Why the Affordable Care Act Will Not Remedy the U.S. Health Crisis

Many liberals are describing the Supreme Court’s decision to uphold “Obamacare” as a resounding victory for the president and likely to contribute to his chances for re-election. I don’t see it that way.

Supporters of the Affordable Care Act rally outside the Supreme Court following the ruling to uphold "Obamacare" on June 28, 2012. Credit: Mackie Lopez/SEIU.

Though I am happy about this development and feel we should celebrate these small steps in the right direction, I see this victory as severely limited by a deep flaw within the health reform plan: it requires people to buy health insurance but has no effective way to keep the insurance companies from endless increases in what they charge the public (and then blaming those charges on the fact that they have to cover people who are sick).

For those of you who have not heard the details yet, the Supreme Court ruled today that most of the “Obamacare” plan was constitutional in a 5-4 vote. The majority opinion—penned by ultra-conservative Chief Justice John Roberts—presents a rationale for why the “individual mandate” (the part of the Patient Protection and Affordable Care Act that requires everyone to buy health care and imposes a penalty payment on those who do not, so that they too can contribute to the well-being of everyone who does need health care) is consistent with Roberts’s interpretation of the Constitution. The court also ruled that some states can opt out of parts of the plan.

I’m glad that parts of the plan that were pressingly needed—including its elimination of the right of insurance companies to deny coverage on the basis that the applicant has a “pre-existing condition” and its part allowing coverage in a family plan of children up to the age of twenty-six—have been validated, though they are unlikely to be implemented before 2014. But a truly resounding health care victory would be one that ensures health care for all, without handing more power to private insurance companies.

We at Tikkun have consistently supported a universal health care plan that would be paid for out of the general tax system, though we also support having that tax system reformed so that rich people and corporations pay their fair share. We have called for a health care system that essentially extends Medicare to everyone! Medicare works. It’s available to everyone over sixty-five, so why not for younger people as well? The arguments for this and the details of what a rational plan might look like have been worked out by a group with which we work—the Physicians for a National Health Plan. These physicians’ reactions, quite similar to ours at Tikkun, can be found below.

Our full vision for health care transformation, however, goes beyond making sure that everyone has adequate coverage to asking what a spiritually coherent health care system would look like if it were based on the Network of Spiritual Progressive’s New Bottom Line of love, kindness, generosity, and really putting the “care” back into the health care system. I’ve worked out some preliminary ideas on that which can be found in my book The Left Hand of God: Taking Back our Country From the Religious Right, and in a very abbreviated form in our Network of Spiritual Progressives’ Spiritual Covenant with America.

Still, it’s important for us to acknowledge and celebrate small steps in the right direction. The Supreme Court decision today will make it easier for many people to get care that they would not have otherwise gotten. For example, here’s a list of ten health care gains that we likely get to keep since Obamacare was upheld.

One outstanding question, though, is whether the Republicans will be able to build up enough resentment of the individual mandate (and its unfair aspect described above) to get a Republican president and Congress elected this fall, and with that mandate repeal the Patient Protection and Affordable Care Act before it fully goes into effect in 2014).

Nevertheless, let’s celebrate a little in the next few days and feel blessed that we are not living under a political dictatorship, and that every once in a while something in the direction of a more humane society appears to get wide-scale popular approval.

And then, let’s return to the struggle for a New Bottom Line of love and generosity and caring for each other and for the planet.

The following statement was released today by leaders of Physicians for a National Health Program www.pnhp.org):

Although the Supreme Court has upheld the Affordable Care Act (ACA), the unfortunate reality is that the law, despite its modest benefits, is not a remedy to our health care crisis: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.

Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would provide truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

Research shows the savings in administrative costs alone under a single-payer plan would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable plans have worked in Massachusetts and other states. Those “reforms” have invariably failed our patients, foundering on the shoals of skyrocketing costs, even as the private insurers have continued to amass vast fortunes.

Our patients, our people and our national economy cannot wait any longer for an effective remedy to our health care woes. The stakes are too high.

