Medicare Single-Payer vs. Affordable Care Act (Obamacare)

The overwrought and repugnant response to the Affordable Care Act (Obamacare) by Looney Tunes Tea Party “activists” and by many so-called mainstream Republicans, is patently absurd in a country that already has a nearly 50-year-old single-payer, government-run, health care insurance program called Medicare. And I purposely include “insurance” in the description of Medicare, because that’s exactly what it is. It is NOT socialized medicine. You still see your private doctor with Medicare. You can still go to a private hospital with Medicare.

But here they go, the right-wingers are going to call me out. They say Medicare is not a single-payer health care insurance program. Why do they point this out? Beats me. They say because Medicare pays 80% of your medical bills, that means it cannot be a single-payer system. But when we talk about health care insurance programs or systems, we are talking about insurance. If you have to spend 20% out of pocket, you are certainly free to call yourself a “payer” but you aren’t a system. And even if you chose to buy supplemental insurance to cover that 20%, that is private insurance that is separate from the system. When we talk about the basic level of coverage you get with Medicare, there is not another player or payer, Medicare is the only game in town. Therefore Medicare is a single-payer system, even if it’s not a comprehensive single-payer system that covers 100% of medical costs.

But now I’ve distracted myself from the original point. If there’s one thing right-wingers are good at, it is changing the subject or modifying the premise to suit their ideology. The original point I’m trying to make is that on a Left/Right scale (for lack of a creative alternative), Medicare sits far to the left of the Affordable Care Act (Obamacare). And because that is true, the over-the-top anti-Obamacare rhetoric from the Right is nonsensical.

Remember all the crazy shouting and demagoguery during the 2009/10 health care “debate”? Or how about all the insane Republican obsession with repeal of the Affordable Care Act? All of the foaming at the mouth nonsense directed at a private market-based solution (Obamacare), has happened in a country that already has a government-run solution called Medicare.

Medicare is a single-payer health care insurance program run by the government, and it has a large insurance pool, which gives it tremendous negotiating ability to keep procedure costs down compared to private insurance. Imagine if Medicare wasn’t age-limited, how much bargaining power would it wield then?

By contrast, Obamacare is a market-driven solution. The Affordable Care Act relies on private for-profit insurance, or in other words, it didn’t change the system we already had, it simply tweaked it. The ACA is simply a set of rules to further regulate a health care marketplace that already existed. And while I have plenty to say in opposition to market-based solutions for health care, this isn’t the article for that.

Nope, the point of this article is not to sell Medicare-for-all, although I do think single-payer is the best solution to our rising health care costs. And the point of this article is not to point out the flaws of a capitalist marked-based health care solution. Instead, the point of this article is make a reasoned distinction between Obamacare and Medicare and then ask a simple question — Can you honestly and with a straight face defend the rabid fanaticism and incendiary oratory (“it will end freedom,” “it will destroy America,” etc.) directed at the Affordable Care Act by many Republicans and conservatives?

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Health CarePolitics

#Affordable Care Act#conservative#health care#health care insurance#insurance#medicare#obamacare#right-wing#single payer#tea party

  • Michael

    1st and foremost, you have a great blog/site here and I’m a little surprised it hasn’t yet drawn the traffic it deserves. While I did not support the PPACA, I am willing to give it a chance and see if my premiums stay the same or go down, ie see if it lives up to the title of ‘affordable’. I would have preferred smaller reform packages over one massive act that now seems to have more exceptions than rules. I think a law preventing insurance companies from denying you coverage based on mistakes they nitpicked from your application would have passed with bi-partisan support, possibly even a law forcing parents to pay for their kids health insurance until they are 26. I would have liked to address the accessibility problem separately as well with vouchers for the poor to purchase health insurance. What I don’t like is the government telling a private company that there overhead costs have to be 20%, or what their insurance plans must cover, or what rates they establish. If the private sector coordinated with other insurance companies and agreed on rates that they all had to abide by, it would be called ‘price fixing’ and would be illegal. Furthermore, I would prefer to see each state address their own health care problems and run 50 separate health care experiments. I am a little worried that health insurance companies will become the next fannie mae and freddie mac, and be private companies only in a very technical sense.

    • Thanks. The blog did alright last summer/fall during election season, but it sometimes feels like starting all over again since then in the traffic department. But I keep plugging away.

      I’m not a huge fan of the ACA. I think it’s better than nothing, but that’s not exactly a ringing endorsement. What I don’t do, however, is demagogue something by using falsehoods, like much of the Right has done with the ACA. There are legitimate critiques, not the least of which is that you can’t really have a market-driven solution for health care insurance because patients are not the same as customers. In fact, they are nothing alike.

