GOP health care plan copies Chairman Mao

Published in the Morning Call, June 23, 2008

In 1965, Communist China was one of the poorest countries of the world. Chairman Mao Tse-Tung created a programā€”widely known as the Barefoot Doctors programā€”to provide health care for his impoverished people.Ā  The Barefoot Doctors, who had a minimal level of medical training, offered basic primary care to people for whom no other medical care was available.

In 2008, the United States is the richest country the world has ever known. And yet Senate Republicans are proposing a similar program for the uninsured of Pennsylvania. Rather than do what every other wealthy country in the world has doneā€”help the uninsured purchase affordable health insuranceā€”they have taken a page from Chairman Mao. They are calling on heavily oversubscribed health clinics and volunteer physicians to give primary care to a half million Pennsylvanians.

This program is an insult to both the uninsured and physicians.

It is an insult to the uninsuredā€”the vast majority of whom works full time and pay taxes on what they earnā€”because, in the richest country in the world charity should supplement not replace health insurance. Every one of our hard-working tax-paying should be able to purchase affordable health insurance. And everyone should have more than just primary health care. They also should have access to:

  • Advanced medical tests and outpatient procedures not performed at health clinics.
  • Medical specialists.
  • Hospital care
  • Prescription drugs.
  • Mental health care.

The citizens of Pennsylvania, in other words, deserve health care provided by highly trained medical specialists with shoes, not by the equivalent of barefoot doctors.

The program is also an insult to the medical profession. The Barefoot Doctors were at least paid for their work. But Senate Republicans expect thousands of Doctors to donate their time to take care of 159,000 people without health insurance. This will not happen. Medical professionals today are frequently part of large, and often hospital owned practices, that demand that they see ever larger numbers of patients. Insurance companies are less and less willing to reimburse doctors for the time spent with their patients. Our hard working physicians cannot and will not take on the additional burden of providing hours of free care each week to people who should have health insurance. And it is an insult to ask them to do so.

Nor, as the Republicans propose, should the system of continuing medical education be corrupted in order to provide an incentive for doctors to care for the uninsured. All of us, insured and uninsured need physicians who keep on top of the most current medical knowledge. To divert doctors from that task will undermine the care we all get. Sooner or later it will give us we all of barefoot doctors.

The Barefoot Doctor proposal is especially insulting because there is another alternative: In the richest county in the world we can provide health insurance for all.

The Pennsylvania Access to Better Care (PA ABC) program which gained bi-partisan support in the House in March, takes us partway to that goal. Under PA ABC, uninsured adults will be able to pay reasonable rates to purchase health insurance that gives them first class medical care covering all that is missing in the Republican program. Those making less than 200% of the Federal Poverty Line ($20,800 for an individual and 42,400 for a family of 4) will pay on a sliding scale $10 to $50 a month.

Moreover, the costs of PA ABC to the state would not be much greater than the costs of the voluntary programs proposed by the Republican Senators. Cost estimates are missing for some elements of their program. But the enumerated costs total $95 million in new state spending. The PA ABC program will require only $179 million in new state spending by 2013, at which time 275,000 more adults will be receiving health insurance.

Why can PA ABC do so much more without spending so much more? Because it draws on $414 million in Federal matching funds and rightly asks the recipients of health insurance to pay for a portion of their insurance.

Extending coverage to the uninsured under PA ABC has another advantage: Today, over six percent of our health premiums go to cover medical care for the uninsured. Voluntary primary care will not do enough to reduce the burden on those who have health insurance.

The time has come to move forward towards a rational medical system in Pennsylvania in which everyone has insurance and, as a result, health care costs are controlled. We canā€™t build such a system by relying on the model of Chairman Mao and his barefoot doctors.

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