Why We Want The ACA, Not Single Payer

Healthcare through a single payer system is not what most Americans want. The so called, Medicare for all, is also not what most Americans want. Americans need choices when it comes to our healthcare. The ACA is what we want, what needs to stay, and as Congressman Hakeem Jeffries, (D-NY), has said,

Mend it, don’t end it.”

Democrats can undo the harm Republicans have done to the ACA by taking over Congress in the 2018 midterm elections. A few fixes, such as the addition of a public option, expanding the ceiling to qualify for subsidies, and finding ways to allow the remaining working poor to participate in purchasing an insurance product on an exchange that State and Federal Governments support, instead of intentionally sabotage, are required. These measures would take our country closer to achieving the goal of provide universal healthcare coverage for all.

These fixes to the ACA, more properly the Patient Protection and Affordable Care Act, would be much simpler than starting over from scratch. The PPACA contains many required coverages many know little about. The wellness components help to prevent small, easily curable conditions from becoming major, life-threatening illnesses. They operate as a cost savings of healthcare dollars spent decades from now.

Medicare For All Is Not Single Payer

Some people mistakenly characterize Medicare as a single payer system, when it is in fact a multi-payer system. Changing our healthcare system to a true single payer system would take away the choices available to us leaving users with no choices. Single payer advocates talk about Medicare as something that would save us all but the truth is Medicare would fall flat if it became the single payer and the sole insurer.

A single payer healthcare system is defined as,

“A health care system in which a single entity, usually the government, collects all fees and pays all costs for health care services.”

The fact is that,

“If your single-payer idea is “Medicare for all,” you should know that Medicare is not a single-payer program. About a third of Medicare beneficiaries are enrolled in Medicare Advantage, in which their benefits are administered by private insurers. Many others have private Medigap plans that cover cost-sharing expenses Medicare doesn’t.”

Lack of Competition Harms Doctors

A disturbing aspect of a single payer system is the lack of competition among payers reducing physician control over medical standards of care and reimbursements. In a pure single payer system, doctors can only contract with the one available payer. Currently, physicians in the United States have a choice of insurers to work with. Doctors can and do opt out of participating with Medicare and Medicaid. They couldn’t do so in a pure single payer system. In other countries with single payer systems, the best doctors, often specialists, have refused to participate opening private clinics offering services not paid for by the single payer system.

Medicare, administered by the government entity, Centers for Medicaid and Medicare Services, CMS, imposes arbitrary rules created through central planning. While central planning ensures uniformity, it has many rules that patients, providers, and Republicans who currently control our entire federal government as well as the vast majority of our states, don’t like. For example, Medicare dictates that certain patients must be in the hospital for a certain number of days before they can be referred to a rehabilitation hospital. These kinds of rules are costing us more by continuing to have patients hospitalized rather than being transferred to less costly rehab centers. Unfortunately, because of CMS rules and central planning, CMS makes the medical decision, not the patient’s doctor. Eliminating arbitrary government rules dictating the specifics on medical care through the CMS would put doctors back in charge.

Why rely on a system where people end up having to buy insurance anyway?

So many people are misinformed about universal healthcare falsely believing that universal healthcare and single payer are the same things, and that all the developed countries with universal healthcare have single payer systems. Most countries today do not have true single payer systems, and most countries that do have single payer, also have private insurers. Sweden, for instance, recently moved from a single payer system to one with private insurers.

There is no need to reinvent the wheel. The ACA is the law of the land and it is a mandated, multi-payer system that works. Just look at the experiences of some of the countries who have tried single payer. Sweden’s single payer started running such high deficits that last August they switched to insurance mandates. Italy is going bankrupt because of it’s health care system and is looking at an Obamacare like replacement system. Croatia is poised to become the next Greece about to default on the national debt in part because of unfunded single payer obligations.

The five countries that caused the Eurozone economic crisis, Spain, Greece Ireland, Italy, Portugal, all racked up huge debts in order to keep their single payer plans functioning. Studies have found that in the EU, the best care for dollar spent comes from regulated, subsidized insurance mandates. France, voted as having the best healthcare system by the World Health Organization, has a two-tiered system. Germany has a multi-payer/insurance mandate system, much like our current system.

The Goal Should Be Universal HealthCare, Not Single Payer.

Most countries around the world that have universal healthcare do so without single payer and most of the countries thought to have better healthcare systems than the US do not have single payer. It is surprising how few countries have national single payer. Single payer is not the most widely used method of arriving at universal healthcare coverage in the world. Single payer only seems to work in smaller countries and these cluster around the middle in quality of care. Germany, the Netherlands, Switzerland use mandate and as previously stated, France is multitiered.

The fact of the matter is that most of countries having achieved universal healthcare for all don’t have single payer systems as,

So few countries actually do that. And most of those countries who are thought to have better health care systems than the US don’t do that either.”

According to a leading expert, Professor Gerald Anderson, of the Johns Hopkins Bloomberg School of Public Health, only Canada and Taiwan have true single payer systems. Single payer has not been proven by any credible source to be the only way to achieve universal healthcare. To risk the loss of the ACA which is currently to improve the lives of millions for a self-interest, politically influenced type of healthcare delivery system, is ludicrous. Single payer is just one way to deliver healthcare and as we have seen, single payer does not result in the best type of medical care, and most other countries with universal healthcare do not have true single payer systems.

Insurers that sell policies to individuals and families are doing better financially than in the first two years of the ACA. They are also doing better than they were before the federal and state governments opened the marketplaces in 2014, according to a Kaiser Family Foundation report published on early July. The data showing improvement confirms earlier reports by Standard & Poor’s, the Congressional Budget Office and research groups that were based on 2016 numbers. While there are still problems in marketplaces in some states, the ACA, or Obamacare, is hardly coming undone.

Our goal is affordable, quality, universal healthcare. Even if single payer was the best way for delivering universal healthcare, which it clearly is not, it has zero chance of passing with the Republican controlled government that many die-hard single payer advocates caused to be elected in 2016. The time has come for the United States to follow the lead of the rest of the world and step forward towards finalizing the goal of providing our citizens universal healthcare for all, not the empty and misleading single payer slogan. Voting in Democrats to Congress and everywhere throughout the United States would be the best way to achieve the goal of universal healthcare. So, let’s join with Congressman Jeffries and the rest of the Democratic Party in the effort to mend the ACA, not end it.


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