The Affordable Care Act (ACA), crafted in large part by corporate stakeholders who are themselves responsible for the high costs of U.S. health care, is more secure with President Obama's win. But regrettably, the law will fail to control costs or prices, will not provide universal access to care, and at best will provide low value, high premium "insurance" that will still make essential health care unaffordable for many millions of patients and families.
The ACA's fundamental flaw is that it props up an inefficient and exploitative private health insurance industry while not recognizing that deregulated markets can't fix systemic problems of access, costs, quality, equity, accountability and sustainability.
President Obama has gained an impressive victory, and Democrats have held control of the Senate. Most importantly, corporate money, power, lies and deception on the right have not prevailed. But of course, the Republican-controlled House is likely to bring continued political gridlock. Overemphasis on austerity and deficit control threaten Medicare, Medicaid and safety net programs.
Going forward, we can expect to see wild battles across the health care landscape, including these examples:
- Continued mergers among the major players, including insurance companies, hospital systems, medical groups and others, which will end up increasing costs and prices while limiting patients' choices of physician and hospital.
- Continued lobbying by the insurance industry to mold accountable care organizations and insurance exchanges in their interests (i.e. cherry pick enrollees and pass along sicker patients to public programs).
- Further privatization and exploitation of Medicare and Medicaid.
- Efforts by insurers to limit definitions of minimal essential benefits.
- Further fragmentation and increasing bureaucracy of our market-based health care system with worse health outcomes.
Under this onslaught, the ACA will not hold up. Health care reform needs to be more progressive than how it ended up with the ACA. The only real fix for our problems is single-payer, improved Medicare for All, a proposal introduced by Rep. John Conyers (D-MI) (H.R. 676), coupled with a private delivery system.
Health care is just one more example of the 99/1 percent challenge facing the country. These are some of the directions that we, the citizens of this great country, can take in restoring hope that all Americans can gain their rightful access to the health care that they deserve:
- Speaking out, individually and collectively, at community, state and federal levels to expose the abuses and cruelty of what passes for health care in its under-regulated state.
- Fighting for a defined benefit program that covers all Americans in a single risk pool with full choice of physicians, other health professionals and institutions. (H.R. 676)
- Supporting efforts at the state level for single-payer financing in the event that reform may first need to be demonstrated at the state level before a national program can be passed by Congress.
- Pushing for a more responsible government oversight of health care at state and federal levels to oversee health care, including an independent, well funded national institute to deal with coverage and cost-effectiveness issues on the basis of scientific evidence, not upon which profit-based interest group can scream the loudest.
- Supporting and participating in divestiture efforts against abusive insurers and other stakeholders in the health care marketplace.
Despite what we are being told by politicians on both sides of the aisle, our deregulated health care marketplace is not sustainable, and there is no real fix short of single-payer financing reform coupled with a more accountable private delivery system.
Other advanced nations around the world learned many years ago that one or another form of public financing is fundamental to a good health care system. The U.S. remains an outlier among these nations in having the most expensive system that still does not provide universal access to essential health care -- even at that we have variable quality and worse outcomes. It is long overdue to learn from the experience of other countries that have coped more successfully with the same health policy issues that we face in this country.
John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington, author of Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, past president of Physicians for a National Health Program (PNHP), and a member of the Institute of Medicine.