Saturday, October 1, 2011

Repeal Obamacare?

In watching the Republican debates, one thing sticks with me more than anything else.  When the discussion moves onto the subject of healthcare, the mantra that is repeated over and over by the candidates is “Repeal Obamacare”.

I get it that they do not like the president’s healthcare reform bill that was signed into law.  But the fact is that it passed not only in the House but also in the Senate, not just by a majority but a supermajority of 60 to avoid a filibuster.  Instead of accepting it as the law of the land and trying to make it work, the Republicans, especially the Tea Partiers want to repeal it.  Government does not work well when laws are passed and then are repealed as soon as the other party regains power.  But for people who hate government, this helps to reinforce their narrative that government doesn’t do anything well.

But more importantly, the “Repeal Obamacare” demand begs the question, “And replace it with what?”  It’s a question I have yet to hear from any of the debates’ moderators.

A number of the law’s provisions have already gone into effect, such as the ability of children to have access to health insurance without being denied for preexisting conditions.  And with so many recent college graduates unable to secure jobs that have health benefits, the ability to add them to their parents’ insurance polices up to age 26 means that they are not forced to go without health insurance.  Would they like to repeal these provisions?

One of the big gripes is the individual mandate that requires everybody to buy insurance.  But without it, the whole system collapses.  Starting in 2014, everybody will be able to obtain health insurance without worry about preexisting conditions.  This is a vital part of the law so that everybody can be covered.  But we cannot realistically force insurance companies to accept all of the sick people without adding all of the healthy people to the risk pool.  And with the price of health insurance being too much for many poor people, we cannot make them buy coverage without subsidizing the cost of the insurance for them.

But still there is the question of whether this law will really work once everybody can enroll in 2014.  Many of those on the political left feel that the law may be fatally flawed without the inclusion of a so-called public option where the federal government offers insurance to keep the private insurers honest in their pricing, a provision that the insurance industry successfully fought to keep out of the law.

So what has happened since the passing of the law?  We now have Health Insurers Pushing Premiums Sharply Higher

Major health insurance companies have been charging sharply higher premiums this year, outstripping any growth in workers’ wages and creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.

The higher premiums are particularly unwelcome at a time when the economy is sputtering and unemployment is hovering at about 9 percent. Many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. The cost of family coverage has about doubled since 2001, compared with a 34 percent gain in wages.

Consumer advocates contend that the latest requests exceed any documented rise in costs, with some companies enjoying three years of record profits and paying millions of dollars in dividends and executive compensation.

And therein lies the rub when entrusting our system solely to the private insurance market.  Corporations like these exist for one and only one purpose – to make as much profit as possible.  While Medicare has an overhead of about 3-4%, private insurers can have an overhead of over 20%, much of that money going to profits instead of providing healthcare.

If health insurance premiums get any more out of control, we may someday be forced to add the public option that was left out of the original law.  Or better yet, offer Medicare for everybody, otherwise known as single-payer.

But let’s get real.  With the present anti-government zeal of those on the right, trying to improve the present law may well be impossible unless the 2012 elections give control of the Congress along with the White House to Democrats.  And the law doesn’t really kick in for most Americans until 2014 – assuming the law doesn’t get overturned in the meantime by a conservative Supreme Court as unconstitutional because of the requirement that everybody buys insurance.

Meanwhile, we still have about 50 million Americans uninsured, a figure that is inflated according to those on the right but in any event is a huge number of uninsured.  What happens to them if the law gets repealed or overturned?

If that happens, we may have no other workable option to provide universal health insurance coverage at an affordable cost than by eliminating the insurance middle-men with single-payer Medicare for all.

It gives credence to Winston Churchill who once said that 'You can always count on Americans to do the right thing – after they’ve tried everything else!'