Let’s be frank. The Affordable Care Act sucks. It’s better than what we had before it, and better than every Republican proposal to replace it, but it still sucks. It was never going to fix the problem of healthcare costs in America, because it never really tried to. Worse, it was pushed through without bipartisan support so was never going to last long. It’s limping along doing the best it can now, while under constant assault from Republicans. Let me be clear, NO plan will ever survive without bipartisan support. Our system isn’t set up to allow it, and that’s probably a good thing.
More importantly though, it never addressed the real problem. To use a medical metaphor, America has a broken hip and the ACA is the walker that let’s America hobble around to where it needs to go. This helps, but doesn’t solve the fact that America needs a new hip. Every plan has been the same – let’s put a bandage on that sucking chest wound to stop the bleeding, and hope that it stitches itself closed.
Ok, enough with the metaphors. Let’s get specific.
The Problem
Everyone calls these bills “Healthcare” as they are intended to bring the cost of healthcare down. Except not a single one addresses healthcare costs. They are all plans to make health insurance more affordable. The big problem with this is that Insurance is what made being healthy unaffordable in the first place. It used to be that you could go to your family doctor (or your doctor came to you!) for a yearly checkup or to address some minor complaint, and then you’d pay for it out of your pocket. This was never cheap, but most people could easily afford it. Treatments weren’t that expensive, and providers would mark things up a little bit to make a profit. For instance, a splint that cost $5 would be billed at $6.50 or so. Emergencies like broken bones or worse things that required surgery cost more than could normally be budgeted for, especially since they were rarely expected. This is where insurance stepped in – to handle the big unexpected bills. You could pay small monthly premiums to insure yourself against sudden expenses that could seriously damage your finances otherwise.
Insurance companies and the Free Market is where it all went wrong. You see, for Insurance Company A to keep customers away from Insurance Company B, they need to offer better deals. They need to be able to tell potential customers that they cover more expenses and charge less for the service. To do that, they went to healthcare providers (hospitals, labs, and doctor offices) and demanded huge discounts on services. In order to do that, providers had to mark up their services to crazy levels. That $5 splint? Providers would mark it up to $20 so they could charge the insurance companies $10. As more and more insurers got into the game and competed for the best deals, providers kept raising their rates higher and higher to leave more room for various plans to have various discounts. That splint is now $100 so insurers can get charged anywhere from $25 to $75 for it. It still only costs the providers $5 so their profits are way up while making insurance companies happy with big discounts. Even better, insurance companies were happy that since $100 is now the going rates for splints, uninsured patients are charged $100 or more for $5 splints. This means people must be insured if they want to afford healthcare at all.
And, of course, some people can’t afford decent insurance plans (or any plan at all) and that is why healthcare in America is such a problem.
The Fake Solutions
So, why do I dislike the ACA and every other plan Congress has proposed? Because they all do the same thing – they try to figure out how to subsidize insurance companies so everyone can afford insurance. Let me put that another way. The government is trying to figure out how to give your tax money to insurers so that you can afford to pay those insurers out of your pocket. So… you pay the insurers what they want, just part of it comes through the government (minus administrative costs, etc.). You still pay more for healthcare than any other person on the planet, while providers and insurers get rich off you. Worse, a lot of the plans merely want you to get any insurance and don’t care if the coverage is any good.
Personally, I’m on the state insurance plan through my wife’s employer. I can’t afford to get yearly checkups since preventative care is not covered by the plan. So I have no way to know if I have a serious but preventable condition until that condition turns into a serious ailment. So a doctor’s visit and lab work that would cost a few hundred dollars isn’t covered, but once I need care that could cost tens of thousands, they step in to cover some of it. The deductible on that is still more than the few hundred dollars preventative care visit. This is horribly, horribly inefficient and crazy and is costing America billions. And those billions are the profits of the insurers and providers.
