Healthcare in America reminds me of the three-headed dog named Cerberus who, in Greek and Roman mythology, guarded the gates to Hades. Hercules was said to have captured this monster as one of his 12 labors. Here is a description of the three menacing heads of Cerberus:

1. Healthcare in America is more expensive than anywhere else in the world today. The cost of American healthcare is also rising faster than anywhere else.
2. Healthcare availability in the U.S. is inequitably maldistributed to U.S. citizens.
3. The outcomes of expensive and inequitably maldistributed healthcare in America are no better, and in some cases, poorer in quality compared to many of our Western industrialized neighbors.

So, will a Hercules emerge from the crowded field of U.S. Presidential wannabes?

Medicare for All is being promoted by Bernie Sanders and Elizabeth Warren. Medicare already pays only about 90% of its costs to its recipients, and the other 10% is borne by private insurance companies and employers. Healthcare costs are rising at a level of 6-8% whereas inflation remains between 2-3%. If private insurance companies and employers stop subsidizing the shortages in our current Medicare system, then decreased payments to hospitals and doctors will result in the closure of many more rural and marginally-funded inner city hospitals, and there will be nearly 1,000,000 unhappy U.S. physicians making much less money than they do now. If the Medicare system stands up to cover its underages, the cost will be another $3 trillion extra dollars added to the national debt. Both Bernie Sanders and Elizabeth Warren are unabashed tax raisers who believe the extra tax burden should be borne by the rich who can better afford to do so.

Moderate Democratic candidates like Pete Buttigieg and Corey Booker believe in Medicare for Some. They would like to see those citizens who like their current private insurance obtained through their jobs or otherwise to be able to keep it, while others less fortunate can choose to join the Medicare program. Both candidates see their schemes as leading to the inevitable Medicare for All of single-payor, nationalized healthcare within the next 10 or so years. Then their plans will presumably be plagued with the same drawbacks as previously described for Medicare for All.

Kamala Harris believes that Americans should all be covered by enlarged Medicare Advantage Plans, where copays exist but are relatively small, and ancillary services such as dental and eyeglasses are supplied. These plans will be administered in partnership between the U.S. government and large healthcare organizations like Humana and United Health Care. Unfortunately, the restrictive hospital and physician networks may not be satisfactory to many patients. This plan will fall short of the ideal that U.S. citizens will be able to see whichever physicians and specialists they choose.

Biden’s plan is to reinforce the ACA by preserving and bolstering private coverage options while expanding Medicaid to ensure coverage of all those who’ve been “left over” or “left out.” Medicaid, in its present form, is “bottom of the barrel” health insurance with a limited number of providers and facilities willing to accept the unconscionably low reimbursements, and there will still be no check on the soaring costs of healthcare in this plan, which are unsustainable at their present rate of increase.

The Republicans and President Trump have been surprisingly quiet about healthcare issues, even though most voters believe their healthcare is one of the top 1 or 2 concerns in the upcoming election season. Maybe that is because they have tried to repeal and replace ObamaCare unsuccessfully year after year since 2010. President Trump favors the current inequitable system where everyone can see their own doctor, provided you are not one of the 44 million U.S. citizens without coverage. He favors skinny plans, which are low-cost alternative health plans with high deductibles and no coverage for pre-existing conditions or maternity care, previously not allowed by ObamaCare.

So, will a Hercules emerge to win the 2020 U.S. Presidential election and slay Cerberus guarding the gates to Hell? And if Cerberus were removed from the entrance and we could look inside Hades, we would probably see about 535 U.S. Congressmen running around like headless chickens, scratching in the dirt for the next vote in order to keep their jobs. There has to be a better way to solve our healthcare problem in this country! What do you think? ■