Obamacare VS Single Payer – Top 10 Things the ACA Gave Us VS the Top 10 We Gave Up

By BAR managing editor Bruce A. Dixon

Most things have two prices --- the price you pay outright, and the opportunity cost, the negative value of what you gave up in order to do what you did. Were the “opportunity costs of the Affordable Care Act, the options we threw away to get it, actually worth more than the Affordable Care Act itself? What if we had pursued single payer instead? Would Republicans be able to block its implementation, and millions remained uncovered, as is happening now?

Obamacare VS Single Payer – Top 10 Things the ACA Gave Us VS the Top 10 We Gave Up

By BAR managing editor Bruce A. Dixon

What happens when opportunity knocks and you tell it to go away? There's a term in economics called an “opportunity cost.” The opportunity cost of any project is the negative value of the most favorable option you gave up to get whatever you got. In the case of the so-called Affordable Care Act, aka Obamacare, the most favorable option not just thrown away, but avoided at every opportunity by the president and Democrats in Congress, despite majority support among their constituents for it at the time, was a single payer health care system.

Back in the days when President Barack Obama was still Illinois state senator Barack Obama, he too was an advocate of single payer, famously telling audiences that all we had to do was elect a Democrat House and Senate, and put a Democrat in the White House to make it happen. The electorate followed Obama's advice, but the president went another way.

What did we gain? What did we lose? Was it worth it?  You decide...



1. We got a swiss cheese system that exempts many large corporations from having to ensure their employees.

The only grain of truth in the mountain of partisan lies Republicans tell about the ACA is that hundreds of large corporations have indeed been granted under-the-table exemptions from the obligation to provide health insurance to many of their workers, along with regulatory loopholes which let them to raise co-pays and deductibles to levels that will compel many of their low-paid workers to take their chances on the federal and state exchanges.

A single payer system would have freed US businesses altogether from the crushing burden of providing health insurance for their employees, and left no one without health insurance.

2. We got a Medicare expansion which can be thwarted at will by current or future Republican controlled state governments.

The only unalloyed silver lining of the ACA was its expansion of Medicaid, which the Supreme Court threw out, enabling state governments to selectively deny Medicaid benefits to millions

Medicare has been settled law for 50 years. Hostile state governments have no say in any part of its funding or administration. Lowering the Medicare qualification age to include everyone is and would have been a legally bulletproof, and Supreme Court proof way of guaranteeing health care for everybody in every state. But we threw that away.

3. We got a chaotic and confusing “marketplace” in which patients with little information are encouraged to conflate low insurance premiums with low-cost quality insurance.

In reality many families of modest means will choose low-cost plans with deductibles and premiums so high and coverage so limited that these costs will remain significant barriers to getting medical care even though they are technically “insured.”

Under a single payer system everyone is insured, period, from the cradle to the grave. Under single payer the experience of shopping --- essentially being preyed upon in a marketplace where the sellers have all the information and all the advantages never happens.

4. We got an initially unworkable internet front end for our chaotic and confusing “marketplace.”

In the first week of open enrollment in the state of New York, which is entirely cooperating with the ACA, almost none of the hundreds of thousands of eligible persons succeeded in enrolling online.

The first day of single payer customers would have to do exactly nothing. The social security system would already have your address and income data, with no confusing and predatory “marketplace” to navigate, people could go about their productive lives.

5. We gave an ongoing river of cash to private health insurance companies. Millions more are now forced to buy their crappy product, with the premiums funded by billion annually in public subsidies.

Health insurance executives got massive salary increases since the passage of the Affordable Care Act. Existing insurance company shareholders saw profits and stock prices spike, first with the passage of the ACA, then with the onset of open enrollment. Anticipated ballooning profits have led health insurance companies to buy back as much of their own stock as possible. What else would you expect? Health insurance company lobbyists wrote the ACA.

While the ACA pads the pockets of insurance company executives and keeps employed an army of advertisers, marketers and bureaucrats, single payer would have created a quarter million new good paying jobs delivering actual health care to people, according to the National Nurses Union.

6. The ACA gives us little or no cost control over medical care and even bans most measures that would lower the cost of prescription drugs.

