By John Perryman, M.D.
Chicago Tribune, Letters, April 29, 2017
In reviewing recommendations by the Tribune Editorial Board regarding round two of the Affordable Care Act repeal effort, a few thoughts came to mind. The suggestions are themselves reasonable in the context of preserving portions of the current system. However, the forest is being missed for the trees.
The Tribune, and the Republican Party, continue to ignore the options of single-payer, despite increasing public support for this option. A Gallup poll from 2016 showed that 58 percent of U.S. adults favored replacing the ACA with a federally funded system that provides health insurance for all Americans. An Economist/YouGov poll performed this year showed that 60 percent of adults favored expanding Medicare to cover every American. This included support from 46 percent of Republicans surveyed.
As pointed out by Drs. Steffie Woolhandler and David Himmelstein in an article published in the Annals of Internal Medicine, single-payer offers a host of advantages compared to our current system. These include hundreds of billions in savings related to overhead reduction, an improved negotiating position with pharmaceutical companies, and (most important) universal coverage that is not lost with job changes or a withdrawal of insurers from a particular marketplace. Trying to maintain profitability for health insurers while providing full coverage with consumer safeguards is an exercise in futility.
There are some types of business in which typical market-based practices simply do not function well. Commercial for-profit health insurance represents a market failure. This failure, even when mitigated by the ACA, still leads to unnecessary suffering and death among our fellow citizens.
So why do these efforts continue? It is a function of how our political system works. Elected representatives, needing increasing amounts of cash to finance campaigns, rely on powerful corporate donors, such as insurers. These organizations also have the resources to out-lobby groups that are not as focused and lack the same resources.
The president promised universal coverage. Congress needs to represent constituents, not special interests and donors from outside the members’ home districts. Time to deliver.