Eyeworld

EW NEWS & OPINION 18 November 2017 Insights by J.C. Noreika, MD, MBA healthcare's 100 most influential people. The American Academy of Family Physicians (AAFP) Congress of Delegates agrees. Meeting in September, the AAFP proposed that "universal access to timely, accept- able, and affordable healthcare of appropriate quality" is a human right. A resolution supporting the development of language in sup- port of a "publicly funded universal primary care program" was adopted. The organization represents almost 120,000 physicians. In The Godfather Part II, Michael Corleone relates to Hyman Roth that he watched a Cuban rebel explode a grenade, killing himself and the ar- resting commandant. "It occurred to me that the soldiers are paid to fight; the rebels aren't." Roth asks him, "What does that tell you?" Corleone responds, "They could win." The Kaiser Family Foundation thinks a government-run healthcare industry in the U.S. is unlikely any- time soon. But fervor flamed by de- mography and fueled in cyberspace may catalyze the process. Physicians should prepare to participate in the process or risk irrelevancy in the outcome. Yes, they could win. EW Editors' note: Dr. Noreika has been a member of ASCRS for more than 35 years. Join the discussion on this article and others on the EyeWorld blog at blog.eyeworld.org. Contact information Noreika: JCNMD@aol.com President Obama's party at the time, killed the provision. The New York Times' Paul Krug- man wrote in August in "What's Next for Progressives?" that univer- sal access to healthcare is now the litmus test for Democratic candi- dates. With partisan co-sponsor- ship, Senator Sanders introduced a "Medicare for All" bill in the Senate, and Representative John Conyers (D-MI) followed suit in the House. Providing benefits surpassing tradi- tional Medicare and all but the most generous private plans, they elim- inate most out-of-pocket costs and include long-term care. Politicians and pundits were quick to jump on board. Senator Kirsten Gillibrand (D-NY) stated that, "too many insurance compa- nies continue to value their profits more than they value the people they are supposed to be helping. It's time for something better." The Wall Street Journal reported share prices of the five largest publicly traded health insurers have quintu- pled since the ACA became law in 2010. In comparison, the S&P is up 116% over the same period. Cigna is expected to earn $9.60 per share this year and forecasts $16 per share in 2021. Among other lobbying efforts opposing repeal and replace attempts, the health insurance in- dustry spent nearly $150 million in 2016 on this. A 2016 Gallup poll found that 58% of all respondents would replace the ACA with a single-payer system; 64% supporting the ACA would jettison it for a universal-ac- cess government-run system. Access for all is framed as a polemic be- tween an intrinsic right to health- care and taxpayers' willingness to pay for it. Its resolution may depend upon demography. According to the Census Bureau, millennials—young adults born between 1980 and 2000—officially became the largest U.S. demographic segment in 2015. In the 2016 Demo- cratic primaries, Bernie Sanders won more 18- to 29-year-old voters than Hillary Clinton and Donald Trump combined. According to the Harvard Institute of Politics, about a third of Americans between 18 and 29 support socialism. In December 2016, Lynn O'Con- nor Vos wrote in Fortune that this generation, "taught to be empow- ered," distrusts authority. It rejects the primary care physician as a trusted advisor. Only 41.5% viewed doctors as the single best source of health information. They are com- fortable orchestrating their care on the internet and see themselves as active collaborators. In her book iGen, psychology professor Jean Twenge posits that generational distinctions have validity and illuminate broader social trends. iGenners represent a demographic born between 1995 and 2012. They make up 24% of the population and are racially and culturally diverse. Exceeded only by a desire for "safety," she found tolerance is their religion. Spend- ing 6 hours per day on new media, technology is their world experi- ence. These meta-millennials tend to prefer virtual to real relationships, are less likely to read books, and their academic skills significantly lag those of earlier generations. They are less informed about current events. They maintain it is govern- ment's duty to provide healthcare for all. They reject crony-capital- ism such as the hiring of Marilyn Tavenner to head America's Health Insurance Plans (AHIP), a trade association representing about 1,300 companies. AHIP is healthcare's largest lobbying and public relations organization. Ms. Tavenner was a key administrator of the Centers for Medicare and Medicaid Services under President Obama. According to Modern Healthcare, she is one of Is access to healthcare a right or a privilege? As a moral question, it transcends medicine and economics T he United States' healthcare system is in disarray. Fact: Even after the enactment of the Affordable Care Act (ACA), some 30 million Americans remain uninsured. Fact: The insured saw premiums, copays and deductibles increase. Fact: 50% of the nation's counties will have a single insurer in an exchange in 2018. Fact: Winning the White House on a platform to repeal Obamacare, Republican majorities failed to produce a replacement. Fact: The physician appointed to lead the Department of Health and Human Services abruptly resigned at the end of September. Fact: Opposed by healthcare's power brokers, a transparent market-driven health- care system isn't feasible. But when politicians endorse a government-run single-payer health- care system for America, the first question should be, "Which one?" Senator Bernie Sanders' (I-VT) proposal of Medicare for All is nei- ther new nor novel. In politics—as in life—timing is everything. In 1943, a single-payer reform was introduced into Congress and en- dorsed by President Harry Truman. Medicare, crafted in the 1950s and enacted in 1965, was envisaged the cornerstone of incremental univer- sal healthcare. Later, then-President Jimmy Carter attempted to extend Medicare to all. Ironically, fellow Democrat Ted Kennedy blocked the effort. This past July, President Carter stated that Obamacare didn't go far enough. The U.S. inevitably would turn to a government-run health insurance system. Compet- ing with commercial insurers in the exchanges, the ACA's government option might have led to Medicare for All. The Senate, controlled by Is single-payer inevitable? J.C. Noreika, MD, MBA

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