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By Margaret Flowers, M.D.
The Indypendent (New York City), Oct. 30, 2013 The battle lines have been drawn and the Inside-the-Beltway media circus is underway. As the Affordable Care Act (or “Obamacare,” as it is popularly known) gets off to a rocky start, Republicans are bellowing that the new health care law should be jettisoned, even though it is modeled on ideas hatched 20 years ago by the conservative Heritage Foundation and originally backed by the likes of Newt Gingrich and Mitt Romney. Meanwhile, the Obama administration insists that once a few computer “glitches” are resolved in the healthcare.gov website by the end of November, everything will turn out swimmingly. “Don’t worry, these plans will not sell out,” President Obama said in late October. “Everyone who wants insurance in the marketplace will get it.” Lost amid the noise is the fact that not only could we adopt a simpler, more effective single-payer system that is common to other industrialized nations — more about that below — but also that we are witnessing perhaps the greatest corporate scam ever. Not only did the health insurance corporations write the Affordable Care Act in 2009-2010 to enhance their profits, but now they also have the government and non-profit groups doing the work of marketing their shoddy products. The foundation of Obamacare, the mandate that uninsured individuals purchase private insurance if they do not qualify for public insurance, goes into effect in 2014. The state health insurance exchanges where people can purchase that private insurance opened on October 1. A new organization called Enroll America was created to organize and train grassroots activists to seek out the uninsured (they even provide maps) and assist them in using the exchanges. The Uninsured Can you imagine this scenario with any other industry? Billions of public dollars and tremendous efforts are being spent to create new health insurance markets, advertise them, subsidize their products and actively solicit buyers for them. This is being done with the belief that the solution to our health care crisis is to reduce the number of people who are uninsured. But our health care crisis runs deeper than that. And having health insurance in the United States isn’t the same as having access to necessary care. Obamacare does not resolve the fatal flaw in our health system — that it is a market-based system rather than a public health-based system, as is the case in all other industrialized nations. Market competition does not improve health outcomes because it consists of health insurance corporations competing for profits by selling policies to those who are the healthiest and denying and restricting payment for care. And regulation of insurers doesn’t work either. Although rules in Obamacare give the appearance of changing insurance company behavior, insurers are already working around them. Remember, the health insurers wrote the rules. This illusion that the health insurance corporations are regulated under Obamacare is one of the reasons that progressives have been seduced to accept a market- based health system rather than continuing to push for the system most of them desire, a single-payer Medicare-for-all national health program. Defenses of Obamacare ignore the long history of private insurance domination and are based on the hope that this time things will be different. But Obamacare has not changed the fact that private insurance companies view their plans as products and have no more allegiance to human health than does Big Energy, which will stop at nothing to drill, frack and blow up the planet for profits. Experience at the state level with similar reforms and a look at current health trends show that Obamacare will leave tens of millions without insurance, will increase the percentage of people who are underinsured, will increase financial barriers to necessary care and will further privatize health care. Cutting out the multitudes of insurers and creating a single publicly-financed universal health care system is the only way to solve our health care crisis. Tweaking the System During and after the health reform process, the President explained that since most people were happy with their health insurance, we should work with the present health system to improve it. This was the reason given for not enacting a Medicare-for-all system. From the outset, it is important to realize that 80 percent of the population is generally healthy and that this is the population that private insurers prefer to enroll. People may believe that their coverage is satisfactory, until they have a serious health problem and discover that the out-of-pocket costs and restrictions on their care make necessary care unaffordable. Is it wise to try to tweak the current system? Will that bring us to universal coverage? The answer is no. About the best that has been achieved by tweaking the present system at the state level is reducing the number of uninsured people by half. That is what happened in Massachusetts, where legislation similar to Obamacare was passed in 2006. There are currently 48 million uninsured people in the United States. At its best, the Congressional Budget Office estimates that Obamacare will leave 31 million people without health insurance when it is completely rolled out. And even that estimate may be too low. Experience at the state level showed that none of the plans that were similarly hailed