Hardly a week passes without a negative Obamacare headline staring at me from the New York Times. The Affordable Care Act, also known as “Obamacare” was passed with great fanfare in March 2010 and was variously labeled as “the greatest advance in healthcare since Medicare and Medicaid” and as the “the most positive thing that this country has done since the civil rights legislation that was passed back in the ’60s.”
The Republican House has voted dozens of times to repeal Obamacare without ever offering a viable alternative. However, it certainly appears that the Affordable Care Act is dying a slow death all by itself without Republican assistance. Look at a few headlines from the last couple of years:
Big Changes in Fine Print of Some 2015 Health Plans
Seeking Rate Increases, Insurers Use Guesswork
Data Shows Large Rise in List Prices at Hospitals
Double Digit Rate Hikes Loom for Obamacare 2016
Sorry, We Don’t Take Obamacare
Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again
Health Insurers Use Process Intended to Curb Rate Increases to Justify Them
Aetna will leave most Obamacare exchanges, projecting losses
Health-care exchange sign-ups fall far short of forecasts
Obamacare Marketplaces Are in Trouble. What Can Be Done?
These news headlines illustrate exactly why I think that the Affordable Care Act cannot continue to exist in its present state: a medical care system intended to ultimately cover everyone and reduce medical costs while relying on corporations whose sole reason for existence is profit.
Michael Moore’s brilliant and prescient film “Sicko”, released almost 10 years ago, made this abundantly clear (by the way, while he is dismissed as a kook by the right, Mr. Moore to me is a sage, prophet and patriot). “Sicko” pointed out that anything less than a single payer program, like “Medicare for all”, any program involving corporations and profit contains the seeds of its own destruction. The medical insurance companies must show a profit and must, like all capitalist enterprises, increase profit and grow. Stasis and balance are not part of the capitalist system. And how does a health insurance company grow and increase profit? By gaining more customers, paying less in benefits or charging more for premiums, a recipe for the failure of any corporate-run effort toward providing universal coverage.
Health care is a public issue and should be a public service like education, highways, water, and electrical service. It should not be viewed as a commodity to be bought and sold. One should not have to buy a health insurance “policy”, as if buying car insurance. Access to affordable healthcare should be a right and should be enshrined among all of our other rights, as it is in European countries. It is interesting to glance back at the “Second Bill of Rights”, proposed by Franklin Delano Roosevelt in 1945 and which surely would have been enshrined in the constitution had he lived. One of the articles in this wonderful document is: “The right to adequate medical care and the opportunity to achieve and enjoy good health”.
It might be useful to consider what health insurance companies do to earn their massive revenue and profits. Well they do essentially what the state bureaucracies operating the Canadian National Health program or the British National Health Service do. They take money from government or private sources and, based on the nature and level of service provided, pass it along to doctors, hospitals and drug distributors. Not very complicated is it? In countries with national health systems, this process is conducted very efficiently and economically. In the US, with United Healthcare, Cigna, Humana, Aetna and a host of other companies performing this simple function, it becomes very expensive because these companies have to make a profit to pay shareholders and to pay their CEOs’ multi-million dollar salaries. Something is indeed wrong with this picture.
So what do you suppose happens at Board meetings or at high level executive meetings in these companies? How do the highly paid “big guns” of United Healthcare or Humana or Aetna sit around their big shiny tables and brainstorm corporate strategy or new products or new markets for future growth? Well, considering what they actually do, they’re embarrassingly limited. A “new product” has to be a new “policy” which provides less service to the consumer or less compensation to the doctor or hospital. A new growth strategy is “how do we get more people or companies to sign up and buy our “product” or “how can we discourage the sick and chronically ill from signing up and encourage more young and healthy people to sign up? Or maybe the best and most simple strategy of all – let’s raise the prices of the health insurance policies we sell. Or better yet, let’s disguise an increase by having the consumer pay a higher deductible and keep the price the same. Or, let’s make the language describing the benefits we provide really confusing and deceptive, surreptitiously raising the deductible or the copay. Or, best of all, since we’re an integral part of Obamacare, how can we squeeze the government for more customers, for bigger subsidies, more money so we can increase profit? These are corporate strategies like none other – no investment in research, invention, engineering, design improvement, raw materials selection, creativity or test marketing. These healthcare corporations must be the envy of all other corporations – my God, they make profit, pay their shareholders, pay millions to their CEO’s for merely performing a simple bureaucratic function and with massive government assistance.
