Looking Past the Affordable Care Act: We Must Sustain the Fight for Universal Coverage

To be fair, the Affordable Care Act has brought some kind of coverage to about 20 million Americans, in good part through the expansion of Medicaid in 32 states (including DC) and the subsidized exchanges. But its negative results far outweigh its gains, as shown by these data points:

Given this dysfunctional reality under the ACA, it’s remarkable that neither major political party has a plan to truly fix the situation.

If elected, Hillary Clinton proposes to bring on the public option (which can’t possibly succeed against the overwhelming market share of a subsidized insurance industry), increase subsidies, add new tax credits for deductibles and co-payments, and lower the age for Medicare eligibility to age 55. These tweaks would not reverse the huge private bureaucracy bent on increasing profits in markets subsidized by taxpayers.

Given the opportunity, Republicans would repeal the ACA with no credible plan for replacement — relying on such long-discredited approaches as consumer-directed health care, health savings accounts, high risk pools, selling insurance across state lines, and giving states more leeway with block grants.

We should have learned by now that segmented risk pools designed for profits by private health insurers will never provide universal access to affordable health care in this country.

Virtually all advanced countries around the world learned this long ago with one or another form of universal health insurance.

Multiple studies have demonstrated that in the US we could save about $500 billion a year by enacting a nonprofit single-payer national health program that streamlines administration. Those savings would be sufficient to guarantee everyone high-quality care, with no cost sharing, on a sustainable basis. The system could also negotiate lower drug prices.

Studies over the past two decades have shown 3 of 5 Americans supporting an improved version of Medicare for all. Support for single payer is also growing among doctors and other health care professionals. Yet the Expanded and Improved Medicare for All Act, H.R. 676 (Rep. John Conyers’ bill), with 62 co-sponsors, sits neglected in a House committee.

Until we recognize that the largest possible risk pool is required to implement universal coverage in the public interest, and that the private health insurance industry is on a death march, we cannot make necessary health care available to all Americans.

Can’t we get to real health care reform on a nonpartisan, win-win basis?