The Affordable Care Act is a step in the right direction, but it is important to remember that it is not the end of the journey toward a working health care system.
Andrew Deskins | Argonaut
The Congressional Budget Office predicts that the law will help 25 million Americans afford health insurance by 2023, but they concede that 31 million will remain uninsured. That’s certainly better, but that number is still unacceptably high for the world’s richest nation.
For the most part, Obamacare addresses the cost of insurance rather than the cost of care itself.
In 2011, health care expenditures accounted for 17.9 percent of the U.S. Gross Domestic Product, according to data from the World Bank.
However, nearly one-third of this money doesn’t even go toward the cost of care, but rather toward administrative costs. Because there are so many insurance providers in this country, health care administration is very complex and costly.
But there is more to this than the market being flooded with insurers. According to Ezra Klein’s Wonkblog, the main problem with health care in the U.S. is the fact that we don’t have a fully state-run, or a fully privatized system. This means that prices aren’t truly set by either the government, or the market, but by health care providers themselves.
The way health care works in other countries is that the government sets prices and companies either choose to sell there or not.
In the U.S, insurers negotiate prices on their own.
While the government sets prices with Medicare at a rate that allows hospitals to cover costs, it takes seriously the notion that non-profit hospitals should actually be non-profit. In the U.S., the designation doesn’t mean hospitals can’t profit, just that they can’t distribute any profit they make to shareholders — private insurers don’t have the same bargaining power as the government and they frequently pay more. Those without insurance have no bargaining power at all.
In “A Bitter Pill,” Time Magazine’s Steven Brill gives an example of the cost difference of charges to someone with Medicare, and someone with no insurance. Medicare would have paid $13.94 for the test but Janice S., who was uninsured, was charged $199.50 for each test. Janice thought she was having a heart attack, she was fine, or at least until she saw her bill. It totaled $21,000.
The cruel joke inherent in our current system is that those who are poor enough to qualify for Medicaid or old enough to draw Medicare are in many ways the best off. Those who qualify for neither and can’t afford insurance of their own are most vulnerable to being crushed by the virtually fraudulent high costs present in the American health care industrial complex.
The logical action is that the U.S. moves toward a single-payer insurance system, where the government or another semi-public agency manages insurance administration in on a regional basis.
Single-payer systems simplify the administration process by essentially paying hospitals with block grants to cover operating costs and capital improvements, rather than on a per-patient basis. It eliminates out-of-pocket costs that act as a barrier to coverage for some, and it guarantees universal, classless coverage for all.
Best of all, the savings from simplifying the administration process — more than $350 billion — would be enough to insure everyone currently without insurance, according to Physicians for a National Health Program. Properly structured savings could cover the entire tab of a national health care system.
A common misconception about American health care is that it is privately run. Even with the ACA, we see the tired right-wing talking point of “government takeover” trotted out over and over again.
The reality is that the taxpayer already foots 60 percent of the bill by providing the funds for government health insurance, and for subsidies for private companies who insure their employees. For comparison, the Canadian taxpayer picks up 70 percent of the tab, but gets truly universal coverage.
Even if you bring the public around, you have to come up against special interests entrenched in government. Skyrocketing health care costs are the geese that laid the golden eggs for providers. They have a tremendous amount of lobbying money to kill meaningful health care reform. This is why a solution as shallow as Obamacare is such a contentious issue even now.
Even worse, the campaign finance laws in this country allow for companies to woo those politicians who set prices.
To address this, Obamacare creates an Independent Payment Advisory Board to which people are appointed so they can be free of the corrupting influences that come from elections. Of course, the Republicans filibustered every appointee to this board until Sen. Harry Reid went nuclear to prevent the filibuster of executive appointments.
Ultimately when it comes to fixing health care in this country, there is another issue that must be tackled first, campaign finance reform. The laws are so weak that special interests run Washington.
Until we reform our election laws, the American health care system will remain easy to navigate for only one group of people, those who don’t get sick.
Andrew Deskins can be reached at [email protected]