With private insurance covering most of the employed and 48 million uninsured, the United States has seen health care costs skyrocket for many decades. Something had to be done, so Congress passed the Affordable Care Act (Obamacare) in 2010. Apparently, the House suddenly awakened to that fact and wanted to shut down the government to reverse history to when George W. Bush was president.
CONTRARY TO THE social media hysteria being sent out, the ACA is not a left-wing socialist program. It is built on a flawed conservative Heritage Foundation proposal that was the basis for Romneycare in Massachusetts. As opposed to what the demagogues spout, the ACA simply expands the private insurance system to cover everyone, a right-of-center concept. Until relatively recently, that was exactly what the Republican Party was advocating, per Bob Dole when he ran for president.
Regardless of the hypocrisy, the pundits are correct that the ACA will increase total costs; fail to cover tens of millions of people (partly because of the refusal of many red states to expand Medicaid because of party politics); and perpetuate the self-interested stranglehold that private insurance companies have on our health care system. And the delays in implementation, many because of politics, should tell all of us how hard it will be to install.
So what is the best alternative?
Medicare is a well-established program beloved by most Americans – Republican, Democrat or independent. It is easy to understand why that support is so strong. Go back and look at what existed before it was enacted: the free market, with older Americans thrown to the wolves.
The Darwinian notion that we simply can return to the bad old days is out of touch with modern society. The radical philosophy of Ayn Rand, formed as a reaction to the communist threat nearly a century ago, is behind the Paul Ryan/GOP health care proposals of today.
In the 1960 presidential debates, Richard Nixon called national health insurance for the elderly “socialism.” Right or wrong, even our right-leaning seniors now love it. Remember the Tea Party placards in 2009 at town hall meetings – “Keep the government out of my Medicare”?
THERE IS TREMENDOUS voter resistance to cutting entitlements (earned benefits, say some) via a Ryanesque Medicare voucher program that takes away the government guarantee of health insurance for the elderly. Having an inevitably decreasing federal ‘‘premium support,” which will
be tied to Washington partisan budget politics, should give few citizens younger than 55 little comfort.
I am a capitalist and a former Republican elected official, but we are going in the wrong direction with the simplistic Ryan approach. Health care is different than other economic markets. The “rational economic man” theory, wherein the buyer can evaluate quality and costs in a perfect world of readily available data, is just not applicable.
We should be setting up regulatory mechanisms to control costs, as other developed countries with more effective national health care systems do. That includes universal budget-setting with control of payments to providers, ensuring that compensation is equitable but not excessive.
The most efficient way to accomplish this goal is single-payer Medicare for all, funded primarily via payroll tax shared by employers and employees. The best place to find out more about single payer is from the Physicians for a National Healthcare Program:
• Private insurance companies have 31 percent administrative and marketing costs vs. 3 percent for Medicare;
• Medical bills are a major cause of bankruptcies in the United States, although most folks going broke had health insurance;
• The current breakdown of payers is not what you might think – 60 percent government; 20 percent private; and 20 percent out of pocket;
• We currently pay more per capita in taxes for government health care (Medicare/Medicaid/Veterans Adminsitration and so forth) than most nations, but we still have tens of millions uninsured.
LET’S ASK OUR politicians to finally put their ideologies aside and do what works for many other developed nations: single payer, universal Medicare.
(The writer is a retired senior health care executive with several national for-profit firms, and was the state of Georgia’s first director of health planning. He lives in Monticello, Ga.)