The deal that enabled the Affordable Care Act to pass Congress required a free enterprise system of direct provider insurance carriers marketing their policies in a competitive market environment. Those policies would have to meet minimum standards to ensure an equable and universal availability of preventive and catastrophic care for all Americans. It looks like that plan is not working. There are rumors that glitches in the system, such as the delayed website, uncooperative states and limited competition in some rural states will result in a need to bail out insurance carriers in order to guarantee affordable premium rates. The other thought is that it will be the consumer who will need to be reimbursed in the face of non-competitive rate setting by these “free market” providers. The very same conservatives who insisted upon a competitive free market for health care are attacking ObamaCare claiming “I told you so!” So, what if the Affordable Care Act had passed with a single payer provision, either in competition with the free market or as a true single payer system.
To be clear, Medicare is a single payer system with minimum standard benefits available for those covered directly by Medicare. Medicare does not close out the “Free Market” or eliminate competition. Private health insurance companies can contract with Medicare to provide mostly HMO, and PPO medical coverage plans and even some premium plans offering significantly expanded coverage or elimination of co-pays. The system is funded by a universal payroll tax, co-pays for medical coverage and premiums. The system works and is fully funded. There are no insurance carrier or consumer bailouts. Naysayers claim that the Medicare program is headed for a financial disaster. But the latest prognosis projects fiscal stability through 2026.
It is true that the current form of the Affordable Care Act, “Obama Care”, is a mess. The website glitches have caused delays in the rate of registrations for insurance coverage. Deficient plans appear to have chosen to dump their insureds rather than adjust coverage to meet the current standards. Employers are using Obama care as an excuse to reduce employee hours to part-time in order to reduce exposure to benefit costs. Medical providers are complaining about reduced reimbursement rates mandated by cuts to Medicare needed to fund the redistribution of healthcare . Hospitals similarly face changes in their Medicare reimbursements due to reduced Disproportionate Share Hospital (DSH) Payments that cover uninsured medical care that will be reimbursed through the universal coverage concept. If universal coverage is not achieved, there would appear to be a net loss for the hospital based system of indigent care.
In hindsight, the problems with the Affordable Care Act appear to be attributable to the necessary compromises needed to pass the program through our Congress. The political success goes to the Republican party and the wing nuts in the Tea party contingent who managed to fracture the potential for any hope of a smooth implementation of universal health care for their own constituency of the American people. Their success is that the entire mess has become blamable as an Obama failure. Had the President not compromised, the effort for universal access to quality health care may have continued to be frustrated. There would be no program today. By accepting compromises, President Obama was caught in a neat trap. There is apparently no price too high to ensure a failed and ineffective government.
A single payer system of universal health care would have followed the successful model of Medicare. There would have been a universal payroll and self-employment tax rolled into or in addition to the current FICA tax. There would have been a universal premium payment system to supplement the tax that would have taken into account the affordability of premiums for low-income payers. Employers would have found no reason to reduce employee hours to avoid participation in providing a healthcare plan for their employees. The best employers would be able to pick up employee premiums or even offer premium plans at an added cost. Any issue of either insurer or consumer bailouts would be resolvable by Congressional adjustments to the funding, just as is now accomplished for Medicare and Medicaid. Best of all, the insurance carriers would be able to compete in a “free market” environment by contracting with the Affordable Care Act to administer the delivery of health care with expanded and premium benefits, just as they do in the successful Medicare system.
Obama Care is in trouble. But it is wrong to place the blame at President Obama’s door. The program can be adjusted to meet the goal of an efficient universal healthcare system. All that it will take is a Congressional will to ensure that quality medical care will be available to every American man woman and child, regardless of income and ability to pay.