With the substandard policies the most families will be able to afford, skimpy coverage, high co-pays and deductibles will continue to threaten hundreds of thousands annually with bankruptcy due to unpayable medical bills.

The US is one of the few places in the developed world in which a family can lose its home, and its children their college educations because of unpayable medical bills. We could have changed that. But we didn't

7. ACA only covers about half the nation's total uninsured. It leaves two thirds of the blacks and single mothers, along with half the low-wage employed currently without health insurance untouched.

You can blame Republicans for blocking ACA implementation, but they're only exploiting the opening Democrats gave them. The White House and Congressional Democrats made the decision to go for piecemeal private insurance reform rather than wholesale public health care reform.

Democrats and the entire political establishment placed much of what little credibility they had after the bank bailout behind the purported achievements of the ACA. A promise is a promise, and people DO remember broken promises. Broken promises poison the well of civic trust for established political parties and candidates.

8. We have to wait till 2016, when the Obama administration is on its way out of office for all the provisions of the ACA to take effect.

Back in 1965 and 66 it took only eleven months from the signing of the Medicare legislation by the president to the sending out of cards to patients, in an era when computers were the size of boxcars.

The same as the previous.... the ACA is for many, another broken promise.

9. Making health insurance and health care privatized commodities instead of human rights granted certain permanent rights to those profits under the currently popular conservative legal “takings” doctrine.

Conservative jurists, like the majority on the current Supreme Court believe that whatever profits corporations lose from future government action must be paid in perpetuity to those corporations. They call this the regulatory takings doctrine. ACA's corporate welfare giveaway will make it enormously difficult to take this billion dollar candy back from health insurance scammers by making health care a human right any time in the future.

We gave up the human right to health care. In exchange we got the right of health insurance corporations to get paid. Such a deal.

10. ACA's scheme of privatized health insurance paid for by public dollars was originally devised by one arm of the ultraconservative Heritage Foundation, and is opposed today by another arm of that same organization. Go figger.

Before it was called Obamacare nationally, it was called Romneycare in Massachusetts when that state's governor implemented it there.

By embracing what was a short time ago a right wing pipe dream as “health care reform” Democrats and so-called progressives have given Republicans encouragement to move further to the right, opposing ACA even though it originated at the nation's premiere right wing think tank.

Bruce A. Dixon is managing editor at Black Agenda Report, and a member of the state committee of the Georgia Green Party, which unashamedly and unwaveringly supported single payer health care. Contact him via this site's contact page, or at bruce.dixon(at)blackagendareport.com.



The old "broad-brush" approach

At times, I find myself reviewing why I think in a particular way. I recall that in my youth, it was through thinkers like Eugene Debs (and others, like Dr. King, etc.) that formed the foundation of who I am, even to today. Even though when I was young, I never called myself a "socialist", I probably was. And besides, young Blacks back in my day called ourselves "revolutionaries" — a much "cooler" title.


I particularly like this quote of Mr. Debs: "I rise with the ranks ... not from the ranks"

I encourage all to review Mr. Debs' history. Everything in his background — to me — tells me that today's Democrat Party has nothing in common with classic socialism. The reason I am no longer a Democrat is because — in my opinion — the Democrats lie even more than the Republicans do. And why not? Democrats are the party in power. Today's Democrat tempts the youthful mind with the idealism of socialism, yet at the end of the day, there is a "bait-and-switch". A "you no longer work for them, you work for me" mentality enters in, somewhere.

From Mr. Debs: "The Republican and Democratic parties, or, to be more exact, the Republican-Democratic party, represent the capitalist class in the class struggle. They are the political wings of the capitalist system and such differences as arise between them relate to spoils and not to principles."

In other words, there's not a dime's worth of difference between the two, so all of you had better jump off of that runaway train.

The ACA (or, "Obamacare") is about power and control, period. A person's "healthcare", and its management, forms the most intimate collection of one's personal information possible — and powerful people want that information. I am unsettled by such a power-grab. All of you should be likewise ill at ease. No good thing can come of this. Obamacare is not social justice. It is a social fraud. It is, as Mr. Debs would claim, more abuse of the working man and woman.


