Time to call out scare tactics blocking needed reform

You can tell it's campaign season when powerful interest groups try to steer the debate over health care reform with misleading scare tactics. We saw this in the 1990s when the insurance industry helped derail President Clinton's health reform proposal with its infamous “Harry and Louise” TV ads, when opponents of President Obama's Affordable Care Act told people it would lead to “death panels” (it didn't), and now, we are seeing it all over again. A coalition that calls itself the Partnership for America's Health Care Future has come out swinging not only against a single payer, Medicare for All approach, but against any and all proposals to offer Americans the choice of enrolling in a publicly funded health care plan.

The partnership is funded by the Pharmaceutical Research and Manufacturers Association of America, Blue Cross Blue Shield Association, America's Health Insurance Plans, the American Hospital Association, and the Federation of American Hospitals, among others. It's running ads on Twitter intended to convince Americans that (in the partnership's own words) “Medicare for All, Medicare buy-in and a public option will all mean the same things for American patients. They'll pay longer for worse care. Get the facts.” The partnership's “facts” include that such changes would lead to a “one-size-fits-all, government takeover of the health care system,” that “Americans would pay more and wait longer for worse care,” and that “all these proposals would put Americans' health care at risk.”

I can think of a lot of impolite words to characterize the partnership's falsehoods cloaked as facts, but let's use a good old-fashioned one: poppycock! (Synonyms include nonsense, rubbish, and garbage.) Because if this group really wanted people to know the facts, its members would admit that Americans wait longer for health care, pay much more, and have worse outcomes than people in other wealthy countries that have achieved universal coverage. Consider the following:

• The United States is the lone high-income industrialized nation without universal health coverage, a crucial component to ensuring everyone can get high-quality health care without excessive financial burden. Affordability is among the most commonly cited reasons for remaining uninsured.
• The nation spends far more per capita on health care compared to other wealthy nations; we charge more for health care services, devices, and medications; and we spend more on administering our complex, multipayer system at the expense of funding coverage, research, and other policies to improve outcomes. To illustrate, of 19 countries included in a recent Commonwealth Fund study, the U.S. ranked worst on “had a medical problem but did not visit a doctor, skipped a medical test, treatment or follow-up recommended by a doctor, and/or did not fill a prescription or skipped doses.” The U.S. ranked more than twice as badly as Canada and more than four times worse than the United Kingdom on this measure of self-reported access to care.
• The U.S. consistently ranks last or near-last in access to care, administrative efficiency, equity, and health care outcomes, and life expectancy in the U.S. has been decreasing.
• Many U.S. residents face systematic barriers to care and discrimination because of personal characteristics, including race, ethnicity, religion, language, sex and sexual orientation, gender and gender identity, and country of origin.

So if you really want to know the facts about “where people pay more and wait longer for worse care,” it is right here today in the USA, not in the countries that have adopted publicly funded health care.

To be sure, there are legitimate arguments that the industry sponsors of the partnership could raise about Medicare for All, or even a public option, without spinning the facts. A system that relies on publicly financed coverage will likely impose price controls on hospitals, physicians, and drug companies that would be substantially below commercial rates (if you read the partnership's posted materials on its website, it becomes clear that this really is what its opposition is mostly about). The partnership could reasonably have argued for ensuring that any publicly funded model pays physicians and hospitals competitive, fair, and negotiated rates.

Instead, the partnership has gone with full-throated opposition to Medicare for All, Medicare buy-in, and a public option.

The American College of Physicians is going in a different direction. We are exploring what is working well in U.S. health care and what is not. We are proposing policy solutions, based on facts and evidence. We aim to offer reforms that will ensure that all Americans have access to coverage and care at a price that they, and the country, can afford. We seek to inform, not scare, the public. The results of our efforts, which we are calling our New Vision of American Health Care, will be available early in 2020. In the meantime, we continue to advocate for improvements in the current system, including offering more options for publicly financed coverage.

The Partnership for America's Health Care Future must not go unchallenged as it plays fast and loose with the facts. The stakes for patients are too high. If the U.S. again misses another opportunity for universal coverage because powerful interest groups mislead the public into opposing it, Americans will continue to have poorer outcomes, longer waits, and higher costs. Some without coverage will die because they can't afford their medications or put off going to a doctor. That, sadly, is the most crucial fact to remember.