We deserve a healthier America! It starts with a proper healthcare policy.
I am a doctor and providing high-quality, affordable health care to patients has been my only mission in 24 years of practice in Central and Southern Illinois. I have served on the Board of Governors of a 350-physician multidisciplinary group practice, and on the Board of Directors of a Health Insurance Company. I have served on the faculty of the Southern Illinois University School of Medicine and on the Faculty Senate of the Southern Illinois University. I served on the Health Policy Council of the North Central Section of the American Urological Association. Aside from being called “dad” or “coach” when my boys were young, my most meaningful title has been doctor. There is a sacred covenant in my profession, which I have honored, to never deny a person medical services regardless of ability to pay, and to treat every person with dignity and with my best effort to restore health. The many physicians I know and respect, have this ethic. We are physicians first, and work within our respective health care institutions second.
Health care ranks first for the federal government to address according to a May 1, 2019 NBC/Wall Street Journal poll. Immigration and border security came in second. Jobs, and the economy came in third. For many years the economy came in first, but now that the economy has improved with GDP growth above 3% and unemployment below 4%, health care comes in as the most important concern for Americans. I believe that Democrat proposals for a single-payer system promoted as “Medicare for All” has created an unnecessary crisis in confidence in our health care system. The American health care system, like all other national health care systems is not perfect, but it is very good.
Most Americans are satisfied with their health care coverage. According to a November 11, 2018 Gallup poll, 70% of Americans rated their union or employer-sponsored health insurance coverage as excellent or good. “Medicare for All,” which is being promoted by Democrats, will eliminate union and employer-sponsored health care insurance enjoyed by 180 million American workers and their families. On July 6, 2017, Mr. Durbin announced at a staged “news conference” in Urbana, Illinois that he eventually wants a “Medicare for All” program in the United States. “Medicare for All” is a lie. Medicare would be replaced with an inferior federal single-payor plan.
In May 2019 the Congressional Budget Office (CBO) released a report on “Establishing a Single Payer Health Care System.” The report was commissioned by the Democrat Chairman of the House Budget Committee, John Yarmuth. Remarkably, Mr. Yarmuth asked that the CBO not include budget estimates in the report. Do most Americans believe that the tax-payer supported non-partisan CBO should not provide budget estimates of potential legislation? The reason the Democrats don’t want a budget estimate from the CBO is that health care expenditures in the United States in 2018 amounted to 3.5 trillion dollars. They don’t want the CBO to give a budget estimate because of the enormous cost and the predictable tax burden on every American.
The CBO report shows that, despite the Affordable Care Act (also known as Obamacare), there are 29 million American citizens under age 65 (9% of the U.S. population) who do not have health insurance. A Kaiser Foundation report in 2017 showed that 77% of the uninsured had at least one full-time worker in the family. However most (71%) worked for an employer that did not offer health benefits. Most of the uninsured are not eligible for free or subsidized coverage, and cost is cited as the most common barrier to obtaining health insurance. Other barriers include loss of employment or change of employer, loss of Medicaid, and change in status (such as marital status, death of a spouse or parent, leaving school, or age). The CBO and Kaiser Foundation reports do not discuss how the uninsured utilize state and federally funded safety net providers such as Public Hospitals, Federally Qualified Health Centers (Community Health Centers, Migrant Health Centers, Health Care for the Homeless Centers, and Public Housing Primary Care C enters), Rural Health Clinics and Rural Health Networks, the Indian Health Services, Community-based Mental Health Centers, and the Ryan White HIV/AIDS Program. If the number of uninsured who use these safety net providers were included in reports, the public would know that the burden on the uninsured has been lessened, although not eliminated entirely. The elephant in the room are the number of uninsured, who for whatever reason, refuse insurance or public aid. The Supreme Court has ruled against the individual mandate for government sponsored insurance, so to some degree, hopefully small, we will always have an uninsured group, even in a single-payor system.
“Medicare-for-All”, which has been proposed in the Senate by Bernie Sanders (D-VT), and in the House by Pramila Jayamal (D-Wash) would cover the 9% by providing inferior coverage through a single-payor plan to the 91%. The proposed bills would outlaw private insurance, including Medicare Advantage plans. Cost-sharing for deductibles and co-pays would be prohibited. The CBO report points-out a fundamental economic principle; that when the cost of a service is lower, the demand for that service increases. Under a single-payor system, the increased demand for health care services will increase U.S health care expenditures. Furthermore, with no cost-sharing in a single-payor system, the increased demand could not be met by the supply of providers, which will lead to longer wait times, extreme rationing of care, and decreased quality. With an increased demand for health care services, the only way to decrease U.S. health care expenditures is to reduce services and reimbursements, which will further decrease the supply of nurses, doctors, and mid-level providers (40% fewer providers by one estimate). A physician shortage should concern every American, because the United States already has a physician shortage. The Association of American Medical Colleges predicts a shortfall of between 61,700 and 94,700 physicians by 2025 in our present health care system.
A single payor federal health insurance plan will:
1) force seniors, especially those in Medicare Advantage into an inferior plan, even though they paid into Medicare their entire working lives,
2) reduce the health care workforce and number of health care facilities because of decreased reimbursements and reduced graduate medical education funding,
3) lead to long wait times and rationing of care, and
4) take away choice and options for all American citizens.
