We have a huge health care problem in the United States. We need to offer health insurance to all our citizens to improve our health outcomes, but the costs of entitlement programs such as Medicare, Medicaid and the Affordable Care Act (ACA) are major drivers of our huge national debt, threatening our economic security. There are currently no comprehensive solutions to this problem being offered by either of our political parties.
The ACA, enacted in January 2014, had the benefit of decreasing our uninsured by 24 million people, from 16% to 8% of the population. The major drawback of this program has been its failure to control costs. Health insurance companies have made record profits over the past 11 years as their customer base increased and the government paid them huge subsidies ($138 billion in 2025). The stock prices of UnitedHealth Group and Anthem, two of the largest health insurance companies, have more than quadrupled over the 11 years since enacting the ACA. By contrast, the stock prices of General Mills and United Services Automobile Association have stayed the same over this time.
The need for universal health insurance coverage of our population is obvious upon reviewing data from the Commonwealth Fund annual report. We have the worst health outcomes of the 11 countries studied, as measured by parameters such as life expectancy, chronic disease burden, and maternal and infant mortality. In addition, we spend 18% of our GDP ($5.1 trillion) on health care, nearly double the percentage of GDP of the other countries. Most experts feel that there is at least 20% waste in our system from unnecessary tests, procedures and administrative inefficiencies.
Currently, 28% of our annual federal budget ($1.9 trillion) is spent on the health care programs of Medicare, Medicaid, the VA and ACA subsidies. Together these government programs cover nearly half of our population of 343 million people. The remaining 170 million people are either uninsured or buy private insurance themselves or through their employer.
There is a simple solution to the expense and complexity problems with the ACA. Eliminate the program and offer its 24 million beneficiaries the option of Medicare enrollment with the current premium payment of $203 per month. The major benefits to Medicare enrollees are the low administrative costs compared to private plans and the built-in cost controls whereby charges for services are capped. These benefits are responsible for the relatively lower growth of costs per capita in Medicare compared to private plans. Medicare is quite popular and has a six-decade history of success.
There are multiple fragmented plans being circulated in Congress now to deal with the ACA subsidies, cuts in Medicaid funding and health care costs. What is badly needed is a bipartisan commission to propose comprehensive reforms to our healthcare system. Dr. Ezekiel Emanuel has proposed some excellent cost control measures in his Washington Post column on Dec. 2, “The Next Steps for Democrats on Health Care Are Clear.”
The key imperative for this commission would be to provide a system of universal coverage at reasonable cost. Consideration should be given to my proposal to simplify the federal programs already existing by combining the ACA into Medicare. The commission should address the additional funding needed for this proposal.
There are certainly many other things to be considered in such comprehensive health care reform planning, including a renewed push for price transparency and drug price controls. This would help consumers make better choices about what is really needed and help reduce wasteful spending. Even though most experts consider fraud to account for only 5% of Medicaid and Medicare costs, accountability efforts to decrease this are important.
Congress, let’s stop procrastinating and solve this vexing problem.
Bob Newman, M.D., of Norfolk is a family physician with more than 40 years of medical experience. He is the author of a book, “Patient’s Compass,” about how to navigate our complex health care system. Email him at fammedrocks13@gmail.com.
