After Obamacare

by David Gimlett. M.D.

As the smoke begins to rise from the newly built structures of the Affordable Care Act (ACA) it is becoming more obvious that there is a real fire that will destroy this latest attempt at managed care.  Expensive, complicated, bug-infested computer programs, loss of insurance policies by individual purchasers, and expanding underinsurance created by the act and copied in new employer sponsored plans are the kindling that will stoke the fire.  Long before the Republicans declared war on Obamacare, long before there was Obamacare, there was a community of health care reform advocates who knew, and spoke to the fact, that incremental patches could only make matters worse. As polls have appeared stating how many people are opposed to the ACA it is assumed that all of the opponents come from the anti-government wing of politics. This ignores those people who have advocated for a single payer medical financing system and know that it will have to be built from the ashes of this corporate charade.  If anyone wants to go back and read the writing on the wall they should visit Dr. John Geyman’s book, “Hijacked,” published in 2010. 1

One of the many unfortunate effects of the ACA is that it can be used by the ant-government contingent to pad their argument that government can’t do anything right. This argument, of course, ignores the popularity and benefits of Medicare as well as many other government services.  The main problem with this characterization of the ACA is that the act is not an example of true governance in action. The ACA was essentially written by representatives of the four big stakeholders who had the most to gain from keeping the existing system intact, i.e., Insurance, Pharmaceutical, Hospitals, and Organized Medicine.  Dr. Geyman referenced the fact that in 2009 industry hired about 4,525 lobbyists to influence the writing of the health care bill.2   Large campaign contributions to congressmen assured their support of industry goals.

The problem, then, is not government. It is corrupt government. There are many individuals and organizations who are working to get the huge influence of money out of Washington, D.C. This is going to take a large, unrelenting, grass roots effort. In the meantime our medical care system is spiraling out of control, now topping $3 trillion a year. This will jump even higher as we pay for the expensive, crippled, federal and state vetting apparatus for the ACA.  These new expenses will be never ending as people move in and out of geographical and economical territories. We are already spending twice as much per person for medical care as any other developed nation and we’re getting poorer results and covering a lower percentage of our population.3 

The escalating costs of medical care are not sustainable. Now that we are not fighting wars the biggest threats to our economy are medical expenses. True cost control cannot be done piece-meal and cost-shifting to personal expenditure is not cost containment. The four stakeholder industries need to be brought under ethical and financial control, starting with the medical insurance industry that siphons off large amounts of money for expenses and profits.

Where there’s smoke, there’s fire. As the Affordable Care Act goes down in flames we need to rebuild with a system that is equitable, comprehensive and economical.  An improved Medicare for all, single payer system fills these criteria and can be the Phoenix that rises from the ashes.4

Suggested Reading

1) Geyman, JP. Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform. Monroe, ME. Common Courage Press, 2010.

2) Eaton, J, Pell, MB. Lobbyists swarm capitol to influence health reform. Washington, D.C. The Center for Public Integrity, Feb 23, 2010

3) OECD Health Data, 2013

4) Funding H.R. 676:  The Expanded and Improved Medicare for All Act – How we can afford a national single-payer health plan in 2014