Congress has spent decades arguing about how to pay the bill without ever asking why is the bill so high. Why? Because the Healthcare industry spends more on lobbying than the Oil and Defense industries combined. Congress has ZERO motivation to change anything, as does the Healthcare industry.
So… what are our options? There aren’t many.
The Single-Payer System
A single-payer national health insurance is the best instrument for a big reform because while it is still focused on making insurance affordable, it does so in a way that will bring actual healthcare costs down. It brings efficiency back to a bloated for-profit system, as well as freedom of choice and eliminates all barriers to care such as co-pays and deductibles. There are many ways to implement a single-payer system, but before we get into the one floating around congress, let’s discuss the basics.
All “single-payer” means is that all essential healthcare costs would be covered by a single public system. Americans would pay for the system through taxes, and everyone would have their healthcare covered by this one system. That’s it. Healthcare providers wouldn’t have to deal with a myriad of insurance companies with various co-pays and deductibles. If nothing else, providers would have their administrative costs extremely reduced as the whole payment process would be streamlined and simple to understand. Since the public plan would be the only plan out there, it would have a huge advantage when settle on healthcare prices. It can set a single set of rules for services provided, reimbursement rates, drug prices, and minimum standards of required services. Also, everyone is paying into a single risk pool which means everyone can get insurance no matter how healthy or not they are.
Medicare for All
Medicare for All is the specific plan currently being discussed in government circles and is slowly gaining support. The goals are to provide universal healthcare, decrease the burden of healthcare costs, and improve the quality of care available. The plan is for a federally administered program that would cover all healthcare costs and work with all healthcare providers (no more out-of-network excuses to gouge you). No more co-pays, deductibles, or figuring out which services are covered or not.
How is this being paid for? The theory here is that we as Americans are already paying WAY too much for healthcare, even if we have good insurance plans. Between co-pays and deductibles, most of us are paying a lot out of our pockets. Many of us have insurance through our employers which lets us pay for insurance at a greatly reduced rate because our employers are subsidizing the rest of the bill. Universal Healthcare means we no longer have out-of-pocket costs, and businesses no longer have to subsidize their employees healthcare insurance. The savings to both consumers and businesses should more than cover the new “health care premiums” charged to employers and households. Additionally, changes in the tax code that more or less undo all the tax breaks for the wealthy the Republicans just passed plus closing loopholes and changing the basic income tax rates (mostly raising them on the wealthy) will raise enough revenue to cover the difference. Oh, and several tax breaks already on the books would go away as unnecessary under the new system and that’ll save billions.
It is important to note that this is NOT socialized medicine as some critics will insist on claiming. Socialized medicine would be if the government were employing the doctors and running the hospitals as well, such as with the Veterans Administration healthcare system. If anything Medicare For All is a “social insurance” that utilizes the private healthcare industry as it exists. So you will not have the government dictating what healthcare you can get and where, they will just be guaranteeing that your healthcare will be paid for.
Inconclusion
The healthcare system in this country is very sick and Congress is largely arguing about how to pay for its care rather than making it better. I feel like I’ve been writing a while and have barely scratched the service of the myriad problems in the system. I’ve barely even mentioned the drug companies making billions off of subsidized research due to extremely friendly patent laws. Even if they somehow fix the ACA so it lives up to its promise, there are myriad inefficiencies in the healthcare industry that work as a constant drag on it and any other plan proposed. This is why despite what we pay for it, it’s not the best healthcare in the world. In many respects, the US healthcare quality is below the average of other developed nations. But we pay far, far more.
The more I look into healthcare, the more I can’t see why there is any resistance to Universal Healthcare plans. Sure, the details will always need to be worked out, but Medicare For All seems like a complete no-brainer to me. It will improve almost every aspect of American life and has few disadvantages. This leaves me wondering if I’m just not able to escape the liberal bubble no matter how hard I try. This really is a case where I just don’t understand the other point of view.
So if you don’t think Medicare For All (or some other Universal Healthcare plan) is the answer, please tell me what I’m missing.