Republicans should back a single-payer health-care system

by Jack Bernard, retired senior health care executive,The Chronicle,  June 23, 2013.

My party, the Republican Party, has staked out amazingly naпve positions on two of the key domestic issues facing us: immigration and health reform. These issues are intertwined.

Health Affairs, one of the most influential professional health care journals, has published a new Medicare study, conducted by Harvard and City University of New York researchers. It found that immigrants were responsible for 8 percent of Medicare expenditures – no surprise there.

What was astounding to me and many others was that nearly 15 percent of Medicare trust fund collections came from this same group of people. In other words, immigrants put in nearly twice the amount of money that was paid out to them.

In 2009 alone, the net gain to Medicare from immigrants was $13.8 billion, whereas native-born Americans had a deficit of $30.9 billion. Much of this difference can be accounted for because of low birth rates and the aging of our U.S.-born population, while immigrants are a much younger cohort. Further, immigrants cost Medicare less on health care because of a variety of reasons.

The bottom line: We need immigration to balance the books for Medicare, as is also true with Social Security. Without it, we will either have to cut benefits or dramatically raise taxes on a proportionally smaller and smaller work force.

So, at least for these programs, the fiscal side is clear. Immigration is a net plus.

What about the political side?

MANY GOP strategists finally are seeing what I have said all along: In 2012, the party shot itself in both feet regarding immigration. Pandering in primaries may win you the nomination, but advocating for ridiculously impractical positions will not win the presidency. In any case, the deportation of 11 million people is something that will never happen, no matter who is president.

By opposing true immigration reform, including a path to citizenship, the uncompromising right wing of the GOP has accomplished two things. Both are long-term negatives for the party.

First, these “nativists” alienated legal immigrants and their families for generations to come. Hispanic voters are being driven to the Democrats, which will cause increased losses in key swing states, such as Texas and Georgia, over time.

Second, as U.S. Sen. Marco Rubio of Florida has correctly stated, by blocking congressional action the right-wingers are in effect continuing unrestrained immigration. Since there has been no national progress on immigration reform, including border security, the illegal problem just gets worse and worse.

Similarly, Republicans have staked out a losing long-term health-care position: Just repeal the Affordable Care Act (Obamacare) and simply let competition reign. But voters are skeptical of the same old worn-out GOP slogans: Medicaid block grants, Medicare vouchers and weakened regulations.

None of these measures will significantly stop rapidly escalating systemic health-care costs or control premiums. Most simply shift risk and/or expenses to the patient or the states – something voters do not like.

THIS IS NOT to say that the ACA is the solution for our ills. The financial basis for universal care via private insurance is the unpopular requirement that everyone buy insurance or be taxed. It is questionable as to how many healthy young people will actually buy insurance, mandate or not. And many “red” states have not agreed to add more Medicaid patients to their roles, citing dubious fiscal issues.

Obamacare does not deal with a key root problem – the private health-insurance model itself. Family premiums already are at $15,000 per year and rising, with a greater proportion picked up by employees every year. The voter will see his/her premiums, copays and out-of-pocket costs increase dramatically as the insurance companies continue to maximize their profits under Obamacare.

Health care as a proportion of gross national product – already completely out of control – will continue to rise. The government will see greater red ink along with growing deficits, while tens of millions remain uninsured.

Richard Nixon once called Medicare “socialism,” but now it is supported by almost all Americans. Further, Medicare administrative costs are 3 percent while private insurance is more than 20 percent.

What should be proposed by the GOP to contain costs and improve access? My advice to my fellow Republicans is to employ your reason vs. your ideology.

Government health insurance is the solution, not the problem. The GOP should promote a single-payer system – Medicare for all.