David Himmelstein is an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program. The author of numerous studies and books, he is a leader in the movement for universal health care.
AARP: H.R. 676 does not address the problem of increasing healthcare costs. Rather, it allows costs to continue to grow. By 2016, projections show total health spending almost doubling to $4.1 trillion and consuming one-fifth of the nation’s gross domestic product. Possible efforts to control costs include: “comparative effectiveness” research, a generic pathway for biologic drugs, and increased attention to prevention and care coordination, none of which are included in H.R. 676.
Dr. David Himmelstein: There is absolutely no evidence that the AARP’s favored cost control mechanisms work. The CBO has refused to credit significant savings from care coordination, or prevention. The recently published Medicare Demonstration project of care coordination found no savings. A New England Journal of Medicine review of prevention found that most prevention efforts result in increased costs, not decreased.
Comparative effectiveness research is worthwhile – as are prevention and care coordination – if done right – but is unlikely to significantly cut costs.
The major recent example is the ALLHT study, a massive federally-financed research project which demonstrated that cheaper drugs for high blood pressure are at least as effective as more expensive ones, but utterly failed to influence prescribing patterns.
Similarly, while pushing generics is worthwhile, the large increase in use of generics in recent years has hardly moderated cost increases.
A single payer program provides a structure within which all of the beneficial aspects of these initiatives could flourish, but does not depend on these vaporware solutions to the cost crisis.
Instead, it relies on massive bureaucratic savings which have been well demonstrated – and credited by the CBO and GAO in the past – as well as improvements in health planning that would slow the proliferation of useless high tech machinery and interventions.
AARP: HR 676 essentially eliminates Medicare, Medicaid, and the SCHIP programs that have served the American public well for many years.
These programs have very finely tuned financing arrangements and have adapted their coverage to meet the needs of many Americans.
Starting over with a new, single-payer program will not eliminate the problems Medicare, Medicaid, and SCHIP currently face, such as the spiraling costs of procedures and prescription medications, as well as technological advances that are often not comprehensively tested to be proven safe or effective before marketing.
Dr. David Himmelstein: HR 676 improves and upgrades Medicare and extends it to all. It would provide far better coverage than SCHIP, and without the onerous enrollment hurdles that keep many needy children off that program. Medicaid is a second class program that is only marginally better than no coverage.
AARP: HR 676 does not promote shared responsibility for healthcare coverage among employers, employees and the government – a basic principle of AARP policy. The bill would relieve employers and individuals of their obligation to contribute toward healthcare coverage.
Therefore, even with the trust fund contained in the bill and other sources of funding, the single-payer system cannot remain solvent for long. Taxes will need to be increased. This means that the bill simply shifts the burden of the rising costs of health care onto the taxpayer alone, with no motivation built in its structure for cost-containment.
Dr. David Himmelstein: Employers and rich people would contribute – by paying taxes, as would employees. Who does the AARP thinks pays taxes if not employers and employees?
AARP: In addition H.R. 676 has not gathered bipartisan support which is important to enacting and implementing any reform.
Dr. David Himmelstein: If freeing the slaves failed to attract bipartisan support would the AARP also oppose it?
AARP: We do, however, support comprehensive healthcare reform. We will continue to monitor H.R. 676 and other legislation regarding the crucial issue of adequate health care for all. We believe quality health care and protecting lifetime financial security are the most pressing domestic issues facing our nation. The time for action is now. Therefore, it is vital that Congress deliver healthcare legislation with the strength to elicit bipartisan support and end the gridlock that continues to obstruct positive change in our country.
Dr. David Himmelstein: The AARP supports reform that protects its massive insurance revenues and has no chance of actually solving the health care crisis.