Thursday, March 16, 2017

Health care for all has only one option

After dozens of votes to repeal "Obamacare," Republicans in Congress have gotten their wish. They have the votes to repeal the Affordable Care Act, but they now face the reality that repealing the act does not improve health care. The repeal leaves huge gaps in health care and eliminates many popular aspects of the Affordable Care Act, such as protecting patients from being punished for having pre-existing conditions.

The reality has hit the GOP leadership: They can't just repeal Obamacare. They have to replace it. A proposed replacement was rolled out this week, but the Congressional Budget Office has found that the GOP health care plan leaves an additional 24 million Americans without health insurance. That figure frightened some less ideological Republicans, and votes to pass the GOP plan are dissipating.

The GOP plan is under attack from the left, as Democrats decry numbers of people who are left out of the new plan, and from the right, as far-right Republicans complain that the new plan is just warmed-over Obamacare.

Maybe this is an opportunity for a bold new approach. Both the Obama plan and the new GOP (Paul Ryan) plan are built on an inherently flawed premise — that America has to keep its network of employers paying premiums for employees and insurance companies paying the bills (or part of the bills) for U.S. healthcare. This system leaves out the unemployed, under-employed and just plain unfortunate. Obama's plan, like the one Hillary Clinton tried to push through during her husband's first term, tried to force the uncovered into buying insurance. Obamacare used tax penalties and government subsidies to make people get health insurance. It increased the percentage of people with healthcare but still left many people uncovered. The new GOP plan uses the same basic strategy but uses incentives to get people to buy health insurance rather than penalties and subsidies. It would leave even more people uncovered.

Perhaps the time is right for a new strategy — one that was rejected in earlier debates, but the only one that will truly cover "all Americans," which President Trump promised the GOP plan would achieve. That option is "single-payer," which is the model nearly all Western democracies use to provide truly nationwide coverage. In this option, all Americans would pay into the system, just as we all pay into Social Security and Medicare, and a federal agency would disburse payments to health care providers. Overhead would be sharply cut with just one agency handling accounts payable rather than hundreds of insurance companies, many of whom pay their CEOs multi-million salaries.

Taxes would rise, but health insurance premiums would be eliminated for both employees and employers. How much does the average worker pay for health insurance? $500 a month? $1,000 a month? How much do employers pay? That amount (or less) would be collected in taxes and used to pay for health care of everyone. The uninsured, who are a drain on the system now, would be eliminated. Taxation could be designed to be fair to all, with the lowest-income paying lower taxes and the most affluent paying more. Making the healthcare tax a separate form of tax on both employees and employers just like Social Security and Medicare, would keep the system transparent. Some co-pays would be appropriate to keep the public from abusing the system.

This is the only way everyone would be covered. Everyone would share the risks in a risk pool of 300 million-plus people. Insurance companies would fight for their survival, but the advantages of this system is too great to allow one interest group to sabotage it.

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