In 2017, 60,000 Canadians purchased health care services in the United States because of long wait times and rationing of care. Under a single-payor system, bureaucrats in Washington will make the rules on eligibility for complex care such as cancer treatment, dialysis, and transplant. Under a single-payor system if Americans don’t like the plan, there will be no other choice.
I take Senate leader Mitch McConnel’s view that we should fix problems in our health care system and keep what works. Americans should be able to keep their insurance, whether provided by a union or employer, from a state or federal exchange, through Medicare or Medicare Advantage, through the Child Health Insurance Program (CHIP), through the VA and through the Federal Employee Health Benefits program.
1) expanding the program of tax-free Health Savings accounts for cost-sharing deductibles, co-pays, and out-of-pocket expenses. If not used, these accounts roll-over year after year with compounded interest
2) allowing small businesses to pool risk to qualify for insurance discounts and tax breaks that larger employers receive
3) allowing renewable short-term insurance plans which are more affordable and generally have broader access to providers. Democrats like Mr. Durbin do not like short-term insurance plans because they offer a choice favored by many Americans who find insurance through an exchange more expensive.
4) allowing Americans to pay into primary care membership plans, which bypass insurance and the government. These membership plans cover routine primary care for a low monthly fee (e.g. around $150/month for a family of 5). Health Care Savings accounts should be allowed to pay for these membership plans. Membership plans need to be supplemented by low-cost high-deductible insurance to cover non-routine services.
6) allowing health insurance to be sold across state lines
7) transparency in pricing and outcomes
8) regulatory relief on hospitals and providers
9) increasing graduate medical education funding to address the shortage of physicians
10) malpractice tort reform
The greatest contribution to U.S health care expenditure is the price of service. Federal and state governments should negotiate drug prices for all subsidized health care programs, in the same way as the Veterans Administration.
The active ingredients for most commonly prescribed drugs are produced in China, which is a security concern. A bipartisan, bicameral Congressional commission should investigate pharmaceutical production and prices, and make recommendations for improving the cost, safety, and security of prescription drugs.
Private insurance fee for service (FFS) prices vary greatly, up to 400% of Medicare FFS, according to the CBO. There are a lot of factors that go into pricing, such as competition, location in rural or urban areas, losses from uninsured patients, and the cost of teaching health care providers. Insurance companies negotiate prices with hospitals which are kept secret from the consumer, usually unions and employers. Transparency in pricing and outcomes will allow unions and employers to know the value of the health insurance dollars they spend, which will reduce health care expenditures.
Regulatory relief on hospitals and providers can also lower the cost of health care delivery without compromising quality. In June 2019, Mr. Durbin stated, ”Let doctors practice medicine and not fight insurance companies.” In the real world, doctors and hospitals spend more time and money on compliance with Medicare, $34 billion in 2018, than fighting insurance companies. The fines for minor infractions can close a practice. Furthermore, regulations such as “meaningful use” are costly and have nothing to do with health outcomes or patient safety.
A significant cost to our health care system is malpractice insurance. Medical malpractice reform, also known as tort reform, is essential to reducing the cost of health care. Hospitals and providers must pass-on the cost of malpractice insurance to patients, unions and employers. Tort reform includes limits on non-economic damages, limits on attorney contingency fees, advance notice of a claim, reducing the time that a claim can be made, and independent arbitration of a claim. Dick Durbin is a lawyer, and lawyers and law firms contributed $1.4 million to his 2014 campaign. Do not expect Dick Durbin to reduce the cost of health care with tort reform.
I do not support an entire transformation of our American health care system to a single-payor system. One size really does not fit all, and it hasn’t in countries with a national health system or with a national health insurance system. Even today, health care dollars are leaving developed countries to pay for health care services, usually elective surgery, in less developed countries. In 2020, it is estimated that India’s medical travel industry will bring in $9 billion.
Changes in current law can provide universal health care in the United States. Employer provided insurance, insurance through state and federal exchanges, Medicare and Medicare Advantage, Medicaid, CHIP, the Veterans Administration, and the Federal Employee Health Benefits program provide health care that is valued by Americans. The U.S. has an extensive, well-funded safety net. We can expand health care savings accounts for cost-sharing, allow renewable short-term insurance plans and primary care membership plans. We can have transparency in prices and outcomes so that unions and employers can provide better options for insurance to their members. We can allow small businesses to pool risk to qualify for insurance discounts and tax breaks that larger employers receive. We can keep what works and fix what doesn’t, which is what most Americans want. We need medical malpractice tort reform to reduce the cost of health care. Americans with pre-existing conditions will be eligible for every type of insurance.
Americans are facing a critical shortage of physicians owing to an increase in the aging population (baby boomer population) and an aging physician workforce. In 2015, 43.2% of working physicians were age 55 or older. There will be a 41% shortfall in my specialty of urology by 2025. Resident physician training is largely funded through the Centers for Medicare and Medicaid Services (CMS), but the number of training positions has not changed since 1996. I will support legislation that re-calculates resident training needs and costs. Congress needs to increase the number of residency training slots to meet our nation’s physician workforce needs.
I am a doctor who has devoted my life to medical research and medical practice. As your Senator, delivery of high-quality, affordable health care to every American will be my highest priority.
Dr. Tom Tarter
Candidate for U.S. Senate