Is Obamacare worth fixing?

Among the most formidable obstacles to health care reform are the insurers, hospitals, health care providers and pharmaceutical companies that benefit from the current system and lobby Congress to preserve it, says Tom O’Rourke, an emeritus professor of community health at Illinois. Photo by L. Brian Stauffer

Tom O’Rourke, a professor emeritus of community health at Illinois, has spent much of his professional career examining the nation’s health care system. He spoke with News Bureau Life Sciences Editor Diana Yates about the prospects for Obamacare.


The Affordable Care Act (aka Obamacare) has its problems. Can it be salvaged?

Politicians, the public and many providers seem to agree that the Affordable Care Act has its problems. Much of their discontent is not about what the law does but rather what it fails to do. Consumers across the country, whether enrolled in the ACA or through private insurance, complain about spikes in premiums, deductibles and copays. They also worry about narrowing provider networks that have forced many patients to change their preferred physicians and hospitals. The individual mandate has not gotten enough younger and healthier people to enroll, and several major insurers have withdrawn from the exchanges.

Given the obvious shortcomings of the ACA, it’s amazing that neither major political party has a viable plan to remedy the situation. Doing so would require massive subsidies, strengthening and enforcing the individual mandate to bring more young and healthy people into the risk pool, bringing a viable public option into the marketplace or using the power of government to control costs the way most other industrial countries do. None of these options appear viable at this time. It is more likely that the situation will continue to deteriorate until the electorate demands action by Congress to make health care both accessible and affordable.

Is the ACA worth fixing?

Despite the law’s goals of containing costs and making health care affordable, the ACA has proved to be too expensive to be sustainable. It is overly complex and bureaucratic. It channels billions of taxpayer dollars to a patchwork of private insurers, each one skimming off its own share of administrative costs and profit that could be spent on patient care. And it still leaves 29 million Americans uninsured. The ACA is on life support, and more bandages are not the answer. Neither is the American Health Care Act, aka “Trumpcare.”

Controlling costs is the only way to make our health care system sustainable. The most effective approach to achieving President Trump’s campaign promises of more coverage, better benefits and lower costs would be to replace the private insurers with a “Medicare for All” program. This would be a single-payer system that, like the current Medicare program, is publicly financed but privately delivered. Medicare is well-known and popular and, importantly, has proved to be a more efficient purchaser of health care services while eliminating much of the administrative waste of our fragmented financing system.

What’s pending on the legislative front?

Interestingly, in his 2000 book “The America We Deserve,” Trump wrote, “We must have universal health care. …We need as a nation, to re-examine the single-payer plan, as many individual states are doing.”  A House bill to that effect, HR 676, the Expanded and Improved Medicare for All Act, has been introduced. Sen. Bernie Sanders plans to introduce a single-payer “Medicare for All” bill. Estimates of potential savings would be enough to provide comprehensive coverage to everyone without increasing our national health care expenditures. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing of supplies, including pharmaceuticals.

We already spend nearly twice as much as any other country on health care, despite using less care for things like doctor visits and time in hospitals. Single-payer systems have proved effective in countries around the world that spend far less than we do, cover everyone and often provide care without deductibles or copays at the point of delivery.

Why don’t we do that?

The current ideological differences between political parties and within them are significant obstacles to meaningful reform. Another barrier is the powerful influence of the insurers, hospitals, health care providers and pharmaceutical companies that benefit from the current system. These parties have a lot of lobbying clout and are significant donors to legislators of both parties. We now devote nearly one-fifth of our economy to health care. These players don’t want to lose their slice of this enormous health care pie.

The Obama 2008 victory, the populist Sanders and Trump campaigns, and the strong recent public rejection of efforts to repeal the ACA demonstrated the electorate’s hunger for new approaches. Average costs for a typical American family of four with an employer-sponsored preferred-provider plan have tripled since 2001, to $25,826 in 2016, with the employee paying $11,033 through payroll deductions and cost sharing.

Do you believe significant reform will happen?

With health care costs rising several times faster than inflation, employers continue to shift more costs to employees. This, and the recent addition of 20 million people insured by the ACA, will likely lead the electorate to become more vocal and mobilized. That might be the needed catalyst for meaningful reform.

A recent Gallup survey found that 58 percent of Americans supported replacing the ACA with a federally funded system that insured everyone. A recent Kaiser Family Foundation poll found that 64 percent of adults had a positive reaction to “Medicare for All.”

Perhaps Winston Churchill got it right when he said, “You can always count on Americans to do the right thing – after they’ve tried everything else.”

Source: Illinois News Bureau/ Diana Yates/Life Sciences Editorexpert Viewpointslaw