Health maintenance should be viewed as a national priority

Health professionals know that all Americans deserve decent healthcare, including primary care and preventive care. We know it in our bones, since we know that everyone is basically the same inside, with a common humanity and similar vulnerabilities.

The assumption that anyone can go to an emergency room doesn’t cut it. Preventive care is necessary to detect and treat problems. It is much easier to cure or control something before costly complications occur. I’d much rather treat someone’s high blood pressure than have to treat something like a disabling stroke, which requires costly long-term care as well as expensive hospital care.

{mosads}The left champions universal coverage to prevent unnecessary suffering and death, but the fiscal cost is very high. Many favor a single payer public plan, knowing that private insurers always extract more value from healthcare than they add to it.

The right champions personal and fiscal responsibility, and free enterprise. They don’t want to pay more to cover benefits for others, and they don’t want all of healthcare to be publicly funded and administered. Their leaders promised to replace the Affordable Care Act (ACA) with something better “for everyone,” but they clearly don’t have anything better. They have focused on reducing coverage and benefits, but the human cost is too great. Can a divided America make quality healthcare both available and affordable?

 The ACA is actually a conservative solution, keeping private insurers in the game —without a competing public option — but under new terms,; it has already done a great deal of good.

 It’s most popular insurance reforms are:

1. Barring exclusions for pre-existing illness, which were very profitable but highly unfair
2. Keeping children on parents’ policies until age 26, which costs insurers little money
3. Covering high value preventive tests such as mammograms and colonoscopies without co-payments, which can lead people to avoid care
4. Increasing the percent of insurer revenue that supports actual care
5. Ending lifetime limits on coverage
6. Giving structure and support to the individual market

The ACA survived by a single Senate vote, but GOP leaders are still pushing to repeal or undermine it and the individual market is struggling with high premiums and few choices.

Unfortunately, insurers created additional barriers to care, such as narrow networks that exclude many local providers. Access to good individual coverage must be protected at a time when so many Americans, especially our young people, are limited to part-time, freelance or small business jobs with no benefits.  

It is outrageous that GOP leaders want this market to implode —  a disaster that, ironically, would only increase support for simpler public solutions, like Medicare for all. 

What about the ACA’s mandate that everyone buy insurance? Well, we clearly need a way to ensure broad participation now that insurers can no longer exclude people with pre-existing conditions. Otherwise, healthy people can take a free ride, letting everyone else fund the system until they are sick and decide to opt in. If enough healthy people become free-riders, insurance for everyone else becomes unaffordable, or insurers face large losses. The House proposal to replace the individual mandate with a small fee when free riders re-enter the system is inadequate.  

I’d really like to know what ACA opponents thought they would do under the old rules, if they suddenly became sick while between jobs or otherwise uncovered. 

ACA-supported Medicaid expansion has been a lifeline in states that participated, but the states that declined are maintaining high rates of uninsured, causing their own hospitals (often the largest local employer) to struggle and sometimes fail. 

The high public cost of Medicare and Medicaid is a huge challenge, which will only worsen as our not-so-healthy population ages. The ACA’s complex cost-saving measures are moving us away from pure fee-for-service medicine, which encourages overuse. New programs reward quality of care and efficiency, encouraging us to avoid unnecessary tests and other low value care. Medical societies have generally accepted these steps, but savings will be modest unless providers receive support at many levels. 

Our lawmakers must start working together, and thankfully some have begun the job.  

Targets for bipartisan cooperation include:

1. Malpractice reform, which has been shown to significantly reduce unnecessary defensive care
2. Working with experts to identify other excessive costs
3. Better planning for managing end-of-life care because we need more palliative care specialists.
4. Allowing doctors to spend more time with patients by reducing our burden of often pointless paperwork
5. Strengthening the individual market

Last but not least, if we are serious about cutting healthcare costs without leaving large numbers of people uninsured, we will have to take much better care of ourselves.

Too many of us  still smoke, eat poorly (too much sugar, salt and saturated fat), and exercise too little. Most major chronic conditions, including obesity, high blood pressure, diabetes, high cholesterol, stroke, heart, lung and kidney disease and cancer  are highly lifestyle-related and largely preventable, but are out of control.

To be specific, over two-thirds of U.S. adults and an alarming number of children are obese or overweight. One-third of adults are hypertensive and another one-third are pre-hypertensive. Fourteen percent are diabetic and 38 percent pre-diabetic.

The expected epidemic of costly complications will overwhelm our healthcare workforce and resources, no matter who sits on our political thrones. In other words, medical winter is coming, if we let it.  

Health maintenance should be viewed as a national priority and a citizen’s duty. Our leaders should emulate Michelle Obama and Michael Bloomberg and do more to help America get healthier. They should work with visionaries like Dr. Valentin Fuster, who partnered with Sesame Street to teach children about healthy living (which spilled over to their parents), and convinced a whole town in his native Spain to become that country’s healthiest.

People argue about diets, but experts agree that added sugars are toxic to our metabolism. Taxes on sugary drinks have lowered consumption and raised valuable funds in places as diverse as Berkeley, Calif. and Mexico. Higher taxes on cigarettes and junk food could also cover some of the damage. Conservatives should support such measures based on the doctrine of personal responsibility. If you freely choose unhealthy habits, you can pay more for the eventual public costs. 

Gerald W. Neuberg M.D. is a cardiologist at New York City and a senior medical ethics consultant. He received his medical degree from Columbia University College of Physicians & Surgeons.

The views expressed by contributors are their own and are not the views of The Hill.