Obamacare is as good as it gets.
No, not HealthCare.Gov, the healthcare portal that has had a rocky rollout, due in part to the numbers of Americans who have tried to browse the site. It will be fixed, though perhaps not by November 30, as promised.
The system itself, the public health insurance program created by the Affordable Care Act, is as good as it gets, at least for now. It’s complicated, but it works, as evidenced in those states, mostly blue, which chose to run their own exchanges. Those portals are functioning, and consumers are signing up for health insurance.
The ACA is not as complicated as critics claim, but it does force consumers to go to the exchanges and fill out forms requesting financial information to see if they qualify for government subsidies and to make choices as to insurers, who have to offer the same policies to everyone.
It’s more complicated than the existing system of Medicare, in which a citizen enrolls at the age of 65 in one plan, pays a modest premium which can be deducted from his or her Social Security check, and then chooses a government-regulated supplemental insurance plan to cover those medical costs not paid by Medicare. After that, a Medicare recipient does next to nothing, rarely seeing a bill.
It’s simple, and it works.
Which raises the obvious question: Why then, when President Obama and Congress were considering reforming the nation’s healthcare system, did they simply not make Medicare available for everyone?
There are many reasons why Medicare for all was never a viable alternative. The insurance industry is too powerful to replace by government insurance, and it would never have settled for a small slice of the healthcare pie, such as the 20 percent of doctor’s costs and outpatient expenses private insurers now get under Medicare.
Most workers who currently receive health insurance through their employers were reluctant to give up that hard-won benefit (thought it should be noted that the percentage of workers with employer-paid plans is shrinking and the costs of worker-paid premiums is increasing).
Current politics impeded any attempt to extend Medicare. The barrage of conservative anti-government critiques of the last several decades has moved the national dialogue to the right, leaving many skeptical of government-run programs, even though it is widely recognized that Medicare is far more efficient than private insurers and that far more of its costs go to paying medical bills than to administrative costs. Despite today’s rightwing objections to Obamacare, it was the most conservative option available, short of doing nothing.
All these reasons meant that the system fashioned under the Affordable Care Act had to be based on private insurers, who would be regulated but who would sell insurance on the exchanges to recipients who would buy those policies under the individual mandate.
It’s as good as it gets, but it’s not Medicare for all.
Nor is Medicare as good as it could be. True, signing up is easy and there are no co-pays nor bills when recipients receive medical services. But seniors pay several hundred dollars a month in premiums (to the government and for supplemental insurance, as well as for prescription insurance).
Medicare is not, contrary to what most believe, a single-payer system. It is a public health insurance program, but it is not national health like the Canadian and United Kingdom systems. A single-payer system means that the administrator or payer is one entity, the governments in Canada and the United Kingdom, for example. The only single-payer system in the United States is the nation’s Military Health System.
Medicare is, for want of a better phrase, a hybrid system of government-provided insurance and private supplemental coverage. Given the conservative bias of American politics, that hybrid system is as good as it gets for seniors. And Obamacare is as good as it gets for everyone else.