Affordable health care for all

Improve the Affordable Care Act? Repeal it? Or replace it?

The Patient Protection and Affordable Care Act (also known as “Obamacare”) made health insurance more affordable for millions of Americans, but it fell well short of providing universal health care and the overall cost of health care in the United States continues to increase and remains much higher than in other advanced, high-income countries.

Covering everyone, at truly affordable rates, will require additional legislation. Support has been building for a single-payer system of some sort (which is what every other advanced country has in place). Medicare-for-all is the most common version of a single-payer system being proposed. Another option is a public option for health insurance, which would be a single-payer system for those who wish to participate, without requiring anyone who is opposed to a government-run system to participate.

Legislation that has been introduced in Congress:

Democrats in Congress have introduced the Choice Act” [S. 194 and H. R. 635] that would address a major flaw in the Affordable Care Act by providing a public option for health insurance. This would offer a single-payer option to everyone who wants that, without requiring anyone who doesn’t want that to participate.

Medicare-for-all (H. R. 676 and S. 1804] is the Democratic version of repeal and replace. (The senate bill was introduced by Bernie Sanders – an independent who caucuses with the Democrats.) Medicare-for-all would reduce the cost of health care by 30% to 40% with no reduction in either the quality or quantity of care provided.

With the exception of Senator Bernie Sanders (an independent) all of the cosponsors of the bills that have been introduced are Democrats. There are no Republican cosponsors. These bills have gone nowhere in a Republican-controlled Congress and will not be passed if Republicans retain control of either chamber. Getting these bills passed would require united support from Democrats and the approval of President Trump.

The Republican Party clearly favors repeal of the Affordable Care Act. To the best of our knowledge, no clear and definite plan for a replacement acceptable to the Republican Party has been introduced in either house of Congress.

We support both the Choice Act and Medicare-for-all. Either of these approaches would be a huge improvement over our present system.

Major party platforms on this issue:

The Democratic Platform:

Democrats believe that health care is a right, not a privilege, and our health care system should put people before profits.

Americans should be able to access public coverage through a public option, and those over 55 should be able to opt in to Medicare.

Democrats will empower the states, which are the true laboratories of democracy, to use innovation waivers under the ACA to develop unique locally tailored approaches to health coverage.

We will keep fighting until the ACA’s Medicaid expansion has been adopted in every state. Nineteen states have not yet expanded Medicaid.

We must treat mental health issues with the same care and seriousness that we treat issues of physical health.

The Republican Platform:

Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare.

It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years. It drove up drug prices by levying a $27 billion tax on manufacturers and importers and, through mandated price cuts for drugs under Medicare and Medicaid, forced pharmaceutical companies to raise prices for everyone else. Its “silver plans,” the most common option on the government insurance exchanges, limit people’s access to their own doctor through narrow networks and restrict drug coverage, forcing many patients to pay for extremely costly medicines for their chronic diseases.

We agree with the four dissenting judges of the Supreme Court: “In our view, the entire Act before us is invalid in its entirety.” It must be removed and replaced with an approach based on genuine competition, patient choice, excellent care, wellness, and timely access to treatment. To that end, a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.

In its place we must combine what worked best in the past with changes needed for the future. We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality. To simplify the system for both patients and providers, we will reduce mandates and enable insurers and providers of care to increase healthcare options and contain costs. Our goal is to ensure that all Americans have improved access to affordable, high-quality healthcare, including those struggling with mental illness.

Polling on this issue:

A “Medicare Buy-In for All” is supported by 71%, with 13% opposed, and 14% neutral).  That included 77% of Democrats polled, with 9% opposed, and 13% neutral; 71% of independents, with 13% opposed, and 13% neutral; and 63% of Republican voters, with 18% opposed, and 16% neutral. (From the poll by GBA Strategies. Other polls show support for Medicare-for-all somewhat lower, at approximately 60%.)

Our view:

The Patient Protection and Affordable Health Care Act was drafted with considerable input from private, for profit health insurance companies and does a better job of serving their interests than it does of serving the common interest, by making health care truly affordable.

Making health care available to all of our citizens at an affordable price cannot be accomplished through a system where private, for-profit health insurance companies act as the gatekeepers for health care in the United States.

Through the subsidies it provides, The Patient Protection and Affordable Health Care Act has made health insurance available to millions of people who could previously afford coverage, but we still have tens of millions of uninsured people and the cost of health care continues to spiral out of control.

Health care in the United States is far more expensive than in any other advanced country, with no benefit evident in terms of longer life expectancy or other outcomes.  Other countries cover all of their citizens (and tourists).

It is time for the United States to join the rest of the industrialized world in making health care available to all people through a simple, single-payer health care system.