The history of providing healthcare in the US is depressing. While European countries and our neighbor to the north moved inexorably toward government funded universal coverage, effort after effort in the United States failed miserably. Proposals were condemned as “socialist” or “communist” or labeled as “interfering with doctor – patient relationships” or a making doctors “slaves”. President Truman’s valiant 1949 effort to provide a national program failed because of powerful conservative opposition from the likes of Senator Robert Taft who claimed it was “right out of the Soviet constitution”. The American Medical Association opposed the program also, with one of their pamphlets reading, “Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared that socialized medicine is the keystone to the arch of the socialist state.”
President Johnson’s “Great Society” efforts in the 1960’s led to Medicare and Medicaid for the elderly and the poor, both supported by the medical establishment, but not to universal coverage for everyone else. President Clinton’s efforts to provide universal coverage, led by then first lady Hillary Clinton, also met with failure because of opposition from health insurance companies and the entire rest of the healthcare industry, exerted through intense lobbying of members of congress.
Another important reason that national healthcare efforts failed over the years was because of the growth of employer-provided health insurance and the companies that administered such plans. During World War II when competition for workers was fierce and employers were not allowed to raise wages, expanding employee benefits was the only way to attract workers so companies began to offer health insurance as one of those benefits. Also of course, companies could deduct the cost of employee health insurance coverage as a cost of doing business. So it’s no surprise that over the years employer provided insurance dampened the demand for universal coverage. The provision of employer provided medical insurance also gave health insurance companies the opportunity to become firmly planted in America’s corporate landscape.
Access to good health insurance is a prominent and consuming concern for most Americans. If your employer covered you and you switched jobs, you might lose your coverage. Employers could change the levels of coverage, requiring larger deductibles or copays to maintain the profit margins for the companies administering the insurance. And buying affordable coverage became almost impossible for the self-employed. I will never forget a statement made by one of my favorite nonfiction authors, Susan Jacoby, remarking in her book “Never Say Die: The Myth and Marketing of the New Old Age”, what an incredible relief it was for her to turn 65 and finally be covered by Medicare. Thank God, the struggles were over – no more worries about medical insurance. One of my brothers, self employed, pays about $25,000 per year to insure him and his spouse and is counting the days to age 65 and Medicare. Another, who receives his medical insurance from his employer, has seen his costs and deductibles rise while his coverage has diminished. And I myself, despite having always worked for employers who covered me and, for an additional charge, the children and the spouse if necessary, the size of deductibles and/or copays was always a concern, as was the cost of drugs required by a family member. And I could still have lost everything I owned if stricken by a catastrophic illness. What a relief for me when I turned 65 and for my spouse when she too became eligible for Medicare, that our worries were over. This is the way it should be for all Americans at all phases of their lives. A Canadian, a Dane, a German, a Frenchman, is simply and logically covered – for everything – no limits or exclusions, from the moment of birth to the moment of death.
The powerful influence of corporations has colored and flavored all recent “advances” in healthcare. First was the intrusion of health insurance corporations into Medicare with “Medicare Advantage” programs, through which they received funds directly from the government to administer and profit from their own enhanced versions of Medicare, further solidifying their positions on the corporate landscape. And the George W. Bush Medicare expansion to provide drug benefits was virtually written by the pharmaceutical corporations, guaranteeing huge profits for themselves through the disallowance of negotiated drug prices. And finally, Obamacare itself was written by the medical insurance companies with the complicity of their congressional lackeys. Retention of private corporations in the program and the exclusion of a “public option” were ways to radically increase the number of their customers at government expense. Like charter schools, the Affordable Care Act became simply another way to shovel public money into corporate coffers.
