The ACA and America’s Health-Care Mess

While it was enacted in 2010 without a single Republican vote, the Patient Protection and Affordable Care Act (ACA), a.k.a. �Obamacare,� was built on a model first proposed by the conservative Heritage Foundation in the 1990s and implemented by Republican Governor Mitt Romney in Massachusetts in 2006. The ACA extends the public safety net to more of the working poor but otherwise keeps the private health insurance system intact. Rather than replacing the private system�and far from the �government takeover of health care� its critics claim�it provides subsidies for individuals to buy private health insurance through state-level �exchanges.�

As social policy, the ACA is a qualified failure. The expansion of Medicaid and mandates for individuals to buy subsidized private insurance will expand health insurance to an additional 30 million people. Regulations establishing minimum standards for coverage and barring exclusions for pre-existing conditions will improve coverage for many. On the other hand, by maintaining the existing system of for-profit medicine and private insurance, the ACA does little to rein in out-of-control cost growth while leaving millions without coverage. We can hope that the ACA�s strengths and its failures will soon pave the way for a rational universal system such as single payer health care.

Not Everyone Will Be Insured: While the ACA will provide health insurance to millions of Americans, millions of others will remain uninsured. While over 25 million will gain coverage either through the expansion of Medicaid or by buying subsidized private insurance, somewhat more will remain without coverage. Some are not covered by the act (including undocumented immigrants); others will be excused from the requirement to have insurance because of cost; and others will not comply.

Problems of People with Insurance Will Remain: Because it builds on the existing private health-insurance system, the ACA does little to reduce access problems for people with health insurance. Those with insurance have dramatically fewer problems accessing health care (including seeing doctors, arranging follow-up visits, and filling prescriptions) than those without. But even insured Americans are twice as likely as citizens of countries with public insurance to have trouble getting care (see Figue 2).
States Rejecting Medicaid Expansion and Exchanges Are Lowering Enrollment: The ACA�s Medicaid expansion would cover everyone with incomes up to 133% of the federal poverty level. Half the states, all with Republican governors, rejected expansion, denying coverage to 7.5 million people. States can establish �health exchanges� for people to choose a health plan and sign up for federal subsidies. Republicans refused to establish exchanges in 34 states.

After a slow start, enrollment has picked up states with their own exchanges. Problems with the federal website slowed errollment elsewhere, though it has recently surged as well. Including those newly covered by the Medicaid expansion, the ACA has now extended coverage to about 4% of the uninsured in non-cooperating states, compared to over 15% of those in the cooperating states. If the proportion enrolling were the same in the non-cooperating states as in states with their own websites, an additional 4 million Americans would now have health insurance.

The ACA Is Highly Redistributive: The ACA will reduce out-of-pocket spending on uncovered expenses, deductibles, and copayments. Federal subsidies will reduce premiums while coverage expansion will lower reduce hospital surcharges for the uninsured. Public spending will increase, on Medicaid and subsidies; expenditures paid for with other savings taxes on expensive insurance plans, and increases in the Medicare payroll tax for high-income individuals. Taxing the rich to provide health care for the working poor, the ACA is the largest redistributive program enacted since the 1960s.

The ACA Does Not Control Costs; Single-Payer Would: The ACA does not establish a sustainable health-care finance system in the United States. Under the ACA, health care spending will continue to increase significantly faster than the economy as a whole and the share of the economy going towards health care will rise in the next decade to nearly 20%. By controlling administrative costs and drug prices, a single-payer system can hold healthcare spending to less than 17% of the GDP.

Is Obamacare a Step Toward Single-Payer?

NO, NO and no: That’s been the Republican Party position on health care reform since the Obama administration’s first months in office. No matter how many pro-industry concessions were made in drafting what came to be called the Affordable Care Act (ACA), Republicans never wavered in their all-out opposition.

But increasingly since its disastrous rollout last fall, the ACA has had critics from the left, too–people who oppose a “reform” that falls far short of universal coverage while threatening harsh financial penalties on those who can afford them least unless they purchase the defective products of the private insurance industry.

Groups that criticized the ACA all along, such as Physicians for a National Health Program and National Nurses United, continue to stand for a “single-payer” program–where the government cuts out the insurers and guarantees health care for all under a system similar to the current Medicare program for the elderly, but much better funded and available to the whole population.

Then there are those among liberals and the left who disagree with both sides. They continue to defend the ACA–on the grounds that it is a step toward universal health care.

