Recently, it has been reported that 7.5 million Americans have enrolled in Obamacare, many more than expected. Yes, it’s better than before: overall, Americans are insured, and insurance companies are no longer allowed to overcharge or deny coverage to the elderly and people with pre-existing conditions. Key issues persist, however: Some people still cannot afford adequate insurance or insurance at all. New issues have arisen as well: 14 million people are left scrambling after their plans were canceled, and others are ignored by the system all together. Going backward is not the answer. But clearly, the Affordable Care Act is not the answer either. So where do we go from here? According to prestigious organizations such as Physicians for a National Health Program, the American Medical Student Association and the California Nurses Association, the answer is clear: single-payer health care.
Single-payer health care is a system in which a single payer — in our case, the federal or state governments — fronts the cost for all health care. There is no insurance industry, and there are no insurance companies to deny people coverage. The system is funded by progressive taxes, so people pay exactly as much as they can afford and no more.
The ACA falls short of a single-payer system on several key points. First off, 29 million people still won’t have health care. Part of this is inherent in any system for which people must proactively sign themselves up — they won’t. Maybe they don’t know how to enroll, or as the Obamacare website demonstrates, enrollment will go awry. In addition, some people are lost in the gap between where their state’s Medicaid ends and Obamacare begins. For example, in states such as Virginia, where requirements for eligibility for Medicaid are notoriously strict, single men are not eligible for state-sponsored care under any circumstances. Obamacare has an income minimum, operating on the assumption that anybody below that minimum will be covered by their state. But as Virginia law demonstrates, this is not always the case. In a single-payer system in which every resident is automatically enrolled at birth, nobody will fall through the cracks.
In addition, Obamacare has proven enormously expensive, both for the federal government and for some citizens. Much of the federal government’s health care expenditures go to administrative costs, which are high for this very complex system. Because single-payer is simpler to administer, it costs less. The ACA is the longest and most intricate piece of legislation passed by Congress in 10 years, whereas the single-payer system is simple enough to be described in the 56 words that make up the second paragraph of this piece. Administering the ACA will cost the government $1.1 trillion over the next 10 years, while the single-payer system would save $400 billion.
Additionally, some citizens will find their health care costs rising under the ACA. These are people who purchased their own plans independent of insurance provided through a job or a government program like Medicare or Medicaid. Many of these people purchased very limited, cheap plans that don’t hold up under the stricter requirements the ACA has set for insurance plans. These people are left with two options: purchase a new plan or pay a hefty fine. In many cases, new plans are much more expensive. There are two reasons for this: Because new plans are required to provide more coverage than before under the new requirements for insurance plans, they are of higher quality and therefore cost more. In addition, since insurance companies are no longer allowed to deny coverage to “high-risk” clients (those with pre-existing conditions who are likely to require a lot of health care), they must charge everyone more to make up for taking on costly clients. Many people find they cannot afford the new insurance options on the market and also cannot pay the fine imposed on them should they choose to forgo health insurance. Because single-payer is a universally imposed progressive tax, everyone will pay as much as he or she can afford and will receive equal coverage. In fact, 95 percent of Americans will pay less than they currently do for equal or greater benefits.
Lastly, the Affordable Care Act does not provide coverage for undocumented immigrants. These people pay much more in taxes than they receive in benefits, so it’s only fair to provide them with basic health care. While some may argue that because these people are not American citizens the American government is not responsible for their health, the health of these undocumented immigrants affects the health of American citizens, which should be the responsibility of the American government. There are currently about 11.7 million undocumented immigrants in the United States, and sometimes they get sick. Sometimes they cannot afford treatment. Sometimes they ride BART, go to the supermarket or attend school or work even though they are ill, and sometimes they spread illness to others. Not only would single-payer give these undocumented immigrants access to a human right they do not currently possess, but it would also improve public health conditions overall.
The health insurance industry is, always has been and always will be broken. Any attempt to reform the health care system that provides for a health insurance industry may help some, but it will also perpetuate the problems inherent in private sector control of a human right. The answer is clear: do away with the health care insurance industry all together. It’s time for single-payer health care.