as comprehensive met their coverage goals before they failed fiscally. Without effective cost controls, care remains unaffordable. Shifting the Costs As health care costs have soared in the United States, the trend in health insurance coverage has been to shift more of the costs onto the individual. This has primarily been done through what are called Consumer-directed Health Plans (CDHPs), which require co-pays, deductibles and co-insurance. This means that patients have to pay thousands of dollars in addition to their premiums before and after their insurance kicks in. These up-front costs are barriers to care. Considering that 76 percent of Americans are living paycheck to paycheck without significant savings, the money simply isn’t there to pay for visits to the doctor, tests or prescriptions. A health survey by the Commonwealth Fund last year found that 80 million people reported not getting care due to cost, 75 million were having difficulty paying medical bills and four million (over two years) went into bankruptcy as a result. The result of CDHPs is that patients self-ration by avoiding or delaying necessary care. And so many people are currently self-rationing that the rise in health care spending in the United States has slowed over the past five years. Reducing access to necessary care is not the kind of cost-control that should be promoted, but Obamacare does just that. The health insurance exchanges sell four tiers of coverage, identified by metals. The lowest levels, silver and bronze, will pay for 70 and 60 percent of covered services once deductibles are met. “Covered services” is the key phrase. Health insurers are restricting their provider networks for plans sold on the exchanges to exclude places where sick people go, large health centers and safety-net hospitals, and to limit the number of doctors. This will force people to go out of the network and bear more or perhaps all of the cost of their care. The silver and bronze plans have lowered the bar on what is considered coverage. These are levels that will leave people at risk of financial ruin if they have a serious accident or illness. And these are the levels that most people will purchase. Subsidies are available for those who qualify based on the price of a silver plan, and because the subsidies are inadequate, peop le will migrate to the cheapest plans. This model means that people will still get the care they can afford rather than the care they need. It means that more people will have insurance but will not be able to afford care. In Massachusetts, eight out of 10 people who see themselves as “sick” report that health care costs are a serious problem for them. That’s quite a gift to the insurance companies. Millions of new customers will pay premiums, and because of the out-of-pocket costs, may not actually use health services. A cap on out-of-pocket costs was included in Obamacare, but has been delayed for a year because insurers said their computer systems were not ready to manage the caps. Thousands of Waivers The delay on out-of-pocket spending caps is one of the tricks that insurers are using to protect their profits. They have used many others, and we can expect more. Obamacare was written with the help of large insurance corporation lobbyists and others from health industries. The reform process was led in the Senate Finance Committee by Liz Fowler, a former WellPoint executive and Senate staffer. After Obamacare was signed into law, Fowler was transferred to the Department of Health and Human Services (HHS) to oversee the regulations. Insurance representatives have also played an active role at the state level in forming the exchanges. It is no secret that most state insurance commissioners have close ties to the industry. The effect that this level of industry influence has had is that thousands of waivers have been issued by HHS to water down provisions in the bill and the industry has participated in writing definitions of terms to their advantage. For example, one area of tension concerned the requirement that insurers spend 80 to 85 percent of what they collect in premiums on health care (called the Medical Loss Ratio, MLR). This requirement simply led to a redefinition of care, and the term was interpreted so broadly as to include insurance brokers. Dr. John Geyman of Physicians for a National Health Program writes, “The insurance lobby won a number of concessions, including counting expenses of quality assurance as medical costs, allowance to deduct many of their taxes from their total premiums before calculating their MLR, and the ability to appeal for a lower MLR standard for up to three years in states where ‘there is a reasonable likelihood that market destabilization could harm consumers.’” Perhaps one of the most egregious examples of insurance company behavior took place six months after Obamacare was signed. At that point, by law, insurers were no longer allowed to deny new policies to children on the basis of pre-existing conditions. Faced with a potential reduction in profit margins, many health insurers simply stopped selling new policies for children. In essence, they pulled the product from the shelf. HHS was able to entice the insurers to sell policies again by offering increased premiums and limiting open enrollment periods. This is one of the ways that insurance corporations cherry pick only the healthiest people. Under Obamacare, some large insurers are avoiding most of the insurance exchanges and