An editorial in the Nation magazine last month, for example, acknowledged that the ACA came about because Barack Obama and Democratic leaders in Congress “believed [single-payer] was politically unachievable, so they cobbled together a hybrid of public regulation and private insurance that has come back to haunt them.”

Nevertheless, wrote the Nation’s editors, the left should defend this “hybrid”: “Progressives must step in not only as ardent advocates for better implementation of the ACA–a relatively easy task–but also for structural repairs to the law that will make it a better bridge to the truly universal, truly humane and truly functional health care system that America needs…Indeed, winning [the fight for the ACA's effective implementation] will make future reforms all the more possible.”

The Nation is wrong. The ACA isn’t a bridge to universal health care. It is a cul-de-sac, structured above all else to maintain the central role of the health care industry in general, and private insurance companies in particular.

Achieving universal health coverage and access to care will require dismantling the core of the ACA and replacing it with something else entirely. Making a defense of the ACA in the way the Nation does–as a step in the direction of a single-payer system–cedes ground to the right and is counterproductive to the goal of winning health care as a human right.

Continue reading…

Maine Advocates Push for Single-Payer Care System

From the AP –

A government-run health care system in Maine would provide universal coverage to residents, cut down on administrative costs and free businesses from the complexities of providing insurance for their employees, supporters of a single-payer model said Thursday.

Advocates of a single-payer system have long been trying to implement the model in Maine with little success, but said they are hopeful that the steps Vermont officials have recently made to spearhead the effort there can help make it a reality in Maine.

“Our current health care system is complicated, is inefficient, unfair and pretty much broken,” said Julie Pease, president of Maine AllCare, the group behind the measure, which she said will “return our system to one where … our medical profession treats our patients based on their health care needs not on their ability to pay or what kind of insurance they have.”

The bill, sponsored by Democratic Rep. Charlie Priest of Brunswick, aims to create a single-payer health care system in Maine by 2017, as officials are trying to do in Vermont. Beginning in 2017, Vermont will offer a set package of coverage benefits to every resident under the program.

But the idea in Maine faces fierce opposition from insurance companies and questions remain about how the state could afford such an endeavor.

Dan Bernier, a lobbyist for the Maine Insurance Agents Association, said that government should focus its limited resources on the poor, elderly and disabled instead of those who can afford coverage.

“It is not the role of government to provide someone like myself, a lawyer and lobbyist, free health insurance,” he told the Insurance and Financial Services Committee on Thursday.

Supporters argue it would ultimately save the state as much as $1 billion down the line by eliminating unnecessary paperwork and administrative costs. The program would be paid for through taxes like people already do for Medicare and Medicaid, they said.

But the state first has to make a commitment to universal health care before every single detail can be worked out, said Joe Lendvai, a Brooklin resident who advocates on behalf of the bill with Maine AllCare.

“Unless we conceptually agree that we need to cover everyone, that every Maine resident deserves access to health care without any barriers, we are not going to succeed,” he said.

But any proposal to raise taxes would likely be rejected by Republican Gov. Paul LePage, who has vowed not to do so while he’s in office and vetoed the state budget last year because it included tax increases.

Democratic Sen. Geoff Gratwick of Bangor acknowledged that it will be tough to pass the measure in this political and economic environment, when budgets are especially tight. But he said that Maine lawmakers have long-understood the serious problems with the current health care system and want a change.

“This is going to happen whether or not we get it now, two years from now, 10 years from now,” he said. “It’s inevitable because our current system is broken,” he said.

The Obamacare We Deserve

Today marks the beginning of health care coverage under the Affordable Care Act�s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president�s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president�s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare�s rocky start � clueless planning, a lousy website, insurance companies raising rates, and the president�s telling people they could keep their coverage when, in fact, not all could � is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics �expose� the fact that President Obama endorsed a single-payer system before 2004, they�re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney�s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they�ll use some of that to try to privatize Medicare.

For many people, the �affordable� part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet � I would be remiss if I didn�t say this � Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter�s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won�t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let�s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year � money that would be going to hospitals and treatment.

In blue states, let�s lobby for a public option on the insurance exchange � a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients� health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont�s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That�s why corporate money will soon flood into Vermont to crush it. The legislators who�ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let�s get started. Obamacare can�t be fixed by its namesake. It�s up to us to make it happen.

Michael Moore is a documentary filmmaker whose 2007 film �Sicko� examined the American health care industry.

The Left After the Failure of Obamacare

It�s satisfying to watch rats flee a sinking ship. This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end. A collective sense of relief is a natural response.

