This much is clear about Obamacare. Republicans can repeal it, but they cannot fix it. They can, however, make things much worse.
If Republicans revive their efforts and pass a healthcare bill in the House, you can be sure it will be draconian in its impact.
Two reasons why: (1) They will make sure the for-profit insurance industry controls everything; (2) they will cut Medicaid. These two will work together to bring back the days when 45,000 Americans were dying from lack of medical care.
There is a better way, even if it will be an uphill battle.
It starts with the recognition that the for-profit insurance industry is the problem, not Obamacare. Insurance companies are behind high premiums and low coverage. Don’t believe me? Consider this.
When UnitedHealth Group based here in Minnesota decided to drop out of the Obamacare market last year because it claimed it was losing money, the CEO of the company was being paid $56 million a year, plus benefits. Here’s a suggestion. Improve the company’s bottom line by the CEO and a few other executives taking a pay cut.
But it gets worse. Currently UnitedHealth is involved in two whistleblower lawsuits that allege it received billions of dollars in fraudulent Medicare “risk adjustment” charges. Federal prosecutors have now joined the suit against UnitedHealth.
So much for leaving the well being of patients to a healthcare industry whose first and only concern is making money any and every way it can.
Besides, that the for-profit insurance industry operates in a competitive market is itself an illusion. They actually do business as a legalized monopoly. There is a reason there is only a marginal difference between the plans and the costs among the various companies.
This means they need real competition, and that is why a public option must be the cornerstone for fixing Obamacare.
A public option means the government would offer an insurance plan that would provide coverage at an affordable price. Insurance companies would have to offer better options than they do now to stay competitive with the public option.
And they would. They might make less money, but in the long run there are still billions of dollars to be made and they won’t leave any of it on the table.
When President Obama called for a public option last July, I think it was his de facto admission that he made a mistake by not including it in 2010. No one knows for sure why he rejected it, but my opinion is that he did because of a deal he made with the insurance companies to get their support for Obamacare.
They gave support initially, but are now trying to pull the rug out from under it in hopes that Republicans will use higher premiums as justification for giving them complete control over healthcare again.
A public option is where a real fix must begin. Bernie Sanders is calling for “Medicare for all,” which would be even better, but there is no chance it would be passed anytime soon, and time is not on our side.
Ideological Republicans will of course, reject the public option, not because it is a bad idea, but because of what we said last time, their uncompromising commitment to a so-called “free market.”
A pubic option is also why the individual mandate to buy insurance should NOT be dropped as Republicans want to do.
The argument that people should be free not to buy insurance is as bogus as it gets because it means that people who refuse to buy insurance want the rest of us to pay their medical bills if they should get sick. They think they never will, but they will and they do, all the time.
That is morally and economically wrong and they should not be allowed to make the rest of us may the price for it. Moreover, with a public option they could afford insurance like everyone else.
A public option is also why we must move away from employer based healthcare that covers 80% of all Americans. Talk to any doctor and he or she will tell you that too many patients with employer provided insurance insist on having unnecessary tests done because, as they say, “it doesn’t cost me anything.”
Here is where the public option can help. It would make it more attractive for employers to stop providing insurance as a benefit and offer supplemental help up to a certain amount to help defray costs of individual insurance.
The public option itself would be available to employees at a reasonable cost, as well as a wide array of for-profit insurance company plans trying to compete with the public option.
Discouraging employer based insurance is also the reason Obamacare should drop the requirement that companies with more than 50 full-time workers to provide health insurance.
It has already proven unworkable because small companies are choosing to hire 49 people to stay under the insurance requirement, but it is also pushing companies in the wrong direction.
A public option makes employer based insurance unnecessary, especially where companies can provide supplemental help.
I believe these are steps in the direction of fixing Obamacare that are workable. Unlike Trump, I know fixing Obamacare is difficult because healthcare is complicated, but it can be done.
In fact, it will always have to be done because circumstances change, making fixes always necessary along the way.
But two principles should guide us in this task: (1) that healthcare is a human right. To make it available on the basis of one’s ability to pay is egregiously immoral; (2) people should be given as much control as possible over their own healthcare decisions.
If it is true, as I believe it is, that one size doesn’t fit all when it comes to healthcare, it is equally true that my decision affects you whether I admit it or not. In short, we are in this thing together, and we can find a solution together.
But only if Republican ideologues who believe the free market justifies putting profits ahead of people’s health are left out of the process.
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Thanks for your thoughts about health care. I agree that this is a very complex issue. I think it is far too complex to expect that a bunch of politicians can come up with a satisfactory solution, especially when they are so prone to including their pet project, like tax cuts for wealthy individuals as was done in the failed “Trumpcare” proposal. I consider them uniquely unqualified to solve difficult problems like this one.