Obamacare’s invitation to “Come, compare policies and select the one that’s best for you and your family” rings hollow. These “policies” are extremely complex. Who is really prepared to weigh and compare deductibles, exclusions, copays, benefits, networks, costs and the many other variables in a typical health insurance company policy? This complexity is designed to result in one thing – concealment of gradual and incremental cost shifting from the insurer to the patient in order to increase profit, not improve healthcare.
Obamacare’s reliance on the fabled capitalist “market” and “competition” is also chimerical. With insurers now leaving the exchange markets in droves, there will soon be little or no competition. Also, the reduction of insurers into fewer and fewer players through buyouts and mergers will undoubtedly result in market collusion to maintain or improve profit, not competition to improve service or gain customers.
Another problem with Obamacare is administering the mandate requiring individuals to buy insurance and providing the subsidy for those qualified to receive assistance. The “punishment” for not buying insurance, imposed in end-of-year tax returns, is not immediate and therefore not effective. And the subsidies are “tax credits” and whether paid up front or at the end of the year are needlessly complex and confusing. All this complexity is the result of retaining the needless role of private corporations in providing health insurance. And many individuals are opting to remain uninsured and simply pay the penalty.
Many individuals covered by employers or purchasing private insurance prior to the ACA have seen their plans change dramatically, rendering President Obama’s assertion that “if you like your health care plan, you can keep your health care plan” and Senate Majority Leader Harry Reid’s claim that “you can keep your family’s doctor or keep your health care plan if you like it” totally fallacious. What actually happened is that insurers administering employer plans sometimes reduced benefits to match the minimums required under Obamacare or sometimes increased deductibles and/or increased copays. Individual plans also changed shape and size after Obamacare. Many self-employed people or people not covered by employers found plans they had purchased before Obamacare increase in price or reduce benefits.
The claim by Obamacare advocates that “market forces” and “competition” would work to keep prices down and benefits up is also false. When maintaining certain levels of benefits or a low price cuts into profit, those efforts are abandoned. This is why the biggest insurer, United Healthcare, has withdrawn from most state insurance marketplaces and why another healthcare giant, Aetna, has abandoned them altogether.
Obamacare has been reduced to the level that in order to maintain the involvement of private insurers, more government money has to be given to them. And to involve private insurers in the first place, Obamacare is incredibly complex and unwieldy. Just go to the website and take a look at what is offered, how subsidies are offered and so on. Your eyes will glaze over, your heart rate will increase, you will perspire and you will need a dose of healthcare yourself, then and there. And even though you hate your job, you will stick with your present employer because your insurance, no matter how meager, is provided for you. And even though your deteriorating physical condition dictates that you should retire now, you will stagger into work until you are 65 just so you can finally stop worrying about medical insurance. And when you finally do have Medicare, you will realize once and for all how important it is to provide health insurance as a right to everyone, regardless of age, employment, health or income.
Also, another important part of Obamacare, the expansion of Medicaid to cover the poor, was foolishly left up to the discretion of the states. Thus, states whose governors or legislators opposed Obamacare, or likely more accurate, disliked the skin color of our president, rejected Medicaid expansion.
So what to do now? When and how can we look at the provision of healthcare like a grownup nation instead of like an immature teenager, pandering to health insurance companies, and spending twice as much on healthcare as necessary? I am sure that the present difficulties will be handled for now by injecting more government money into the program to prop up insurers’ profits. But only a truly national program, arbitrarily enrolling every American of every age and of every measure of health, will provide a pool large enough that everyone can be covered at a reasonable cost. And the modest tax increase necessary to do this will be more than compensated for by reduced personal costs for each American.
The most recent headline in the Times about Obamacare’s problems, today October 3, 2016, reads, “Ailing Obama Health Care Act May Have to Change to Survive”, introducing an article rehashing much of what I have written above and concluding that inclusion of a public option, dropped during the writing of the law at the behest of private insurers, may now be necessary.
So Obamacare cannot survive as written and surely will die, unless changed completely from what was planned by corporations and their congressional servants. Above I have offered its obituary. Below I suggest an appropriate epitaph:
HERE LIES OBAMACARE
BORN 2010 LIVED BRIEFLY THEN DIED CIRCA 2016
CONCEIVED TO SERVE A PUBLIC NEED
KILLED BY PRIVATE CORPORATE GREED