are focused instead on offering plans to employers or serving as benefit administrators. Another method is restricting networks to avoid facilities that care for the sickest or by reducing the number of providers in a plan. And the third will be to pull out of geographic areas if they prove to be money-losers. Insurers are not allowed to charge more for people with pre-existing conditions, but they are allowed to charge more for smokers, up to three times more based on age and more in geographic areas where health care costs are high or the population has greater medical needs. As it is with markets, health insurers will sell their products where they can make the most profit. We will watch and see what insurers do over the coming years. We can expect them to justify charging higher premiums. In the past, they have reduced premiums temporarily to lure people in or avoid government intervention and then raised them later. We can expect them to push for lower levels of coverage or fewer required services. And we can expect that HHS and state insurance commissioners will be compliant, as they have been. Towards Greater Privatization Another myth used to lure progressives to support Obamacare is to say that it is a step in the right direction, meaning towards universal coverage. But Obamacare is actually a step towards greater privatization of our entire health system. It lacks provisions to stop the consolidation of ownership of health facilities by large for-profit entities, something that large insurers are doing more. It cuts funding to safety-net hospitals. And under Obamacare, public insurances are becoming more privatized. Medicaid is state health insurance for people with low incomes. More states are moving their Medicaid patients into managed care organizations (MCOs). MCOS, such as Amerigroup which was bought by WellPoint after Obamacare passed, are for-profit administrators that compete with each other to cover the healthiest patients and are incentivized to cut care. Currently 75 percent of Medicaid patients are in MCOs and that number is expected to increase further under Obamacare. Medicare is public insurance for people 65 years of age and older and who are disabled. One of the early goals of Obamacare was to cut back on Medicare Advantage plans, which are essentially private insurance plans paid for through Medicare. The Advantage plans primarily insure the healthiest seniors and cost more than traditional Medicare. Instead of cutting back, the Obama administration boosted payment to the Advantage plans. And enrollment in the plans has increased by 30 percent since 2010. There is good reason to suspect that Medicare may be completely privatized in the coming years by being turned into a defined premium plan rather than the defined benefit plan that it is now. This means that seniors would receive a certain amount of money each year to purchase private insurance instead of knowing each year that they would have Medicare with its required benefits. This is the plan being pushed by Republican Congressman Paul Ryan. The idea came out of the National Commission for Fiscal Responsibility and Reform created by President Obama in 2010. Not the Reform We Need Looking at Obamacare from a distance, it is difficult to see it as anything more than a law designed by and for the health industries that profit from the current health system. The regulations can be circumvented or waived. The insurers can continue to find innovative ways to avoid the sick and not pay for care. And overall the system is becoming more privatized, which is the opposite direction from the real solution, Medicare for all. Medicare for all, also called single-payer, would create a health system that treats health care as a public good rather than as a commodity. The system would be paid for up front through progressive taxation. There would be no premiums or out of pocket costs, so while taxes would be higher, people would be able to get the health care they need rather than being limited to what they could afford. In a Medicare-for-all system, every person in the United States would be in the system from birth to death and it would cover all necessary care. It would be much simpler to use because there would be one set of rules and all health professionals would be included. People would have more choices of where to go for care and would be able to change jobs or travel freely without worrying about not being covered. Barriers to receiving care would be removed. There would be no more worries about whether a person qualifies for this or that because everyone would have access to the same standard of care. Current health care spending in the United States is more tha n adequate to pay for a Medicare-for-all system. This has been proven time and again in studies at the state and national levels. In fact, a Medicare-for-all system would allow better management of our health care dollars and the ability to negotiate for fair prices for medications and services. And Medicare for all would have a broader impact on our public policy because the bottom line would be public health rather than profits. Clean air and water, access to healthy food and fewer toxins in consumer products would reduce health care spending rather than padding the pockets of the health industry. The work for Medicare for all continues. There is a bill, HR 676, in the House of Representatives that is collecting co-sponsors and which outlines a Medicare-for-all plan. Single-payer