Don’t Like “Obamacare”? Advocate Something Better, Like Medicare For All

A New York Post column (“The 49ers“) laments the potential job losses as a result of full implementation of “Obamacare.” The use of the term “Obamacare” in place of “Affordable Care Act” should be your first tip-off of what’s to come. The article’s author is Michael Tanner, a senior fellow at the Cato Institute, which is a libertarian think tank. That should be your second tip-off.

The crux of the problem that Tanner focuses on is the Affordable Care Act rule that mandates companies with 50 or greater employees provide health benefits.

Under the circumstances, how likely is the company to hire that 50th worker? Or, if a company already has 50 workers, isn’t the company likely to lay off one employee? Or cut hours and make some employees part time, thus getting under the 50 employee cap? Indeed, a study by Mercer found that 18% of companies were likely to do exactly that. It’s worth noting that in France, another country where numerous government regulations kick in at 50 workers, there are 1,500 companies with 48 employees and 1,600 with 49 employees, but just 660 with 50 and only 500 with 51. – The 49ers

Indeed, this sounds like it could be an issue, but not because of the Affordable Care Act. No, it’s that employers cannot be trusted to do right by their employees. Tanner’s argument assumes that all companies are strapped for cash and are unable to extend health benefits to their employees. That may be true in some cases, and it may not be true in other cases. Tanner’s argument that Obamacare is bad because companies will react by firing employees seems like the foundation of a movement; one that advocates taking health care insurance decisions out of the hands of employers altogether. If we cannot build a true universal health care  system while employers are part of the equation, then why not remove them from the process? I say we take that burden away from employers and we focus our efforts on extending true universal health care to all citizens — Medicare for all.

Even if you believe it was misguided, it doesn’t change that Obamacare was intended to help millions of Americans gain access to affordable health care. Instead of putting so much energy into a mission against Obamacare, why not put that energy into solving the problem? Why not take health care administration and overhead costs out of the hands of employers? Why would an employer who is not in the health care insurance industry want to be in that business anyway? I would assume most employers would be happy to give up that burden as long as it didn’t mean losing competitiveness in the marketplace. So for all the people who are against Obamacare, why not put your energy into taking this burden away from businesses? Why not advocate Medicare for all?

As long as health care coverage is largely provided by employers, there will never be fair and equal access to health care. I’ll readily admit that the Affordable Care Act builds on this flawed system, but I do not believe we should dismantle it. Instead we should strive to convert the ACA into Medicare for all. If it was possible, I would welcome the end of Obamacare if it meant flipping a switch and opening up Medicare to all citizens. But since that’s probably unrealistic, we need to work to improve the Affordable Care Act with the end goal of transitioning it to a real universal health care insurance system. I say “insurance” because we aren’t talking about the actual health care itself, but instead the insurance that allows us to afford it. Insurance works by having a diverse risk pool. There is nothing more diverse than 300 million Americans.

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