The Affordable Care Act – a.k.a. “Obamacare’ – has figured prominently in the recent election. On top of well-publicized technical shortcomings the program has been presented as an attempt to replace the U.S. “free market” health care system with “socialized medicine”.
The accusation is not fully accurate.
First, the United States already has a variety of “medical systems”: the fully government-run Veterans Administration; two hybrid single-payer systems, Medicare and Medicaid; a variety of private insurance plans, often provided by the employer; “Obamacare”; and finally a purely cash-for-service form of care often preferred by the young and healthy as well as by the very rich.
Second, the single-payer (government controlled) arrangements in place in dozens of countries from Belgium and Germany to Japan and Taiwan are not “socialist”, but a variety of hybrids combining private health care delivery by doctors and hospitals with government financing and pricing. They are generally well-accepted by the populations concerned, an acceptance grounded in two main factors:
- The programs were generally developed through collaboration of all stakeholders: patient advocates, doctors, hospitals, government and medical industry representatives.
- Great attention was paid to ease of use, price controls, incentives and internal efficiency. Systems were thoroughly explained and tested before rollout.
With these benefits go important drawbacks:
- While these systems cover many medical conditions, including the most common ones, they do not cover everything. There is always some degree of rationing as well as inertia in dealing with new challenges.
- Most such systems were introduced during the post-WW II period of rapid economic growth. As growth slows, the population ages and new medical technology raises costs, the systems tend to run deficits and become less affordable over time.
Based on the experience of the many nations who have adopted single-payer systems, these have shown to be workable as well as popular, provided that design and implementation were done carefully and allowed broad input from all involved. In the specific case of the United States further issues are introduced by the great variety of care delivery systems already in place and the differences in health care approaches between States.
The basic question thus arises: Are the United States – in terms of geography, population, culture and technology – a suitable ground for the introduction of a national (single payer) health care system? If not, how do we fix the current complicated situation?
The first issue is the sheer size of the U.S. population. In centralized systems, administration costs tend to increase with size, while efficiency and flexibility tend to diminish. A single national health care system for 320 million participants might be too unwieldy to function effectively.
Second comes the current care cost level, which is far higher here than in most other countries. A system based on current cost levels could be unaffordable.
Third is the huge task of combining our several disparate modes of health care delivery and reconciling all the interests involved. This is a mammoth task that might not be achievable under current political and economic circumstances.
We need a new approach, similar to what most other countries have done before opting for one type of system or another: a national discussion and dialogue to define what we expect from health care, how we want to structure delivery, and what price we are willing or able, to pay. There has been a lot of national discussion and some agreement on what parts of the ACA are acceptable to the American people and which ones are particularly onerous. Congress and the administration need to resolve the more onerous grievances of the American people. Only once there is agreement on the basic functions and structure should we begin to experiment with implementation.
Doing the discussion and experimentation work at the state level is likely to be cheaper and faster than attempting to design a system for the entire country. It will also leave more room for initiative, inventiveness and innovation, which Americans are particularly good at. Working at the state level will make it easier to serve differing needs that stem from rural locations vs. the needs of city dwellers and other differences/preferences from state to state.
In the meantime we must work at improving the health care systems we do have – particularly in terms of cost, access, technology and simplicity of use.
This step by step improvement work must include the acceptable parts of “Obamacare”. So far the system has fared poorly in terms of implementation, ease of use, cost and transparency. Its mandates and implementation schedules therefore need to be pushed into the future until these issues have been resolved.
However we choose to proceed, one thing we have learned is that full transparency is vital and the discussion needs to include all stakeholders. The main message in the last election was we expect Congress and the administration work together to develop solutions.
Born in Poland, Jacek Popiel was educated in Africa, Canada, and the United States. He speaks five languages. His career spans military and international business development in the Soviet Union, Eastern and Western Europe, North America, and Japan. He is currently a freelance writer and political consultant. His book “Viable Energy Now,” grew out of his military and international business experience and his professional involvement with energy issues.
Status of “We the People’s” Platform:
Restore U.S. Manufacturing with balanced trade
- Confront China on trade relations
- Implement the Michael Graetz tax reform plan
Achieve energy self-sufficiency
- Upgrade our energy infrastructure
- Settle the “climate change” issue
- Create simplified regulatory framework
- Research and Development for future energy sources
Fix our broken health care systems
- Codify the parts of the ACA that are acceptable to Americans
- Continue the national dialogue on the contentious parts
- Delegate as much as possible to the states