0
Editorials: Point and Counterpoint |

Rebuttal From Dr Berdine FREE TO VIEW

Gilbert G. Berdine, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Departments of Internal Medicine and Medical Education, Texas Tech University Health Sciences Center, and Free Market Institute, Lubbock, TX

CORRESPONDENCE TO: Gilbert G. Berdine, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St, STOP 9410, Lubbock, TX 79430


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):15-16. doi:10.1016/j.chest.2016.02.662
Text Size: A A A
Published online

In making their point, Drs Gaffney, Verhoef, and Hall illustrate how ACA has failed to achieve universal coverage or make US health care affordable. The failures of ACA were predictable and were predicted. My opponents propose a single-payer national health program to fix the flaws in ACA. While I share the goal of making health care accessible and affordable to everyone, I must respectfully disagree with their prescription.

Annual US health expenditures were $9,523 per person in 2014. This amount is the lowest possible “premium” for a homogenized risk pool. To the extent that the poor and elderly are subsidized, that figure must increase for those who pay full price. Whether the average person pays a transparent premium or cost shifts via taxation, the full bill must be paid. The only way to decrease premiums to acceptable figures is through cost-containment, but subsidies inexorably increase expenditures.

My opponents point out that Medicare is prohibited under the ACA from using its monopoly position to negotiate lower prices from pharmaceutical companies. This situation is not a bug in the ACA but one of its features. With whom would Medicare negotiate? The government grants monopoly privileges to pharmaceutical companies through patents. The government fixes prices of pharmaceuticals based on input from lobbyists. Medicare would be negotiating with the government beneficiaries of these lobbyists rather than the pharmaceutical companies. The pharmaceutical lobbyists would ensure this “feature” was part of any new single-payer program.

My opponents claim that a single-payer program would achieve efficiencies in administration. The experience with Medicare suggests otherwise. Where are the savings from the Health Insurance Portability and Accountability Act? How about the 10th revision of the International Statistical Classification of Diseases and Related Health Problems? History suggests that government single-payer programs lead to an inexorable increase in administrative costs.

I see many Veterans Health Administration patients in my outpatient clinic. Government efficiency means that a Lubbock resident must travel > 100 miles to Amarillo for a chest radiograph and return to Lubbock to see me, but that I will not be able to view a film or see a report for at least 1 week. The Amarillo Veterans Health Administration saved a small fee, but how did that efficiency work out for the patient?

The government has different goals than health-care providers and the patients we serve. Some situations illustrate that the government can be brutally efficient. Bureaucrats who form what I call the “CPAP Police” require CPAP machines with monitor/spy chips. If the chip determines that the patient did not use the device for a capricious and arbitrary length of time, the device will be confiscated. This is George Orwell’s boot masquerading as cost-containment. If the government would get out of the CPAP business altogether, the machines would cost no more than a toaster, and the only question asked of the patient would be, “Which color would you like?”

“Health insurance” is no longer pooled risk in America. The first step to making health care affordable is to separate catastrophic and insurable costs from routine health maintenance. It is impossible to subsidize an entire nation.

References

Gaffney A.W. .Verhoef P.A. .Hall J.B. . Point: Should pulmonary/ICU physicians support single-payer health-care reform? Yes. Chest. 2016;150:9-11 [PubMed]journal
 
Berdine G. The Supreme Court Decision on Obama Care Part III: the unintended consequences on the already insured. The Southwest Respiratory and Critical Care Chronicles website.http://www.pulmonarychronicles.com/ojs/index.php?journal=pulmonarychronicles&page=article&op=view&path[]=68&path[]=157. Accessed May 9, 2016.
 
NHE fact sheet. Centers for Medicare & Medicaid Services website.https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html. Accessed May 9, 2016.
 
Berdine G. . Counterpoint: Should pulmonary/ICU physicians support single-payer health-care reform? No. Chest. 2016;150:11-14 [PubMed]journal
 

Figures

Tables

References

Gaffney A.W. .Verhoef P.A. .Hall J.B. . Point: Should pulmonary/ICU physicians support single-payer health-care reform? Yes. Chest. 2016;150:9-11 [PubMed]journal
 
Berdine G. The Supreme Court Decision on Obama Care Part III: the unintended consequences on the already insured. The Southwest Respiratory and Critical Care Chronicles website.http://www.pulmonarychronicles.com/ojs/index.php?journal=pulmonarychronicles&page=article&op=view&path[]=68&path[]=157. Accessed May 9, 2016.
 
NHE fact sheet. Centers for Medicare & Medicaid Services website.https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html. Accessed May 9, 2016.
 
Berdine G. . Counterpoint: Should pulmonary/ICU physicians support single-payer health-care reform? No. Chest. 2016;150:11-14 [PubMed]journal
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543