Contrary to the claims of those who say we are “unrealistic,” a single-payer system is within practical reach. The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages. There is legislation before Congress, notably H.R. 676, the “Expanded and Improved Medicare for All Act,” which would do precisely that.

What is truly unrealistic is believing that we can provide universal and affordable health care in a system dominated by private insurers and Big Pharma.

The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.

We pledge to step up our work for the only equitable, financially responsible and humane cure for our health care ills: single-payer national health insurance, an expanded and improved Medicare for all.

Garrett Adams, M.D.

Andrew Coates, M.D.

Oliver Fein, M.D.
Past President

Claudia Fegan, M.D.
Past President

David Himmelstein, M.D.

Steffie Woolhandler, M.D.

Quentin Young, M.D.
National Coordinator

Don McCanne, M.D.
Senior Health Policy Fellow

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who advocate for single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Rabbi Michael Lerner is editor of Tikkun, co-chair with Indian environmental activist Vandana Shiva of the Network of Spiritual Progressives, and rabbi of Beyt Tikkun Synagogue-Without-Walls in San Francisco and Berkeley, California. He is the author of eleven books, including two national bestsellers—The Left Hand of God and Jewish Renewal: A Path to Healing and Transformation. His most recent book, Embracing Israel/Palestine, is available on Kindle from Amazon.com and in hard copy from tikkun.org/eip. He welcomes your responses and invites you to join with him by joining the Network of Spiritual Progressives (membership comes with a subscription to Tikkun magazine). You can contact him at rabbilerner.tikkun@gmail.com.
tags: Economy/Poverty/Wealth, Health, US Politics   
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2 Responses to Why the Affordable Care Act Will Not Remedy the U.S. Health Crisis

  1. Jennie Chamblee July 6, 2012 at 10:56 am

    I agree with Mr. Lerner that “medicare for all”, AKA “single payer”, is the ideal solution for our health care crisis. It is, in the current political environment, impossible to achieve. There’s no way it could have been passed in lieu of the law we now have. Our new national health care law is a tremendous beginning. It can be modified as time passes until it truly serves it’s purpose in an all-inclusive and fiscally feasible way.

  2. Paula Friedman January 23, 2013 at 2:16 pm

    Yes, the ACA will help many people and many insurance companies. But paying for it has, from the get-go, been predicated on “savings” from “trimming” “waste and inefficiency” from Medicare (and, originally, when a “public option” was to be included, from Medicaid too); see Obama’s Feb. 2009 speech on health coverage reform. The presumption, then and since, that such cuts can be made without harm to Medicare patients has been largely based on results summarized in the Dartmouth Health Atlas (ca. 2007/2008), which studied data from thousands of patients, in hundreds of hospitals throughout the U.S., during their last two years of life, beginning with when they first came under hospitalization; the data showed that, no matter the “intensivity” of their treatment (in terms of frequency of specialist visits, number of tests, and readmissions), the outcome was the same.
    Big surprise, that.
    Of course, the details are more nuanced, as the Dartmouth researchers reminded any critic; yet, as pointed out by UCLA’s Dr. Rosenthal in the Dec. 22/23, 2009, NYT article by Reed Abel on end of life care, and pointed out again by a Dr. Bach in an NEJM article cited in early 2010 by Gardner Harris in the NYT, those nuances don’t change the fact that the research cited in the DHA does not, in fact, show the wonderful “less is not less” results on which Obama, apparently under the suasion of Orszag, premised his plan to rob the Peter of Medicare to pay the Paul of subsidizing the more underpaid Americans’ health insurance, and thus the insurance companies, under the ACA.
    Of course, two thirds of the cut to Medicare involves trimming the overcharges of “accountable care organizations”; however, that leaves one third to come in cuts to hospitals and doctors (primarily specialists) and home health care and . . . no indeed, those cuts won’t come directly from patients’ pockets–only, as doctors pull out of Medicare and hospitals save monies through dangerous shortcuts and tests get discouraged, from patients’ flesh. From lives, really.

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