Recent efforts to defund Obamacare evoked hot air from both
sides of the aisle. Perhaps it is now
time for serious talk instead of talking points.
While it has some good aspects, there are four principal
problems with Obamacare:
1. It is outrageously
complex, confronts individuals and
employers with decisions they are poorly equipped to make, and requires government to pull
together vast amounts of information in determining eligibility for subsidies.
2. It leaves millions
uninsured, especially since the Supreme
Court eviscerated Medicaid expansion by allowing states to ignore it without
losing federal funding for their existing Medicaid programs.
3. It perpetuates
employment-based insurance (while
undermining it for some). People who
become too sick to work will continue to lose their insurance, and their loss
of income will make it impossible to buy insurance privately without prolonged
paperwork at the exchanges.
4. Under Obamacare insurers are gaming the system, offering low prices on the exchanges but restricting
coverage to very limited “networks” of doctors and hospitals, making
it harder for people to get care.
There is an obvious solution to these problems: a taxpayer-funded single-payer insurance
system, “Medicare For All.”
Medicare For All could be very simple, with low
administrative costs. Individuals could
participate without having to make complicated decisions requiring them to
consult accountants, lawyers . . . and
psychiatrists.
The system would cover everyone without any exceptions, and
would allow overlapping systems like Medicaid to be phased out.
People wouldn’t depend on employment for insurance. Those too sick to work would not lose
coverage. Employers would have no
incentive to move towards part-time work or to avoid hiring older people, whose
medical costs tend to be higher.
Under single-payer there would be no “out of network” doctors and hospitals. People could chose doctors and hospitals to
their taste and convenience.
The major political obstacle to a single payer system is
that it would require higher taxes. But the
average person’s out of pocket costs for insurance would be reduced by more
than their taxes would increase, leaving more in their pockets.
Single payer eliminates payment of personal insurance premiums. It also eliminates the premiums now paid by
employers, money by necessity subtracted
from the wages they pay. (That is why
low paid workers are not provided with insurance, since their wages cannot be
reduced below the legal minimum, and why the employer mandate drives employers
of low-paid workers to make them part-time to avoid insuring them.)
To retain qualified workers, employers will have to
redistribute these savings as increased wages.
By greatly reducing administrative costs and eliminating
private profits and the magnificent salaries of insurance executives, single payer’s total cost would be less than
Obamacare and less than the pre-Obamacare system. This lower system cost is why the average
person will retain more in-pocket even after paying increased taxes.
Having given up
on defunding, John Boehner now says he will continue fighting Mr. Obama’s
health care law, but in a different manner.
Perhaps he should consider supporting a replacement that would
incorporate the conservative values of simplicity, uniformity, and efficiency: a single payer
system paid for with taxes, Medicare For
All.
**********
This op-ed has appeared in the Adrian Daily Telegram.