groups throughout the country continue to press forward. And Physicians for a National Health Program will continue to document the problems with our health system and educate about Medicare for all. It’s crucial that single-payer supporters continue to articulate what a real solution to our health care crisis would look like and not silence themselves out of a misguided desire to shield Obama and the Democrats and the poor decisions they have made from attacks by Republican demagogues. We cannot cross our fingers and hope that Obamacare “works.” That attitude means hundreds of thousands will suffer and die from preventable causes and millions of families each year will continue to go bankrupt because of medical illness and costs. The moral imperative is to realize that health care never has been and never will be a commodity and to stop treating it as such by taking it out of the marketplace altogether. Margaret Flowers is a pediatrician and co-chair of the Maryland chapter of Physicians for a National Health Program. She serves on the board of Healthcare-Now and of the Maryland Health Care is a Human Right campaign. She is also an editor at popularresistance.org. https://indypendent.org/2013/10/30/health-care-market-madness

GOP base doesn’t understand right wants to turn Medicare, Social Security and more into a very similar program

By Michael Lind
Salon, Oct. 28, 2013 The smartest thing yet written about the botched rollout of the Affordable Care Act’s federal exchange program is a post by Mike Konczal of the Roosevelt Institute at his “Rortybomb” blog at Next New Deal.  Konczal makes two points, each of which deserves careful pondering. The first point is that to some degree the problems with the website have been caused by the overly complicated design of Obamacare itself.  Instead of being a simple, universal program like Social Security or Medicare, the Affordable Care Act system is designed as if to illustrate Steven Teles’ notion of “kludgeocracy” or needless, counterproductive complexity in public policy.  By using means-testing to vary subsidies among individuals and by trying to match individuals with private insurance companies, the ACA requires far more information about people who try to sign up than do simpler public programs like Social Security and Medicare.  If Congress had passed Medicare for All, the left’s preferred simple, universal alternative to the kludgeocratic ACA mess, signing up would have been a lot easier and the potential for website snafus correspondingly less. Konczal’s second point is even more important — the worst features of Obamacare are the very features that conservatives want to impose on all federal social policy: means-testing, a major role for the states, and subsidies to private providers instead of direct public provision of health or retirement benefits.   This is not surprising, because Obamacare’s models are right-wing models — the Heritage Foundation’s healthcare plan in the 1990s and Mitt Romney’s “Romneycare” in Massachusetts. This point is worth dwelling on. Conservatives want all social insurance to look like Obamacare.  The radical right would like to replace Social Security with an Obamacare-like system, in which mandates or incentives pressure Americans to steer money into tax-favored savings accounts like 401(k)s and to purchase annuities at retirement, with means-tested subsidies to help the poor make their private purchases.  And most conservative and libertarian plans for healthcare for the elderly involve replacing Medicare with a totally new system designed along the lines of Obamacare, with similar mandates or incentives to compel the elderly to buy private health insurance from for-profit corporations. If you don’t like Obamacare, you should really, really hate the proposed conservative alternatives to Social Security and Medicare.  Konczal writes:     “Conservatives in particular think this website has broad implications for liberalism as a philosophical and political project. I think it does, but for the exact opposite reasons: it highlights the problems inherent in the move to a neoliberal form of governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism. This point is floating out there, and it turns out to be a major problem for conservatives as well, so let’s make it clear and explicit here.” Building on an insightful discussion of public policy by means of subsidies or “coupons” published by the New America Foundation’s Next Social Contract initiative, Konczal contrasts the indirect, market-based, state-based  neoliberal/conservative approach to social insurance that inspired Obamacare with the kind of universal federal social insurance preferred by liberals in the tradition of FDR and LBJ:     “So this tells a story. Let’s refer to these features of social insurance, which are also playing a major role in the rollout problems, as ‘Category A.’ Now, what would the opposite of this look like? Let’s define the opposite of this as ‘Category B’ social insurance. And let’s take these two categories and chart them out.” Konczal speculates that the flaws of Obamacare may undermine public support for proposed conservative replacements of Social Security and Medicare:     “However, the smarter conservatives who are thinking several moves ahead (e.g. Ross Douthat) understand that this failed rollout is a significant problem for conservatives. Because if all the problems are driven by means-testing, state-level decisions and privatization of social insurance, the fact that the core conservative plan for social insurance is focused like a laser beam on means-testing, block-granting and privatization is a rather large problem. As Ezra Klein notes, ‘Paul Ryan’s health-care plan — and his Medicare plan — would also require the government to run online insurance marketplaces.’ Additionally, the Medicaid expansion is working well where it is being implemented, and the ACA is perhaps even bending the cost curve of Medicare, the two paths forward that conservatives don’t want to take.” Will the flaws of Obamacare really hurt the right and help center-left supporters of universal social insurance?  I doubt it. To begin with, this implies a willingness of the right to acknowledge that Obamacare, in its design, is essentially a conservative program, not a traditional liberal one.  But we have just been through a presidential campaign in which Mitt Romney, who as governor of Massachusetts presided over the creation of the most important model for Obamacare, rejected any comparison of Romneycare with Obamacare.   What is more, instead of agreeing with Konczal that the flaws of Obamacare are shared by most conservative entitlement reform proposals, conservatives are likely simply to denounce Obamacare as “socialism” or “collectivism” while promoting their own, Obamacare-like replacements for Social Security and Medicare, with blithe indifference to their own inconsistency. Nor are progressives likely to press the point in present or future debates.  Unlike conservatives, who are right-wingers first and Republicans second, all too many progressives put loyalty to the Democratic Party — most of whose politicians, including Obama, are not economic progressives — above fidelity to a consistent progressive economic philosophy.  These partisan Democratic spinmeisters are now treating Obamacare, not as an essentially conservative program that is better than nothing, but as something it is not — namely, a great victory of progressive public policy on the scale of Social Security and Medicare. In doing so, progressive defenders of Obamacare may inadvertently be digging the graves of Social Security and Medicare. If Obamacare — built on means-testing, privatizing and decentralization to the states — is treated by progressives as the greatest liberal public policy success in the last half-century, then how will progressives be able to argue against proposals by conservative Republicans and center-right neoliberal Democrats to means-test, privatize and decentralize Social Security and Medicare in the years ahead? I predict that it is only a matter of time before conservatives and Wall Street-backed  “New Democrats” begin to argue that, with Obamacare in place, it makes no sense to have two separate healthcare systems for the middle class — Obamacare for working-age Americans, Medicare for retired Americans.  They will suggest, in a great bipartisan chorus:  Let’s get rid of Medicare, in favor of Lifelong Obamac are!  Let’s require the elderly to keep purchasing private insurance until they die! I’m sure a number of token “centrist” Democrats will be found, in due time, to support the replacement of Medicare by Lifelong Obamacare.  And with neoliberal Democratic supporters of the proposal as cover, the overclass centrists of the corporate media will begin pushing for Lifelong Obamacare as the sober, responsible, “adult” policy in one unsigned editorial after another. Once Medicare has been abolished in favor of Lifelong Obamacare, perhaps by a future neoliberal Democratic president like Clinton and Obama, Social Security won’t last very long. The conservative Republicans and centrist Democrats will argue that the success of Obamacare, in both its initial version and the new and improved Lifelong Obamacare version, proves that a fee-based, means-tested, privatized and state-based system is superior to the universal, federal, tax-based Social Security program enacted nearly a century ago in the Dark Age known as the New Deal.  We will be told that, in a world with computers and globalization and apps or whatever, simple, universal, one-size-fits all social insurance is obsolete.  In the “new economy,” public policy needs to offer as many baffling choices as airlines or gyms, like the ridiculous bronze, silver, gold and platinum plans of Obamacare. At some point in the future, the right will introduce a plan to replace Social Security with a system of individual mandates and fines to compel working-age Americans to invest in for-profit Wall Street mutual funds during one’s working years, and to compel them to buy annuities from for-profit money managers at retirement (which with the help of centrist Democrats will be postponed to 70 or beyond).  The genuine progressives will respond with a defense of Social Security.  Whereupon the faux-progressives, the neoliberal heirs of Carter, Clinton and Obama, will reject the option of preserving Social Security — why, that’s crazy left-wing radical talk! — but insist that the subsidies for the poorest of the elderly be slightly increased, as the price for their adoption of the conservative plan to destroy Social Security.  Throughout the process, the right-wing Republicans and neoliberal Democrats will ask, “How can progressives object to means-testing, privatization and 50 state programs, when those are the very features of the Obamacare system that our friends on the left celebrate as a great achievement?” Think about it, progressives.  The real “suicide caucus” may consist of those on the center-left who, by passionately defending the Affordable Care Act rather than holding their noses, are unwittingly reinforcing the legitimacy of the right’s long-term strategy of repealing the greatest achievements of American liberalism. Michael Lind is the author of “Land of Promise: An Economic History of the United States” and co-founder of the New America Foundation. http://www.salon.com/2013/10/28/what_the_tea_party_misses_if_you_hate_obamacare_youll_really_hate_what_the_right_wants_to_do_to_social_security/

