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...
WHAT WE GOT WITH THE AFFORDABLE CARE ACT
WHAT WE GAVE UP WHEN OUR LEADERS REFUSED TO PUSH SINGLE PAYER
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.