Shrink Greed, Not Medicaid: Why Cutting Care for 20 Million Is Wrong for America

Cut the greed, not the care — America’s health crisis isn’t Medicaid, it’s corporate profiteering.

Last month, the House passed a budget resolution that would cut health care spending by around $90 billion a year over the next decade. Republicans on the House Energy and Commerce Committee will have to figure out details. We think most Americans would prefer to cut price-gouging and greed out of health care than people out of Medicaid.

As physicians with decades of clinical and health administration experience, we know that the U.S. spends too much money on health care. Since we graduated from medical school, the percentage of national spending on health care has more than tripled, to around 17%, twice the average of other prosperous countries where people live longer and healthier and have fewer administrative barriers to get care. We pay more and we get less.

Is cutting the number of Medicaid recipients the best way to reduce federal health care spending? Absolutely not. Medicaid is a program that improves health. For the young and poor, it provides “ounces of prevention” that reduce later spending on “pounds of expensive cure.” Pregnancy care prevents fetal deaths and life-altering complications. Senior care keeps the elderly as safe and healthy as possible in their waning years. We have personally cared for hundreds of patients whose health was improved and whose lives were changed by Medicaid.

Cuts to Medicaid could take coverage away from up to 20 million people, with devastating impacts on children, low-income workers, the elderly and their families. To cut tens of billions of dollars annually from health care spending without harming the health of Americans, we have to attack greed in health care - rampant price-gouging and profiteering.

Here are some ways to cut health care spending without causing fear, pain and lack of access to care.

• Cut prices on more drugs now. Originally, some pharmacy benefit managers helped cut prices, but now PBMs mostly increase profits for their affiliated insurers. Americans should pay no more for medications than citizens of other prosperous countries.

• Eliminate upcoding, or service code gaming in Medicare Advantage, which allows giant insurers to increase their profits. 

• Reduce misleading and inaccurate ads during the Medicare open enrollment period.

• Decrease the allowable percentage of insurance revenues that go for “administration” instead of medical care from 15% to 10%.

• A number of other recommendations can be found in a recent report by Dr. Don Berwick and colleagues.

These and other measures could help American health care come closer to becoming USA – Universal, Simple, Affordable. Many Republicans and Democrats understand that excessive complexity and unaffordability are the biggest problems in America’s health care today.

Sadly, the odds of success in attacking health care greed are low. Health care’s “special interests” – big insurance, big drug companies, big hospital systems, big medical associations – throw big money into politics through misleading advertisements, lobbying and campaign contributions. Their moneyed voices have more influence than the 20 million ordinary Americans threatened with the loss of Medicaid coverage.

Greed steals from need. People’s health and patient care are damaged by profit-oriented systems that promote complexity over simplicity. Major illnesses quickly and unexpectedly overwhelm family budgets, adding to the financial burden of millions of American families.

Shrinking Medicaid to expand tax cuts for the ultra-wealthy is a national disgrace. Billionaires do not need more tax cuts, but people on Medicaid depend on it for their health care. And if lawmakers want to take on the waste, fraud, and abuse in the health care system they should look at the big insurance companies that make billions in profits, not the vulnerable communities that depend on Medicaid. Save access to Medicaid for all who need it. Diminish greed in health care to reduce federal spending, decrease personal health care costs, and improve everyone’s health.

Dr. Ken Frisof is a retired family physician in Cleveland, Ohio, and a long-term health care justice advocate. Dr. Donald Lighter is a retired pediatrician and health care executive in Knoxville, Tennessee.