I think your thoughts provide a good framework for working on this problem. The question is who will work on this problem. It seems we need a blue ribbon “committee” (ugh, I dislike that word) made of up of knowledgeable, qualified people dedicated and committed to solving this issue, and then we need to listen seriously to them when they reach conclusions. We need to exclude any politician from this committee. Then any proposals the committee comes up with may not be politically acceptable, but It will have our best chance of reaching a workable solution. Unfortunately, the politicians will still have to enact legislation to implement any solution, but that is a separate problem.
Wally, I doubt any such committee will be called together, and if it were, as you say, any recommendations it made would still have to be passed by politicians. I think the normal legislative process, as dysfunctional as it is, remains our best hope.
Kentucky tried a public option with very experienced administrators and many people signed up for it. I think it was actually the most chosen option. But they were unable to sustain it for very ill folk were signed on and charges just eventually overwhelmed them. I don’t know anymore of the specifics but it seems it would be a valuable case study to evaluate if there is a way it could work.
States don’t have a public option. They have state exchanges that offer various polices through insurance companies, and for people who qualify they have federal/state Medicaid, which is a different program. But based on what I have read, your current governor has undermined entire the Kentucky exchange and that is why the program is having more problems than it once did.
States don’t have a public option. They have state exchanges that offer various polices through insurance companies, and for people who qualify they have federal/state Medicaid, which is a different program. But based on what I have read, your current governor has undermined entire the Kentucky exchange and that is why the program is having more problems than it once did.
I agree with your conclusions. Yet how to work forward? I suggest we already have a fine program in place call Medicare. Therefore by reducing the age requirement for Medicare in five year increments and requiring total participation of those ages our country would soon accomplish healthcare for all without suddenly destroying the free market. Supplemental health insurance would still be available as is now. Affordable Care Act and Medicade would stay in place until participants moved into Medicare eventually phasing out those programs.
I agree, Eleanor, but, as I indicted, the expansion of Medicare cannot get enacted because Republicans don’t want it because it would serve to replace most of the for-profit insurance market. In fact, they want to get rid of Medicare itself, or, more particularly, make it income based which would destroy it. The public option competes with traditional insurance instead of replacing it.
In a “free enterprise/market” system, as Adam Smith explained so long ago, the “motivator” is self interest but the “regulator” is competition! Mega industries and institutions of recent decades have reduced or eliminated the competition part of the equation to eliminate or minimize the “invisible hand” of balance and self correction which can make capitalism work for ALL. (Hell, J. D. Rockefeller killed his competition [regulation] by buying up many metropolitan trolley companies and burned all the cars to elevate his fossil oriented self interest. Nothing invisible about his mentality!) Such attitudes are blatantly visible in many other industries such as energy but glaringly so in the health and health insurance businesses. So I agree that without moral or true competitors at the helms of various corporations it MUST be government that restores the balance! Greed is proving Keynes correct; government has a balancing role!
A Medicare for all plan needs renewed emphasis although I agree it likely won’t go far in this congress. (Both Conyers of MI. and Sanders are pursuing.) I do think Medicare’s “flat rates” are regressive though. That a household with a $20K/ yr. income pays the same as one of $84K (7% vs. 1,6%) is wrong! MN Care, their state program, uses premiums that are proportional to household income. (I/we use to use it.) I say that is more fair and less stressful to increasingly income depressed middle and low income households than the flat rates of Medicare now in place.
Thank you for this set of articles. This subject deserves much much discussion.
Bob, I am sure you will agree that one of the great inconsistencies of radical capitalists is that they praise the free market, yet support how it is manipulated and circumvented in hundreds of different ways. That is why a genuine “free market” is a mythical concept. It never has existed and never will, especially at this time in history where corporations are larger than some national governments.
The caution I would add regarding graduated costs for Medicare is that Lyndon Johnson chose to follow FDR’s example when he established Social Security and resisted making any of it need based. Once any part of a program is, that opens the door to turning the whole thing into a need based program. If that happened to Medicare, as with SS, it would destroy it. Need based is why we have Medicaid. Medicare was never intended to be that.
Thanks for writing.
Jan, to me, you have presented an extremely “mindful” analysis and solution in both Part I and Part II. I would add that the pharmaceutical industry is a large culprit in this debate as much as insurance companies. They are the reason our prescription costs are astronomically high compared to any other country on the planet. With respect to “mindfulness”, the republicans, and trump somehow got elected because their cauffers bought into the arguments that Hilary is bad, Obama is really bad, and Obamacare is really, really bad. Not one mindful analysis or proposal was presented. And it worked for them. But, now they are finding that “democracy” does have its checks and balances. I see hope for at least some improvement to be enacted by both parties on Obamacare. But, not the whole nine yards as you suggest. But, this could lead to something more substantial down the road if we all keep “holding them accountable”. Thanks for your continued insight.
Thank you for your contribution to this discussion, John. Including the pharmaceutical industry as part of the problem is spot on. That was an omission on my part, so I am glad you raised the subject. I hope you are right about the chance for some progress to be made. It’s there for the taking, but I am not convinced yet that even non-ideological Republicans will be willing to do anything with Democrats. But we can hope.