By Craig Klugman, Ph.D.
Bioethics.net Blog, Aug. 24, 2016
In Illinois, Land of Lincoln insurance and Aetna announced that they are pulling out of the health insurance Marketplace. In other states, United HealthCare and Humana have announced pulling out of the exchanges. As a result, many newspaper headlines and political pundits have declared the Affordable Care Act (ACA, also known as Obamacare) to be in a “death spiral.”
Such statements are undermined by the latest studies showing the ACA is working. The Kaiser Family Foundation reported that three-quarters of people who lacked insurance before the ACA now have it. RAND Corp found that more people are receiving medical treatment and getting needed prescriptions as a result of the ACA. The ACA is accomplishing its intent—giving more people insurance coverage so that they can receive medical care and have their diseases managed. Preventive management is cheaper than intensive and expensive interventions after a disease has progressed.
An internal Aetna letter obtained by the Huffington Post and comments from Rep. Frank Pallone (D-NJ) suggest that Aetna’s move was not about losing money, but rather retaliation for the Department of Justice blocking the company’s proposed merger with Humana.
The Affordable Care Act leaves our health care subject to the whims of powerful corporations that exist to maximize profit and shareholder value, not to help policyholders access needed care. The health care of all Americans should not be held hostage by such companies.
In fifteen years as a professor of clinical bioethics and health policy, the one conclusion reached by every class I have taught is that the only long-term viable solution for affordable health care in this country is a single-payer system.
According to the United Nations Declaration of Human Rights, health care is a basic human right recognized by most industrialized nations. Even the U.S.-drafted Iraqi constitution guarantees every citizen a right to health care. In Canada and Sweden, the government is the insurer and provider of health care. In Germany, the government is the main insurer and while the provision of medical care is private, the government regulates reimbursement rates and drug costs. The U.K. has a government system of insurance and hospitals and a parallel private system. In managed systems, government regulation ensures that everyone has access to affordable care.
This contrasts with the U.S. where except for the VA and Medicare/Medicaid, insurance companies and medical providers dictate the terms and costs. Regulated systems prevent the game that Aetna is playing where people’s health come second to profit.
Critics of the Affordable Care Act state that the U.S. has the best medical care in the world. If by “best” one means the most expensive, then the U.S. does hold that honor. If one means longest life span, lowest infant mortality rate, and highest quality of health, then the U.S. ranks behind most industrialized nations. According to the CIA, we rank 43rd in life expectancy and 58th in infant mortality.
Single-payer saves money by eliminating third party payer administration and profit costs. The American Hospital Association reports that healthcare providers spend millions of dollars in time, technology and personnel managing dozens of competing and contradictory insurance company policies and forms.
To be sure, this would shake up the medical insurance industry, but the same companies complained that they would not survive the Affordable Care Act, which gave them 20 million new subscribers. Similar to the UK and Germany, these companies can offer private insurance plans for those who can afford them or who wish coverage above and beyond what the government insurance would provide.
The most economical and efficient solution is a single-payer system that keeps the goal of caring for people as the highest priority and protects Americans from the tantrums of private companies profiting on human suffering.
Craig Klugman, Ph.D., is a bioethicist and medical anthropologist who teaches at DePaul University.