The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group�s resources�and integrity� to sell a crappy product to the American people.

Those in the deepest denial went �all in� for Obamacare� such as some unions and groups like Moveon.org� while the more conniving groups and individuals�like Michael Moore� playacted �critical� of Obamacare, while nevertheless declaring it �progressive�, in effect adding crucial political support to a project that deserved none.

But of course Obamacare was always more barrier than progress: we�ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction� into the pockets of the insurance mega corporations. A couple progressive patches on the sails won�t keep her afloat. It�s shipbuilding time.

It was painful to watch otherwise intelligent people lend support to something that�s such an obviously bad idea. So it�s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare�s Titanic failure. Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.

The inevitable failure of Obamacare is not due to a bad website, but deeper issues. The hammering of the nails in the coffin has begun: millions of young people are suddenly realizing that Obamacare does not offer affordable health care. It�s a lie, and they aren�t buying it, literally.

The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population. Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they�re opting out, inevitably sinking Obamacare in the process.

Those young people who actually do buy Obamacare plans�to avoid the �mandate� fine� will be further enraged when they attempt to actually use their �insurance�. Many of the cheapest plans�the obvious choice for most young people� have $5,000 deductibles before the insurance will pay for anything. For poor young people this is no insurance at all, but a form of extortion.

At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the �Cadillac� tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.

Lower paid union workers will suffer as well. Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get. This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member�s dollars propping it up.

Ultimately, the American working class will collectively cheer Obamacare�s demise. They just need labor and other lefties to cheer lead its destruction a little more fiercely.

Surprisingly, most of the rats are still clinging to Obama�s hopeless vessel, frantically bailing water. Sure they�ve put on their life preservers and anxiously eyeing the lifeboats, but they�re also preaching about how to re-align the deckchairs.

For example, in his �critical� New York Times op-ed piece, Michael Moore called Obamacare �awful�, but also called it a �godsend�, singing his same tired tune. Part of Moore�s solution for Obamacare�which was cheered on in the Daily Kos� is equally ludicrous, and follows his consistently flawed logic that Obamacare is worth saving, since its �progress� that we can build on. Moore writes:

�Those who live in red [Republican dominated] states need the benefit of Medicaid expansion [a provision of Obamacare]�. In blue [Democrat dominated] states, let�s lobby for a public option on the insurance exchange � a health plan run by the state government, rather than a private insurer.�

This is Moore at his absolute worst. He�s neck deep in the flooded hull of the U.S.S Obamacare and giving us advice on how to tread water.

Of course Moore doesn�t criticize the heart of Obamacare, the individual mandate, the most hated component.

Moore also relies on the trump card argument of the pro-Obamacare liberals: there are progressive aspects to the scheme�such as the expansion of Medicaid� and therefore the whole system is worth saving.

Of course it�s untrue that we need Obamacare to expand Medicaid. In fact, the expansion of Medicaid acted more as a Trojan horse to introduce the pro-corporate heart of the system; a horse that Moore and other liberals nauseatingly continue to ride on.

But Moore�s sneakiest argument is his advice to blue states to ��lobby for a public option on the insurance exchange��

Again, Moore implies that it�s ok if we are �mandated� to buy health insurance, so long is there is a public option. But that aside, the deeper scheme here is that Moore wants us to further waste our energy �reforming� Obamacare, rather than driving it to the bottom of the sea.

Moore surely knows that very few people are going to march in the streets demanding a public option at this point; he therefore knows that even this tiny reform of the system is unachievable. He�s wasting our time. Real change only happens in politics when there is a surge of energy among large sections of the population, and it�s extremely unlikely that more than a handful of people are going to be active towards �fixing� Obamacare� they want to drown it.

Moore�s attempt to funnel people�s outrage at Obamacare towards a �public option� falls laughably short, and this is likely his intention, since his ongoing piecemeal �criticisms� of the system have only served to salvage a sunken ship.

Instead of wasting energy trying to pry Obamacare out of the grip of the corporations, Moore would be better served to focus exclusive energy towards expanding the movement for Medicare For All, which he claims that he also supports, while maintaining that somehow Obamacare will evolve into Single Payer system.

Most developed nations have achieved universal health care through a single payer system, which in the United States can be easily achieved by expanding Medicare to everybody. Once the realities of Obamacare directly affect the majority of the population and exacerbates the crisis of U.S. healthcare, people will inevitably choose to support the movement of Medicare for All, the only real option for a sane health care system.