrupt when they lose their job and health benefits. Or do we believe that no one is to die, become maimed and suffer because of an unquestioned irrational faith in a proven false and lethal theory of free market healthcare?

Brad Cotton is an emergency physician and member of Physicians for a National Health Program