Obamacare is flawed, but there is a solution
The Affordable Care Act has increased access to health care, but it has serious drawbacks. That's why a large, respected group of physicians is proposing a different, single-payer health care system
By Jessica Schorr Saxe, M.D.
The Charlotte Observer, May 5, 2016
Why, in the age of the Affordable Care Act, would a large, respected group of physicians develop A Physicians' Proposal for Single-Payer Health Care Reform? On Thursday, this document was released by a panel at the National Press Club and published online in the American Journal of Public Health.
Are you or someone you know forgoing medical care for financial reasons, having trouble with medical bills, being forced to change providers due to network problems, or reeling from arbitrary increases in premiums or deductibles? If so, you know the ACA has drawbacks.
While the ACA has increased access to health care, it falls short in achieving the goals of making care available and affordable to all and controlling costs.
Although millions have gained insurance, the Congressional Budget Office estimates 28 million Americans will remain uninsured in 10 years when the law is fully operational.
Additionally, underinsurance is an increasing, often overlooked problem. The underinsured are those who, despite coverage, are not able to afford their deductibles or out-of-pocket costs. According to the Commonwealth Fund, this included 21 percent of adults below Medicare age in 2014. More than one-third of Americans did not get needed care due to financial barriers, and more than one-third have trouble paying a medical bill.
Free clinics, which expected declining numbers after the ACA, are seeing an influx of insured patients who cannot afford co-pays or deductibles.
Though health care inflation was relatively low for a few years, it is now rising. Currently at about 18 percent of gross domestic product (about twice that of most other developed countries), health care is projected to reach almost 20 percent by 2024.
Administrative costs consume an inordinate amount of our health care budget. Bureaucracy plagues providers and patients. If the forms now contained in the electronic record were hard copies, physicians would be crushed under their weight.
Surely we can agree that Americans are entitled to better care. The Physicians Proposal outlines a better course.
A single-payer health care system, sometimes referred to as Expanded and Improved Medicare for All, would provide comprehensive health care with no deductibles or co-pays. Financing would be federal, much like current Medicare, and paid for largely through progressive taxes. Even those who consider raising taxes anathema would likely be pleasantly surprised to find these taxes are more than offset by reductions in premiums, co-pays and other medical expenses.
Expanded (covering more people) and Improved (more comprehensive) services would be made possible by savings in many areas. Administrative costs would plummet by eliminating private insurance companies, the expensive middle men that siphon off dollars that could otherwise be spent on actual health care. Cutting administrative costs to the level of Canada would save about $500 billion annually. The National Health Plan would negotiate pharmaceutical prices, as do other countries, yielding further and extensive savings. For-profit hospitals and clinics, documented to be of poorer quality and more expensive, would be prohibited.
Single-payer health care is a financing mechanism. Current private hospitals and practices would continue to deliver health care, much as they do now, except that they would submit bills to a single entity. With a unified system, there would be no more separate networks. The opportunity to choose providers and relief from financial barriers would strengthen the currently endangered physician-patient relationship.
Critics insist widespread opposition is an obstacle. In fact, polls show rising support. In 2008, a national survey showed that 59 percent of physicians supported a national health insurance plan, and in December 2015, a Kaiser poll indicated that 58 percent of Americans support Medicare for All. As both physicians and patients feel more beleaguered by our current system, expect those numbers to rise.
Can we afford it? Yes. And, given current trends, we cannot afford to delay its implementation.
If you are or know an individual suffering from lack of access, oppressive medical bills, unbearable bureaucracy, or fear of your own rising medical costs or the collective burden on the U.S. economy, you, too, should support a single-payer health care system.
Dr. Jessica Schorr Saxe is chair of Health Care Justice NC, a chapter of Physicians for a National Health Program. Email: HCJusticeNC@gmail.com. The Physicians Proposal is available at: http://www.pnhp.org/beyond_aca/Physicians_Proposal.pdf.