Why I’ve Soured on Obama’s Health Care Bill

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When Congress finally passed Obama’s health care bill back in 2010, I was fairly happy with it. Among many other items, the bill addressed three huge problems with our previous ways of managing healthcare:

  1. Denial of coverage for pre-existing conditions (prohibited for childen now, prohibited for adults starting in 2014),
  2. The huge number of uninsured Americans (about 30 million more Americans will get coverage through expanded Medicaid)
  3. Lack of options for the self-employed, uninsured, and small business employees (each state will have an insurance exchange in which these people can pool their resources for more competitive coverage)

I was, and continue to be, frustrated by the ignorance among the general public regarding the bill. Its detractors generally call it Obamacare. Many of them mistakenly believe it calls for socialized medicine, prevents people from choosing their own doctors, creates government “death panels” who decide whether individual patients get to live or die, and other fallacies. Wikipedia offers a nice summary of the bill and the effective dates for each of its provisions. For many people, including our family, this bill has very little impact. But millions of Americans will benefit if all provisions are implemented. One potential obstacle, other than a retraction of the bill by Congress, is the Supreme Court case that will decide whether the bill is constitutional. Some argue that the government doesn’t have the power to force people to buy health insurance or penalize them if they don’t. That case will be decided next summer.

So why have I soured on the bill? I don’t think it goes far enough. It still leaves millions of Americans without coverage. It still keeps our healthcare hostage to for-profit companies who have financial incentive to deny claims. It doesn’t address the tremendous inefficiency in the system.

I want to see a universal healthcare system, also known as a single-payer system. I want every person in this country to have the ability to get the medical care they need without having to worry about how much it costs.

There are many ways to accomplish universal healthcare, and many pros and cons associated with it. This site offers several good points on both sides. It also clarifies an important point regarding universal healthcare versus socialized medicine:

It is important to note the distinction between universal health care and socialized medicine before we proceed. Many people confuse the terms. Under universal health care, hospitals, doctors, drug companies, nurses, dentists, etc can all remain independent. They can be for-profit or non-profit. In socialized medicine the whole industry is the government. So if you wanted to be a doctor, you would work for the government.

The main difference between today’s healthcare system and a universal healthcare system is how the providers get paid.

In today’s system, providers get paid in a variety of ways and need one or several employees just to handle all the financial paperwork. One patient might pay cash. One might pay with Medicare. Another might pay with private insurance, which limits the pool of potential patients to those who are “in-network” and forces the provider’s insurance guru to figure out the right way to code everything about the visit to ensure that the insurance company pays correctly. The guru sends the insurance company a bill for some outlandish amount, well beyond the actual cost to provide the service, and the insurance company agrees to pay some fraction of that amount. It’s all a game. Naturally, if a potential patient lacks insurance and can’t afford to pay cash, the provider doesn’t make any money, and the patient stays sick or injured. No one wins there.

In a single-payer system, the provider treats a patient just like today. To get paid, the provider notifies the plan administrator about the treatment, and the administrator reimburses the provider. The difference? The provider no longer needs an army of office workers to deal with dozens of insurance companies and hundreds of different plans. The patient doesn’t have to worry about whether he/she has insurance or what the insurance company will or won’t cover. The patient probably has a set fee for the visit unless he/she is unable to pay. The government pays for the rest. The provider gets paid. The patient gets treated. Both parties win.

Thanks to Medicare and Medicaid, a large part of our nation’s healthcare system is already single-payer. Yes, Medicaid has a variety of issues. Medicare isn’t perfect, but it seems to work pretty well for older Americans, and its administrative costs are much lower than those of private insurance companies. Although its payments to providers might be lower than those of private insurance companies or patients who pay cash, working with Medicare is much less of a headache for the providers. That’s one of the main reasons why one poll indicated that a majority of providers favor a single-payer system.

Obviously, the elephant in the discussion is how to pay for all this. No doubt it would be expensive since more people would receive care. But the funding model is much different. Rather than paying for health insurance for their employees, companies could pay a healthcare tax instead. Individuals could stop paying insurance premiums and pay more in taxes. Since private insurance companies and their $48 million CEOs would no longer be necessary, their disappearance would reduce the cost of healthcare per patient. Plus the providers’ cost would drop due to greatly simplified billing. The system would become much more streamlined. Also, in theory, a single-payer system would make it easier to improve preventative medicine, both through better accessibility and through financial incentives for the providers. It’s much cheaper to keep people healthy than to heal the sick and injured.

I could go on and on, but A) I’ve only scratched the surface in my own research and have much to learn, and B) this post is already quite long.

For me, the bottom line is simple. I have very good health insurance for my whole family through my employer. It has covered two c-sections, biannual mole removals, a gall bladder removal, ER visits for my son, and much more at a reasonable cost. I want every person in this country to have access to the same level of care that we do, if not better. It is inexcusable that in the wealthiest nation in the history of the world, a nation that many claim is founded on Christian principles, thousands of people die and millions suffer needlessly because they cannot afford healthcare. We can debate how to change that, and there are many different ideas, but that change is long overdue.

Repeal Obamacare. Enact universal healthcare.

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