The Affordable Care Act has not ended our national
healthcare crisis. As a student of health policy reform, I would argue that it
was not designed to-- not exactly. What is clear about the ACA is that it was
intended to transform the healthcare industry. The ACA is stuffed with
provisions that rein in the worst excesses of our healthcare system, and there
are many. The individual and employer mandates of the law established partial
community rating, attractive to insurance firms because more customers means
less financial risk as long as a significant portion of the pool is healthy.
But the purchase mandates are only one aspect of a much larger sea change
hiding in plain sight within the text of the ACA: an unprecedented conversion
of our healthcare system into a functional, pro-consumer entity that will one
day be guaranteed to every American soul. Far from an end unto itself, this
legislation is in fact the means to a much more elegant solution—single-payer
healthcare.
In a 2014 study of 11 of the wealthiest nations’ healthcare systems, the US ranked number 11. The very items we associate with unchecked competition –efficiency, equity, and more overall (in this case, more health)—were the categories that we ranked dead last in. The data showed that our health expenditures per capita were nearly double those of the next worst system on the list: Canada. We spend more than double per person than the UK does, the number 1 ranked system in the study.
So, we are paying more—far more—to receive poor access, clunky service, and bad returns. The evidence-based solution to our healthcare crisis, then, would be to pattern our system after those of the world’s very best. The solution is single-payer.
In a single-payer healthcare system, the care of each citizen is funded through a single pot of money which is collected through taxation and managed by the federal government (though it could also be divided between the feds and the states). In some nationalized systems, care is provided directly by the government –making doctors and hospitals federal employees- and in others, the government pays contracted private providers with tax money. When a patient goes to the doctor, there is no charge, or perhaps a very low copay, for services. This guarantee extends to all citizens, regardless of age, health status, or financial profile. Patients can see any doctor they like. Drug prices are negotiated through the federal government, which dramatically lowers their costs (this is why Americans sometimes purchase their scripts from Canada, which has a single-payer system).
Medical price inflation, barriers to competition and excessive provider autonomy have caused healthcare costs to vastly exceed what working Americans are able to pay, and third party insurance only aggravated, not offset, that dilemma for many. Worse, we don’t get very good results for all of that money. The Affordable Care Act addressed these issues by incentivizing efficient, effective patient care. The end of the fee-for-service free-for-all that has claimed 17% of the national gross domestic product in recent years has quietly flipped the allied industries on their ears as innovation and value are being reintroduced into the healthcare market.
Many feel frustrated by the convoluted nature of the new
insurance system. It lowered prices for many, but raised prices for others.
Many have been covered by expanded Medicaid, but there are a shortage of
Medicaid providers on the market and 34 states still have yet to expand. There
are still millions in the “coverage gap” or stuck with exceedingly costly
employee-sponsored plans. The solution is not to repeal the new reforms and
replace them with yet more complex channels through which our dollars must
travel instead of going directly to patient care- the solution is to build on
the reforms established by the ACA by finishing what it started: making
universal healthcare a fact of life for all Americans.
