Posts Tagged ‘Single-payer health insurance’

Obamacare: conservatism as the new liberalism

October 24, 2013


Even though I think the Affordable Care Act is a bad law, I’m opposed to most of the people who oppose the law.

Most opponents of the law are against it because they don’t agree with having the government guarantee a minimum level of medical care to all.  I’m opposed to the law because I don’t think it will come anywhere near to accomplishing that purpose.

Defenders of the Affordable Care Act point out that it originated as a conservative Republican plan, drafted by the right-wing Heritage Foundation and first implemented by Mitt Romney as governor of Massachusetts.

From my standpoint, that is the problem. I am a liberal Democrat who voted for Barack Obama in 2008, and I did not vote for him in order to advance a conservative Republican agenda.

I’m pretty sure that the Heritage staff did not offer up their plan because they felt an urgent desire to assure health insurance for everybody.  I think they proposed their plan as a way to avoid enacting Medicare-for-all, aka a single-payer plan.

The chief merit of the Obama / Heritage plan from the right-wing point of view is that it locks the for-profit insurance companies into the system and gives them a captive market, even though they add no value to medical care.  The threat of a universal system would be that there would be no role for the insurance cmpanies.

Back in 2008, the single-payer plan was the mainstream Democratic position. Both Hillary Clinton and John Edwards advocated it in their presidential campaigns.  Barack Obama offered a moderate compromise, a public option in which an affordable government insurance plan would be made available, which at the time that seemed reasonable to me.

But as soon as President Obama took office, he embraced the Heritage / Romney plan.   His staff ridiculed anybody who took his campaign promise seriously.

If Obama thought that this would bring the Republicans on board, he was sadly mistaken.  They reverted to what they really wanted all along, which is to do nothing or take away what we have.

In five years, the former mainstream liberal position has been taken off the table for discussion. The former mainstream conservative position has been redefined as the liberal position.  The extreme right-wing position which was not then on the table has been redefined as the mainstream conservative position.

Nobody really wanted Obamacare.  It was originally proposed as a lesser evil from the conservative point of view,  and it was enacted as being a lesser evil from the liberal point of view.   The right-wing Republican goal is to get rid of it altogether.   The liberal Democratic goal should be to replace it with something adequate.


Will Vermont show the way on health care?

June 20, 2011

Health care reformers now look to the state of Vermont rather than the federal government to lead the way on the way to a universal public health insurance system.

Vermont Gov. Peter Shumlin in May signed into law a bill which commits the state of Vermont to set up a publicly-funded, publicly-administered health insurance system that would cover all 622,000 residents of the state.

More than 5 percent of Vermonters are without health insurance, and another 15 percent are considered under-insured.  Health care costs in Vermont are rising at the rate of 9 percent a year, twice the rate of the state’s economic growth.  Shumlin and other reformers say the new plan will give everyone the coverage they need, and at less cost than the present system.

Under the law, a five-member board will be appointed in October to set up a plan called Green Mountain Care.  The first step will be for Vermont to set up a health insurance exchange to provide a simplified health insurance marketplace as called for under the federal Affordable Care Act.  Starting in 2014, the public would have a choice between the new Green Mountain Care system and at least one private system.  The goal is to go to a single-payer system by 2017.

There are a lot of things yet to be worked out – in particular, how to pay for the system, and how much health care providers will be paid.  The original idea was a payroll tax variously estimated at 12.5 percent or 14 percent, most of it, in theory, paid by the employer.  This is a lot!  While many people pay an even higher percentage of their incomes for private health insurance, that is still a lot of money.

The board’s mandate is to set up a system that will (1) not have a negative effect on Vermont’s economy, (2) have a sustainable system of financing, (3) cost less to administer than the present system, (4) reduce the rate of growth in per-person health care spending, and (5) reimburse health care providers at a sufficient rate that doctors, nurses and other health care workers will not leave the state.

Vermont’s health care reformers think that it actually is feasible to provide better health care at less cost.  One way to do this is by means of preventive care – helping people to stay healthy so they won’t need a lot of medical treatments.  Under the new law, the board will look into capitation, a system of paying health care providers a set amount per patient rather than fee for each service provided.  Under a fee-for-service system, the financial incentive is to maximize visits to clinics and doctor’s offices; under a capitation system, the incentive is to minimize the need for visits.

Another way health care costs would be kept down is that a public system would not have to pay actuaries to determine the individual risk and premium level for each person, nor set aside an amount as profit for the owners.

You might wonder whether this is realistic.  In fact, a number of foreign countries provide more extensive health insurance coverage than in the United States and at less cost through just these methods.