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Health Care Reform’s History of Utter Failure

Summary: The persistent malfunctioning of our health insurance system is clearer than ever. The futility of periodic piecemeal reforms is undeniable. Yet, we’re on the verge of another set of modest changes that won’t resolve the fundamental problems. Let’s turn to single payer to properly revamp the system.

Pain Machine: Why our health care system is broken.
The Nation
November 28, 2021
By Ryan Cooper

The American health care system is a notorious disaster. On the one hand, even “good” private employer-based insurance is often a nightmare to actually use, while tens of millions of people have much worse coverage or none at all. At the same time, our system is also incredibly expensive — eating up 17 percent of the US gross domestic product, or nearly twice what peer rich nations spend on average.

Why are we stuck with this expensive, broken system? One good answer can be found in Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, an excellent new book by veteran health care reporter Jonathan Cohn about the political history of health care reform in this country. Cohn shows how repeated failures by both Democrats and Republicans to get a decent policy through our rickety 18th-century constitutional structure led to the strategy that produced Obamacare, formally known as the Affordable Care Act — a policy that improved our system in many ways but also entrenched some of its worst elements.

Throwing trainloads of money at the extant hideous semi-private health care mess might, someday, get almost everyone in the United States technically insured. But the coverage will probably not be very good, and it will not stop the cost bloat that is devouring the American economy from the inside. If we want true universal health care, where anyone who is sick can go to the doctor without the terror of being slammed with an unpayable bill, and we want the price of that care not to eat up nearly a fifth of the economy, a lot of powerful corporate interests are going to have to take a major hit. Time is short: Democrats may not keep their current razor-thin congressional majorities for long, so it’s up to them to take the initiative — and for the rest of us to keep up the pressure.

The Ten Year War
MacMillan
2021
By Jonathan Cohn

The Affordable Care Act was an attempt to achieve the liberal end of universal coverage through a more conservative scheme that relied heavily on competition among private insurers. But the intellectual foundation for that calculation seems increasingly shaky, especially when it comes to controlling the cost of care. Although the law’s delivery reforms have probably helped slow the rise in health care spending, overall competition among insurers hasn’t pushed the system toward efficiency as much as the experts had hoped. Even many card-carrying economists schooled in the virtues of markets and hazards of government control now wonder whether it’s time for the United States, like other developed nations, to set a global budget for health care, have the government regulate prices, or maybe do both of those things.

If the United States keeps moving in this direction, until everybody has coverage, it could end up with a single, government-run insurance program for everyone.

The reality is that any system that covers everybody with low out-of-pocket costs and some kind of government control over spending is going to look a lot more like Medicare for All than what the U.S. has now.

Democrats’ Bill Would Go Far Toward ‘Patching the Holes’ in Health Coverage
The New York Times
December 1, 2021
By Reed Abelson et al

More than 75 years after Truman first proposed universal coverage, Democrats are still chasing his dream. If President Biden’s social policy bill becomes law, they will make major strides toward fulfilling it.

If the measure passes, the United States will retain its patchwork system, where people obtain different health coverage depending on where they live, what they earn, where they work and how old they are.

As a group, the health care provisions will cost $330 billion over the next decade and come with compensating health savings of $325 billion, according to an analysis of Congressional Budget Office data by the Committee for a Responsible Federal Budget. But that balance is slightly misleading: The parts that save money are designed as permanent, while several new coverage provisions would expire after 2025.

Even with the changes, the Congressional Budget Office estimates that more than 27 million people would remain uninsured.

Comment by: Don McCanne

Although health reform efforts in the United States have produced some modest improvements here and there, the overall result must be considered a failure when considering the high costs and remaining deficiencies. The current efforts are no different. We would spend more money and yet fail to correct most of the deficiencies in the system, still leaving 27 million people without coverage.

It has long been recognized that adopting the policies of single payer financing would correct the deficiencies while filling the voids in coverage. Let’s do it right this time even if it requires a reset in the current legislative effort. It would be less expensive and better for everyone except maybe for those who are diverting our health care assets to their own pecuniary interests.

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