Medicare was implemented quickly, but...

...the Expanded & Improved Medicare For All Act, H.R. 676, the single-payer legislation that has existed in Congress long before Obamacare's enactment, will be implemented "over a 15 year period, through the sale of U.S. treasury bonds." Maybe in reality it can be implemented more quickly, but that is what the bill states, & a 15-year single-payer implementation is still better than Obamacare, though quicker implementation will save lives & reduce medical bankruptcies. http://www.healthcare-now.org/whats-single-payer/hr-676

Saying that the ACA will cover half the uninsured is generous

At the time the ACA was enacted, we had a little over 50 million uninsured at any given time and nearly 60 million uninsured for at least some period of time in a given year. Now that the initial impact of the Great Recession has lessened slightly and that the ACA's first provisions have taken effect -- specifically, young adults being able to remain on their family's policies through age 25 -- we have 48 million uninsured. According to the CBO's latest projections, when the ACA has fully entered into effect, in 2019/2020, we will have 31 million completely uninsured. I guess if we compare 31 million point-in-time uninsured to 60 million at least part-time uninsured over one full year, that would yield almost half, but I think (48-31)/48 = 35% or (50-31/50) = 38% would be a more accurate measure.

And for what it's worth, the ACA won't be reducing the drain our healthcare system places on the economy -- it will be increasing it. We currently spend 17.8% of GDP on healthcare, by far the highest in the world. (Runners-up like France and Switzerland come in at around 12% of GDP.) The CBO projects that, under the ACA, we will be spending over 20% of GDP on healthcare by 2019. Compared to France and Switzerland, which provide very good coverage to 100% of their populations, we are currently wasting / being gouged for an additional ~$880 billion a year (6% of a $14.7 trillion GDP) while providing mediocre coverage to ~85% of the population. Under the ACA, that will rise to over $1.18 trillion a year (8% of a $14.7 trillion GDP) while we continue to provide mediocre coverage to ~90% of the population. Under the ACA, the United States will continue to be the world's El Dorado of healthcare profiteering, and its people the least well, and most expensively, insured of the developed world.

So the ACA is a gold mine for Big Health. How about for patients? We currently rank near the bottom of the OECD's health outcomes charts; hopefully we will continue to beat Turkey and Mexico, and maybe even overtake a couple of the other stragglers, as the ACA roll-out is completed. I wouldn't count on it; that's not really what the ACA was designed to do.

How did Obamacare come about?

I think the real tell on what Obamacare is was revealed by Glenn Greenwald: (http://www.theguardian.com/commentisfree/2012/dec/05/obamacare-fowler-lo...)

The person who drafted the Obamacare legislation was Elizabeth Fowler. She was Senator Max Baucus’s chief health policy counsel and had joined his staff after having been a VP at WellPoint, the US’s largest health insurance provider. And when she left her government job she went back to the health care industry at the pharmaceutical giant, Johnson & Johnson.

A mutual admiration society in Washington

As one poster noted, the Republicans continued to play this game of One Upsmanship against the Democrats even though the final version of the ACA exclusively benefitted many of their long time advocates in the business and financial sectors.

How much more evidence do we need to confirm the fact that long time Progressive Democrat and safety legislation advocate Ralph Nader defined a few years back; "both parties have become a two party duopoly, two sides of the same coin !". Their has been little difference between the two majority parties in this country since the Democrat party leadership was siezed by Neo-Liberal forces in the late nineteen eighties. Many political commentators have recently observed and written that both parties seem to have adopted a strategy that appears to be a reawakening of Southern Confederate policies, originally promoted in the 19th century by elements of the British government who sought to bring down the union, with various factions calling for sucession from the union as they demonized the central government. A Boss Hogg mentality that stilll exists in many areas of the South.

Since that late nineteen eigthies, the Republican Party has been joined by the New Democrat Party in the struggle to gain political advantage by selling their services to the highest bidder from that club of wealthy private power brokers who long ago rejected a functioning Democracy as it tended to severely limit their private profitability and control over their minions in government !