Obamacare Debate: Flowers vs. Baker

The Real News, October 1, 2013

JESSICA DESVARIEUX, TRNN PRODUCER:  With us to discuss the Affordable Care Act are Dean Baker and Dr. Margaret Flowers. Dr. Flowers joins us in-studio. She’s a pediatrician in the Baltimore area and the Maryland chapter of Physicians for a National Health Program cochair, and she’s the secretary of health for the Green Shadow Cabinet… And joining us from Washington, D.C., is Dean Baker. He’s the codirector of the Center for Economic and Policy Research.

DEAN BAKER, CODIRECTOR, CEPR:  There’s lots of grounds for criticizing the ACA. But this is a huge step forward. We’re going to have tens of millions of people that will be able to get insurance who haven’t had it previously. And, again, for the 100-plus million who are now insured, they will actually have real insurance, because if they do get sick, lose their job, they’ll still in most cases be able to get affordable insurance through the exchanges. So I have to see that as a big step forward.

DESVARIEUX: Okay. Let’s have Dr. Flowers respond to that. Do you see that as a step forward?

DR. MARGARET FLOWERS, COCHAIR, PNHP:  No, I actually see the Affordable Care Act as a step backwards. It takes us farther in the direction of privatized health care. And the way that we really need to go is towards greater–a publicly financed universal health care system. That’s the most efficient and most equitable way to provide health care…

BAKER: Well, it’d be great to have, you know, universal Medicare, but that wasn’t about to be coming. So basically our choice is having health care provided through private insurers or not having it at all. And the fact is, we have 100-plus million people who get most of their health care through private insurers now. And yeah, they do lots of bad things, but the alternative is not getting it all. So I can’t somehow tell people they’re better off not getting health care than having it provided through private insurers, as much as I may not like them.

DESVARIEUX: But is that true? Is that really the alternative? We only have two choices here?

FLOWERS: No. And, actually, during the health reform debate, a point that we were making, especially towards the end when it looked like the Affordable Care Act was going to go through, was don’t give hundreds of millions of dollars in subsidies to private insurance companies where they’re going to hang on to a lot of that and still deny people care. We should be giving that to our public programs to expand them more and really shift us in the direction we need to go, towards a greater publicly financed health care system.

Part of the reason that the Affordable Care Act went through is that it wasn’t challenged by people on the left, by people that supported single-payer. People were told, well, this is all that we can get, and so they accepted that.


The Single-Payer Alternative

By Nancy Folbre
The New York Times, November 25, 2013

Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.

Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges.

In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.

The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage.

David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, regularly assert that elimination of the huge paperwork and overhead imposed by private insurance companies could save enough to cover the estimated 31 million of Americans who will remain uninsured under the Affordable Care Act.

My fellow Economix blogger Uwe E. Reinhardt, expanding on this theme, notes that the Institute of Medicine of the National Academy of Sciences recently estimated excess administrative costs of $191 billion, again more than enough to attain truly universal health care coverage.

Most such estimates are limited to the monetary costs incurred by insurers, doctors and hospitals and don’t include the value of the time that health care consumers must devote to managing a torrent of inscrutable paperwork that can become truly frightening for the critically ill.

A single-payer insurance system, whether based on an extension of Medicare or on the Canadian model, promises many profoundly important benefits. Right off the mark, it promises simplicity.

No wonder conservative pundits are afraid of it.

(Nancy Folbre is professor emerita of economics at the University of Massachusetts, Amherst.)


Experts across the political spectrum have long understood how much more effective a single payer system would be in achieving our goals of universality, comprehensiveness and affordability than is our current financing infrastructure that was left in place by the Affordable Care Act. When this fact was so obvious at the time reform was being crafted, even to President Obama, then why did we reject single payer in favor of our highly flawed system?

It was the progressive community, of all people, that took it off of the table. The words of Dean Baker echo the prevailing view of many progressives at that time: “Well, it’d be great to have, you know, universal Medicare, but that wasn’t about to be coming. So basically our choice is having health care provided through private insurers or not having it at all.”

So the view was, single payer is the system that will work for us, so let’s choose between expanding our current dysfunctional system of private insurers or let’s have nothing at all. Talk about a non sequitur!

Two developments stem from this unwise choice in reform, both related to how unsatisfactory the policies are – costly but all too ineffective. On the one hand, the conservatives opposed to any effective reform are telling us that things are in such a mess that we will have to resort to single payer to bail us out. On the other hand, many progressives, like Professor Nancy Folbre, are now motivated to speak up in favor of single payer since the Affordable Care Act clearly is going to fall intolerably short of our goals. Most moderates and even some conservatives understand the imperative of single payer.

The point is that now is the time to talk about single payer, with a loud and clear voice. As the deficiencies in the Affordable Care Act become ever more obvious to the public at large, they need to know that there is a way out. Let’s hear it, loud and clear now: We should have gone for single payer… and we still can!