Why continue to build a movement for single payer now? It’s the key to lasting economic recovery
By Walter Heath
The people of Massachusetts have four years’ experience with the healthcare payment system that is the template for the Patient Protection and Affordable Care Act (ACA), and a sizable majority recently decided that a publicly-financed health insurance system – similar to Medicare – is what their state actually needs.
The following non-binding ballot question was asked of 220,865 Massachusetts voters in the November, 2010 general election: “Should the state representative from this district be instructed to support legislation establishing health care as a human right regardless of age, state of health, or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”
192,230 Massachusetts voters (87%) voted on the question, a fact which speaks volumes about continuing interest in this issue. Sixty-two percent of voters (119,275) instructed their state representative to support a single-payer health insurance system such as Medicare. The voters polled constitute a random cross-section of Massachusetts life: rural, small town, suburban and urban.
A substantial majority of Massachusetts voters sent a clear message. A publicly-financed replacement for the private, for-profit health insurance exchanges put in place by Mitt Romney and emulated by Congress should be sought because they are defective products. Sadly, the ACA may actually be worse than the Massachusetts experiment, which is why U.S. Sen. Scott Brown of Massachusetts is advocating for ACA waiver applications to be permitted starting in 2014 instead of 2017. Five of the districts polled in November lie in Sen. Brown’s former state senatorial district.
The ACA has major weaknesses in three areas: Coverage, cost and choice. The best estimate for health-insurance coverage with the ACA is 92% of the population. Considering that the ACA will leave 3 million people in California without routine, ongoing access to a physician (and 24 million nationwide), one can hardly give the ACA a passing grade. The Massachusetts health-insurance exchange advertises 98% coverage of its population.
While the ACA stipulates that health-insurance plans pay out 80% of premiums collected for health care, it does little to stem the rising tide of healthcare costs and even less to reduce double-digit increases in health-insurance premiums. A single payer of healthcare claims will have the authority to negotiate for the largest volume discounts imaginable for the largest risk pool imaginable—our entire nation.
Our nation, the richest nation on Earth, will continue to ration health care according to wealth when the ACA takes effect. The insurance exchanges will sell insurance policies which regulate an individual’s access to healthcare providers by how much for-profit health insurance they can afford. There are no stipulated limits on annual premium increases as long as the insurance company meets the criteria for participation in the exchange. If your doctor is not participating in the health plan you buy, you will have to see a different doctor.
Despite hopes for the ACA as the answer to rising healthcare costs that are eroding our nation’s competitiveness in a global economy and undermining job creation, it will merely slow the rate of demise of America’s middle class. We spend nearly twice what citizens of every other industrialized country spend for health care. The sooner we realize that the dysfunctional, fragmented way by which our nation pays for health care is ruining the budgets of businesses and governments, the sooner lasting economic recovery can begin.
Table 1. Results for Question 4 (or 5 in some districts) on Massachusetts November, 2010 general-election ballot.
Source: http://www.sec.state.ma.us/ele/elepdf/rov10.pdf Demographic information added based on the composition of towns and cities in the district. 80 towns and cities out of 351 towns and cities in Massachusetts were accounted for by this vote.