The health insurance “system” in the United States has evolved without much planning. It’s twice as expensive than it needs to be, leaves millions uninsured, and it produces inferior outcomes. Now that the Affordable Care Act (ACA, or Obamacare) is in effect, there will be improvements, including subsidized premiums, coverage for pre-existing conditions, caps on yearly and lifetime out-of-pocket medical expenses, and expanded Medicaid coverage. The ACA is a good first step, but we can do better. Working together, we can build on the ACA. We can provide simple, effective, comprehensive, low-cost health insurance that is already available in other developed countries.
Most Americans (55%) have employer-provided insurance. It’s actually an outgrowth of wage controls during World War II. But by thus increasing direct labor costs, U.S. industry has been placed at a competitive disadvantage, encouraging the offshoring and automation of good-paying American jobs. We can do better. We can place our domestic businesses on a par with foreign companies.
The ACA also keeps the crazy quilt of for-profit insurance companies with their high overhead and duplicative billing systems, and continues to allow unregulated and non-negotiated pricing by drug companies. We can do better.
The ACA expands Medicaid coverage to low-income people in some states, but nearly five million people who were supposed to be covered under the ACA won’t be, because their states (all with Republican governors) have refused to expand Medicaid. If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year, money that would be going to hospitals and treatment, and an estimated 7,000 to 17,000 people will die as a consequence. We can do better.
The ACA subsidizes premiums for lower-income people buying individual coverage, but deductibles and co-pays on some policies can still amount to several thousand dollars for a serious illness. We can do better.
Despite its klutzy introduction, the ACA is working. Problems with the federal web site and the Oregon web site are being ironed out. The ACA is becoming a success in California — a state with an already-functioning web site — so it’s almost certain it will work across the country. In California, people are signing up at the rate of 10,000 per day, and young, healthy people are enrolling – an important component of the risk pool, as described in this article.
Working together, we can build on this progress and increase the impact of successful health insurance reform.
A Path Forward and Beyond
Currently, Medicare, Medicaid, SCHIP, military TRICARE, and VA Health cover 31% of people and account for 44% of our health care spending. These programs feature low overhead and low costs and offer a foundation for a unified and simplified insurance system, known as single payer.
In 2011, the state of Vermont established Green Mountain Care that provides for such a system, starting in 2017. In Oregon, fifteen Coordinated Care Organizations have enrolled 90% of Oregon Health Plan (Medicaid) members in an groundbreaking initiative to reduce health costs, and an organization called Health Care for All Oregon is providing important and substantial advocacy for a single-payer system right here. On May 19, 2016, the Oregon Health Authority selected RAND Corp. to conduct an independent study of different ways of configuring Oregon’s health care system, including a single-payer model.
What is now called the ACA was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the Republican governor. Nevertheless, defeat and repeal of the ACA are top goals for today’s radical Congressional Republicans. This was the motivation for their 16-day shutdown of the U.S. government in October, 2013, and will likely be at the center of Republican political strategy during 2014.
Mostly, Republicans offer mis-information. Four Republican falsehoods about the ACA appeared in the top ten most-viewed fact-checks by Politifact in 2013. Their political ads in early 2014 feature false stories of people who have been hurt by the ACA.
Unfortunately, Republicans fail to offer meaningful alternatives. “No” is not a solution. The extent of their proposals is limited to helping insurance companies, by allowing them to sell policies from states with lax insurance regulations and to capping malpractice awards. Because of their dogmatic opposition to a very positive step forward for the American people, Republicans risk a resounding political defeat.
Our U.S. Representative, Greg Walden, voted for the 2013 government shutdown (costing our economy about $24 billion) and against ending it. In December, 2013, he started sponsoring fundraising ads on the Internet against Obamacare.
We believe that the radical naysayers will be shown to be in the same league as those who opposed Social Security, Medicare, child labor laws, unions, the Civil Rights Act, woman’s suffrage, the FDA, the 8 hour work day, 40 hour work week, unemployment insurance, workers compensation, public education, the EPA, conservation, seat belt laws, and so on.
Greg Walden and the rest of the Republican leadership are on the wrong side of history – and the needs of the American people.
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and not authorized by any candidate or candidate’s committee.