Goodbye Obamacare – Where Do We Go from Here?

We’re on the brink of seeing significant shifts in health care with the Republican repeal of the Affordable Care Act. I’m hopeful that we will see wisdom and thoughtfulness in the replacement, but there are fundamental challenges that need to be brought to light as this process goes forward. Health insurance as a for-profit business just doesn’t work when most people can’t afford to purchase it. We’ve been denying this fact over the years, while secretly propping up the broken system with government funds. More than 50% of healthcare financing already comes from the government. It’s time to accept the fact that we can build a more efficient and functional entity by going to a single payer system.

The Skyrocketing Cost of Health Care

Health care has become too expensive for American workers to support in a free market economy. The millions of people taking advantage of the exchanges are the middle class, not the unemployed. The government, through Obamacare, subsidizes their premiums to make it as affordable as possible. Even with this safety net, healthcare premiums are too expensive for most households and large insurers like Aetna, Blue Cross, Humana, and United Healthcare are struggling to make it work as a business in many states. Republicans want to scrap universal healthcare altogether and hope that opening up insurance over state lines will solve what ails the healthcare system. Democrats want to double down on Obamacare, with the thought that it just needs more time to work. In my opinion, a single payer approach is the only viable option to drive healthcare costs down and provide access to all.

The Perils of Employment-Based Health Insurance

We’ve always known that health insurance only works when everyone contributes, especially the young and healthy, because people can least afford medical care when they need it most. This is the danger in attaching health insurance to employment – when people lose their jobs, they generally can’t afford medical care. Additionally, I believe we are giving up a competitive edge in requiring employers to cover their workers. I was amazed years ago, when I heard that GM was spending more on health insurance than they were on steel. How many more factories could stay in this country if our industries were freed of this burden? I believe it’s time to shift this responsibility completely away from employers and onto the government.

The Beauty of Medicare

People seem to think that the government can’t do anything right, but it’s evident to me that Medicare is one of the few successful areas of healthcare reimbursement. How many Americans just try to hold on until they are 65 and can get guaranteed coverage? At the same time, Medicare has been evolving its payment structures to increase value and we are seeing less inflation here than we have in other areas of health care. The Federal Government can tax us in a way that we all contribute to health care, and at a lower rate than it is currently costing us to support the for-profit insurance industry. Just think of the billions of dollars in executive salaries and shareholder profit that would go directly to providing medical care. Top that off with savings from increased bargaining power and the efficiencies of streamlined processes and we have our best shot at affordable health care.

How to Usher in a Single Payer System

We all need health care throughout our lifetimes and it should be the right of all citizens in the wealthiest country in the world. We can gradually convert to a “Medicare for all” structure by sequentially lowering the age of Medicare entry over several years. This has the advantage of getting coverage to people in their 50s when ageing begins to impact them, whereas delaying their treatment until they are 65 tends to make their medical care more expensive and less effective. This gradual transition to a single payer system would prevent some of the growing pains experienced with Obamacare and would allow more time and thought to go into ways to improve the delivery of care in this country.

Claire Trescott, M.D.
Practicing Physician & Former Primary Care Medical Director
HCIM Senior Executive Adviser