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In Health Care, Fake Good News Beats Disaster

The Affordable Care Act is far from perfect, we hear again. That’s true. But health insurance with the GOP in power would be far worse, and would cut off the potential for truly effective comprehensive health care financing reform.

March 27, 2024

A Tsunami of Fake Good News
Healing and Stealing
March 23, 2024
By John Canham-Clyne

 Really, the ACA is getting us there! Just give us 500 years!

Since the ACA passed in 2010, the percentage of American adults who have health insurance that actually protects them from financial ruin has barely changed. According to biennial Commonwealth Fund surveys, the percentage of U.S. adults who are insured all year but who aren’t underinsured only grew from 56% to 57% between 2010 and 2022. That pace leads to everyone in the U.S. being fully insured in around 500 years.

The number of people who have been kicked off Medicaid over the past year far outstrips the year-to-year increase of roughly 5 million people enrolled in private Obamacare exchange plans.

It’s also true that several million fewer people were uninsured in 2023 than 2014, so we can expect to hear phrases like “the national uninsured rate reached an all-time low” nearly as often as “record ACA enrollment” for the rest of the year. At the same time, the ACA’s failure to control costs has driven deductibles, copays and coinsurance to record heights in employer-sponsored health insurance, Medicare and many of the ACA exchange plans. This dramatic increase in the number of people who are underinsured largely cancels the gains from the reduction in the uninsured rate.

In the end, what matters about health insurance is whether or not it allows people to get the health care they need. The number of adults ages 19-64 who report skipping at least one of four different types of health care due to cost in the past year is higher now than it was when Obama signed the ACA in 2010. (The four types skipped: 1) Didn’t see Doc for problem, 2) Didn’t fill Rx, 3) Skipped test/treatment/FU, 4) Didn’t get specialist care.)

The weakness of Biden’s opponent can’t turn the ACA into a credibly successful law. Fourteen years after passage, more adults than ever before are skipping treatment or prescriptions because of cost, even though we still spend twice as much as other wealthy nations on “healthcare”. That won’t stop the tsunami of fake good news from washing over us for the next 8 months.


Comment by: Don McCanne & Jim Kahn

Maybe the timing doesn’t seem right to talk about the lack of success of the Affordable Care Act just before the presidential elections, but actually the timing probably couldn’t be better.

First of all, ACA has been effective in maintaining a modest level of health care coverage, even if overpriced and inadequate. Biden’s opponent has offered an alternative that is far worse: no standards for fair or good insurance, and likely for most Americans a Hobbesian choice: catastrophic insurance that fails to fund ongoing needs, or a largely self-funded health savings account that would run out when medical catastrophe hits. Voters must realize that we need to elect a Democratic President and a Congress composed of Representatives and Senators with progressive views if we expect to replace our current dysfunctional financing system with one that will work for all of us: a single payer, improved Medicare for All program.

Sure, we don’t want to be taken in by a good guy with fake good news. But it would be far worse to yield to the phony guy with the hidden horrendous news. It is crucial that we, the public, understand what is going on, and (at the risk of repeating ourselves) elect leaders accordingly. A system that will provide all of us access to comprehensive, high quality health care, that each of us can afford through progressive public financing, is exactly what we should be aiming for, and election time is when we have the greatest control over that. Let’s not settle for mediocrity for the next 500 years. Let’s go for the real thing now!


About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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