ACA: Easy way not necessarily best way

“The Affordable Care Act is good on access to health care but bad on cost. Young, healthy people will pay the required tax rather than buy insurance. Previously uninsured sicker or older people will buy insurance, causing premiums to go through the roof for the rest of us. The act may have been ruled constitutional, but it is bad policy.”

This quote is from a letter of mine that was published in the Washington Post, 6-29-12. I wish that I had been wrong, but I was not.

Frankly, anyone with any insurance or healthcare managerial experience knew that what I predicted in 2012 would be accurate. It is incomprehensible that the authors of the ACA did not understand the basic insurance principle of “adverse selection” as stated above. So why did they take this approach?

The answer is that they took the easy way out politically. It is obvious that these policy wonks and politicians knew the recent history of health reform. Further, in 2008 only 54% of Americans believed that it was the “responsibility of the federal government to ensure that all Americans have healthcare coverage” (Gallup, 10-16). A fight for true health reform would be bloody.

The last time that health insurance reform was attempted, led by a more naïve and idealistic Hillary Clinton in the ‘90s, the insurance lobby killed it dead as a door nail. I still remember how well done and devastatingly effective those TV ads were.

It is with this history in mind that the wonks and politicos (including President Obama) looked at the 2009 congressional situation. They found no support at all for any reform at all within the GOP and very little from realistically scared “Blue Dog” Democrats.

Therefore, the authors of the ACA determined that the best solution, expansion of Medicare to cover all ages (rather than just those over 65), was unachievable politically. So they thought that the only way to get anything at all passed was to co-opt big pharma and the insurance industry this time around. Thus, we ended up with the ACA, marketed via ads paid for by the insurance lobby.

Since then, the Affordable Care Act (Obamacare) has covered an additional 20 million people. And that is a very good thing. But 30 million people, the majority of whom are working, remain without healthcare coverage.

Approval remains mixed, but since enactment of the law support has never gone over 48%. Currently, support is at 44% while opposition is at 51% (Gallup, 10-16).

Due both to adverse selection and to incredible mismanagement by insurance company executives, premiums for the ACA are going up 22% next year, as I once predicted they would. Although 80% of recipients have subsidies which largely insulate them from these increases, it is not a positive development for U.S. taxpayers. And, it is made even worse when we compare ourselves to other modern countries.

Our costs per capita for healthcare are more than double those of many other developed nations. These other countries have single-payer or something like it which covers everyone. In 2013, the cost per capita in the USA was $8,713 while for the average developed nation it was only $3,453 (OECD). And outcomes (as measured by morbidity and mortality) are better in all of these countries, as opposed to what some blustery politicians would have you believe.

The USA is spending more and more of its GNP on healthcare. When I was director of planning for the state of Georgia in the 1970s, it was 8%. It is double that now and rising. What this means to the average citizen is that there is less money spent on things like job training, energy independence and infrastructure, i.e. our decaying roads and bridges.

I agree with my fellow Republicans that the ACA must be repealed. But I also believe that we need to have a real plan to replace it, not just a miscellaneous series of private enterprise initiatives (as Rep. Tom Price and Speaker Paul Ryan have proposed) which will leave tens of millions uninsured.

According to a Gallup poll earlier this year, 58% of Americans now want to replace the ACA with a federally funded single-payer system. Isn't it time that we get our politicians to stop taking money from the insurance and big pharma lobbies and start doing what is right for our nation — Medicare for all?

This story was originally published December 4, 2016 at 4:59 PM with the headline "ACA: Easy way not necessarily best way."