By David Freudberg
The Huffington Post, Oct. 28, 2013 Advocates of a single-payer health system have long touted what they see as its cost-saving advantages. In light of the recent Obamacare rollout, they would be justified in citing another benefit as well: simplified sign-up. An easy shorthand for single-payer is Medicare for All. The concept is to take a health coverage system that is highly popular and generally works well and just expand it. Without reinventing the wheel, simply lift the age restriction for Medicare eligibility. Instead of covering only seniors, single-payer champions urge allowing everyone to be covered by a federal system — the way health care is provided in basically every other industrialized nation. For example, in Canada’s single-payer system, you select your own doctor (and if unsatisfied, you pick a new one). There are some limitations on what services a patient can get when, but they’re apparently not seen as too drastic: A Gallup Poll showed a majority of Canadians to be “satisfied” or “very satisfied” with their system. And for Americans, of course, there are limits to coverage from private insurers as well. Just ask anyone who has recently braved healthcare.gov and studied the fine print of competing private policies offered on the new exchanges. Or anyone who has had the unpleasant experience of being denied medical care by an American insurer. I’m not sure which is more incomprehensible: the ham-handed launch of registration for the Affordable Care Act (ACA) or the system’s mind-numbing complexity. But the two are related. Failing to beta-test a national site with this many moving parts til two weeks before the liftoff date would strike most IT professionals I know as webmaster malpractice or at least dereliction of management at HHS. But that doesn’t clarify why so many moving parts were needed in the first place. What explains the system’s convolution is the numerous powerful health care industry lobbies. Their behind-the-scenes influence before the ACA was passed by Congress in 2010 produced one of the least healthy foods on the planet: legislative sausage. With about 50 million Americans, including many children, uninsured at the time of President Obama’s first election, the time had come to do something to foster greater fairness in health care. But the awkward compromise reached, dubbed the Affordable Care Act, left no one fully satisfied. As the legislative machinery kicked into gear in the spring of 2009, Senate finance committee chair Max Baucus, who led the deliberations, famously declared that single-payer coverage was “off the table.” On two occasions in March of that year, Baucus even ejected single-payer activists from Senate hearings. Yet single-payer was widely popular. A New York Times poll published the previous month found that “59 percent [of Americans] say the government should provide national health insurance, including 49 percent who say such insurance should cover all medical problems.” But there is powerful opposition to single-payer from a corporate sector that stands to lose billions — the health insurance industry. Last year health insurers invested $243 million in lobbying. The ACA, with its individual mandate to buy coverage, was passed by Congress partly because health insurers went along with it. After all, they were eying tens of millions of new customers. And competition for those customers, projected to yield billions in profits, has brought us the new health care exchanges, which are so complicated that the federal ACA website has been unable to put the pieces together, at least thus far. Imagine what the rollout this month would have looked like if single-payer had carried the day in Washington instead. Undoubtedly, there’d be some computer glitches as happen with all website launches. And Congressional opponents of the law probably would still be griping loudly. But rather than sorting through a bewildering maze of plans, the burden on health care consumers would likely be a far simpler registration for guaranteed health care. And by many calculations, the economies of scale from including more patients would slash the nation’s per capita health costs, a boon to federal deficit reduction. Says Marcia Angell, former editor of the New England Journal of Medicine, “The underlying problem with our health care system, the thing that makes it such a mess, is that it is based on seeking profits and not on providing health care.” David Freudberg is host of the public radio series “Humankind.” http://www.huffingtonpost.com/david-freudberg/the-other-reason-for-health_b_4169711.html

By Jack Bernard
The Augusta (Ga.) Chronicle, Oct. 26, 2013 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 Administration 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. http://chronicle.augusta.com/opinion/opinion-columns/2013-10-26/amid-tangle-obamacare-consider-single-payer-health-care