      I’m definitely for a simpler, if not necessarily smaller (in the sense of less changes required to get there), solution to universal health care. For me, single-payer is the way to go, and it’s way simpler, even if on the scale of health care reform ideas, it’s a bigger idea than the ACA (if that makes any sense).

      I can understand arguments concerning government dictating to companies what their cost structure should be, but here’s the problem, basic health care insurance should not be provided by for-profit companies. Just because that’s the way it’s “worked” in this country for a long time does not make it the right way or the best way. And the other thing that is definitely not the best way is having your insurance tied to your employer. We need to get off that. And the ACA does nothing to move us off of that.

      I’m not saying for-profit health care insurance cannot exist, but it should only exist as a supplement to the primary universal insurance that all citizens should have access to.

      • Michael

        Completely agree, ironically enough from what I’ve read the employer based coverage is really an accident of history from when the govt set salary caps during WWII, business had to compete for talent by offering benefits as opposed to salary. I think most people would agree to two fundamental ideas surrounding health care. My only concerns about single payer is that if the medical industry only has one customer (the government) then the government would basically have the power to set prices for 1/6 of the economy. I still think at a basic economics level that price should be determined by supply and demand. An interesting philosophical question I have been wrestling with has been that in this country, people can buy advantages over other people, a bigger t.v., a bigger house, better restaurants etc…should health care be one of those? And I’m just talking about fancier hospital rooms or better hospital rooms, should the well off be able to buy health care that poorer people simply wouldn’t have access to?

        • Yeah, employer based coverage is definitely not something that came about from careful consideration of the various options. It is very much an accident of history.

          Price control is one of the biggest problems in health care. That Time Magazine article from early this year by Steven Brill really shined a light on how much profit is built into the system, even at so-called non-profit hospitals. And the biggest justification for the insane costs of procedures (compared to nations with universal health care, or even Medicare) is the uninsured. They say they have to charge what they charge to cover the uninsured (since we don’t turn them away of course). While I think this is mostly BS (there are some people getting pretty wealthy off the current system) if there’s any truth to it at all (I’m sure there is) it’s a big justification for a single-payer system that can cover everyone and keep costs down.

          As for your question, I do not think monetary means should allow you to get preferential treatment for the same medical procedure. But, if there are going to still be private hospitals, then sure, if a hospital wants to cater itself to the wealthy, so be it. And yeah, it would be lucrative for that hospital, but it would be a niche market that didn’t compete with the health care system at large for most people. And this is something that already exists within the current system anyway.

          • Michael

            At this point, although philosophically opposed to single payer, I’d be willing to give it a chance. As a scientist I am always willing to experiment, but before I experiment I always know which potential results of an experiment would force me to abandon my theory. I think it is wise to do the same thing with the PPACA. Let’s look at the promises of the PPACA; “If you like your insurance, keep it”, it will bring costs down for everyone, deficit neutral over 10 years as scored by CBO, no rationing, no death panels. In 10 years time, what if there really are ‘waiting lists’? What if there really are people deciding that you can’t get this treatment on some utilitarian grounds? What if in 10 years the growth of health care costs have not slowed down? Will we abandon PPACA, or double down and go single payer…

          • My opinion on this issue (and many) is that we never go far enough to actually fix problems because we always face opposition to change for opposition sake, well, and also fear. So if the ACA doesn’t do what’s promised, it’s not proof single-payer wouldn’t. It’s simply proof the ACA didn’t go far enough and the people who supported it will as zealous in their support as those who were in opposition.

            As for the idea of a death panel, well, that already exists, but of course it’s not called a death panel. When insurance executives are sitting around a board room table deciding what they will or won’t cover, why is that not also a death panel? Obviously I don’t think it should be referred to by that name as it’s beyond hyperbolic, but I would much rather those decisions were made in the public sphere, and not by a private company driven by profit. After all, a company can provide a great service, but it’s first priority is to itself and shareholders. That’s just a simple fact. We can bemoan corruption in government, but the number one priority of government (outside of individual agendas) is for the public good.

          • Michael

            Maybe the worst part of the ACA is that it mandates one plan for all states. It would be nice to see free market health care states running side by side single payer states, again I love experimentation.

          • Just as I believe rights delayed are rights denied, the same could be said of universal access to health care. But having said that, I know we aren’t going to have national single-payer health care anytime soon. So I too would be fine with a state-by-state trial run.