President Obama has been almost giddy, with good reason, about the success of the Affordable Care Act, aka Obamacare. After a rocky start, the president celebrated the numbers: more than 11 million people now have insurance because of the Health Insurance Marketplace, his expansion of Medicaid and the Children’s Health Insurance Program.
Supporters of Obamacare should be cautious, however, because the ACA is doomed to fail, though it will succeed at the same time. To understand why, it is necessary to review the health care mess we had before the ACA, why the ACA will not solve this mess, and what can be done to make health care truly available and affordable to everybody.
Before the ACA, we had a deny-care system instead of a health care system. The health insurance companies were virtually unregulated and used their independence to enroll people who were unlikely to need medical care, to refuse payment of claims, or to drop coverage, often on minor technicalities, and to move individuals to policies with high deductibles and co-pays to reduce their payouts. The insurance companies’ goal was to avoid paying claims by denying care.
This deny-care system produced arguably—and perhaps unarguably—the worst health care system of any developed country, with outcomes at or near the bottom in most categories. We have had at least 43 million people uninsured in the U.S. since 2005 leading to about 45,000 unnecessary deaths per year due to lack of medical care and untold pain and suffering.
One point that is not arguable is that the United States, by a wide margin, has the most expensive health care system in the world. This expense causes people to forgo necessary medical care, and causes or contributes significantly to more than 60 percent of personal bankruptcies.
The ACA provides some benefits. It mitigates some of the problems caused by our deny-care system. It makes health insurance affordable for some who previously could not afford it or were unable to get it, and for the first time consumers have some protections. The ACA also expands Medicaid, providing health care for millions of struggling Americans. Further, the ACA mandates that some preventive procedures be provided without co-pays or deductibles, making health care even more affordable.
Despite the benefits, the ACA has serious problems. Many people will be left without insurance. The Congressional Budget Office estimates that by 2024 there will be 31 million uninsured, although this is an improvement over the millions more who would lack insurance without the ACA. There are still deductibles and co-pays under the ACA. These out-of-pocket expenses are high ($6,350 for individuals and $12,700 for families), so financial hardship and bankruptcy are still likely. Additionally, many policies in the ACA Marketplace severely restrict users’ choice of physicians and hospitals.
Finally, the ACA is unlikely to bend the cost curve. Gerald Friedman, an economist at the University of Massachusetts, Amherst, describes the ACA’s efforts this way:
“The Affordable Care Act has a whole lot of the…Jackson Pollock school of health policy. Throwing a whole lot of things against the wall and hoping that some of them will help in controlling costs… They have had a lot of whistling in the dark and wishful thinking.”
For all it flaws, the ACA will be successful because it mitigates a few of the worst problems of the current system, and is better than what consumers had before—nothing. It will fail when people discover that it does not provide universal coverage or prevent financial ruin.
What will doom the ACA is that it has to operate within the heinous deny-care system; a system so broken that nothing can fix it. That is why single-payer is needed. Single-payer is not a solution to the health-care crisis in this country–it is the only solution that can heal our system by making health care affordable and available to all.
The advantages of single-payer are many. Everybody is covered and enrollment would be automatic, removing the need for websites.
Single-payer eliminates out-of-pocket expenses because co-pays and deductibles are not required, making health care available and affordable to everybody. .
Single-payer covers more services than the ACA. It covers all necessary medical procedures and services, mental health services, prescription drugs and medical equipment. For example, adult dental services are covered under a single-payer system, but not under the ACA.
Single-payer provides more freedom of selection since you can choose any medical professional or hospital without restriction, unlike the limits imposed by insurance networks.
A single-payer system saves money for most people. According to Friedman, 95 percent of the population would spend the same or less on health care.
Single-payer also saves the country money. Friedman calculates that by 2023, single-payer would cost $1.5 trillion less than the current system. Single-payer stabilizes costs over the long-term. Without single-payer, costs will continue to rise, making health care unaffordable, and, according to Friedman, nobody will get a pay raise “because health care will swallowed up all the increase in compensation.”
The threat of excessive health care spending cannot be overstated; with or without the ACA, we spend at least $870 billion per year more than necessary.
One expert states that there is no potential debt problem from “out-of-control spending on food stamps” or other similar programs. “All of the long-term problem is health care spending. If health care spending continues to rise at that rate that they [Congressional Budget Office] use in the very long-term decades-out forecast, then you will have an actual debt problem,” says Neil Buchanan, an economist and lawyer whose expertise includes taxes, debt, and the federal budget.
For these reasons, the question is not whether we move to single-payer, but when. We cannot afford anything else, which is why experts such as Buchanan and Friedman endorse single-payer. It is time for the country to save lives, reduce costs, and provide universal coverage. We should not wait until a year from now, a day from now, or even an hour from now. We need to start right now.