HealthCare at the Crossroads


On November 1, ObamaCare entered into its fourth and final sign-up stretch under the President Obama. The President came to Florida last month as part of his final push to convince the last 23 million people in the U.S. who are still without insurance coverage to sign up on

Thirty-two states have already embraced ObamaCare’s expansion of Medicaid. The president– and local health care advocates– have been trying to convince Republican lawmakers here and in 18 other states to do the same.

This new enrollment period will likely face an uphill struggle. Some of the insurers say they need a more younger, healthier people to stay in the marketplace. More premiums being spent by younger people who don’t go the doctor as much means more money available to pay for the older and more sickly persons who do.

If younger people do not turn out to sign up for insurance coverage durng this go-around, insurers are threatening to pull out of the insurance marketplaces all together. This would lead to a decrease in competition among insurers and the high prices that would likely result.

Younger people may not see the immediate need for ObamaCare, but most are concerned about the health insurance burden facing their parents and worry about having to foot their bills. The argument for ObamaCare– or some kind of health insurance remedy– makes sense at that point.

In 2007, before Obama was elected, in a poll conducted by CBS News/New York Times, 54% of people surveyed said the U.S. health care system needed “fundamental changes,” and 36% said it needed to be “completely rebuilt.”

When asked if government “should guarantee health insurance for all,” 64% said yes, saying guaranteed insurance was more important to them than keeping prices down (65-31 percent).

Today, while one in five citizens are very satisfied with what they pay for health care (20%), a majority (52%) are dissatisfied. A third of them are very dissatisfied.

Dr. Zeke Emanuel, one of the architects of ObamaCare in 2009, said he blames the GOP for some of the law’s underlying problems.

“I think people are frustrated by the fact we can’t make changes,” Emanuel said. “Hopefuly once we’re past this election, we’re done with the ‘repeal and repeal’ rhetoric and we can we get on with, ‘Alrighty, what are we going to do to make this work?’

His comment suggests that ObamaCare–  as critics charge–  isn’t working. Nearly one-fifth of people with ObamaCare are likely to only have one option for insurance on the exchanges next year, according to a study by the McKinsey Centers. Even ObamaCare supporters acknowledge that the number of high-profile insurers leaving the program— UnitedHealth and Aetna, just to name two—proves that the law needs to be revised.

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While clearly some action is needed to deal with existing problems with the Act, the question that needs to be thoughtfully considered is: do you throw the baby out with the bathwater?  After all, the first-step goal of the Affordable Care Act was to get more Americans covered by insurance.  And it did.

With 20 million Americans having been added to the rolls of the newly insured, suddenly depriving them of coverage will not sit well with those who need it– despite the inconvenience of the costs.  The ability to get insured in spite of pre-existing conditions is huge.  People literally die for lack of insurance in the United States.   The task facing the incoming administration is to either work out the financial kinks in the system, or throw millions of people back into the uninsured health care hole.

 The Commonwealth Fund, a private foundation that supports independent research on health care issues and makes grants to promote a high performing health care system, has estimated that Trump’s plan would increase the number of people who lack health insurance by as many as 25 million, and increase the federal budget by as much as $41 billion– because it gives tax breaks to encourage people to buy insurance, while Obamacare requires people to buy it.

Despite being the minority party, Democrats in the Senate could use the filibuster to prevent a repeal of Obamacare. Because there are no limits  on the time a senator can speak, a democratic senator who has been given the floor could speak for as long as s/he was able to prevent the vote from ever taking place.  To prevent a filibuster from taking place, the chairperson would have to not allow any Democratic senator to speak– at all.

Once started, the only way to end a filibuster is with 60 votes out of 100 in opposition (a filibuster can only happen in the Senate). While 52 votes give Republicans control of the Senate (the Democrats have 46 and there are 2 Independents who caucus with the Democrats) that number is not enough,  under Senate Rules, to defeat a filibuster.

Despite Trump’s repeated threats to dismantle the ACA, though, Forbes reported today that 250,000 new enrollees signed up for Obamacare over the last 12 days, and a total of 1 million have selected plans since open enrollment started on November 1.  Seven hundred fifty thousand of those are renewals.  This seems proof enough that Americans want, and need, the essential components of Obamacare– in the absence of a more inclusive universal healthcare.  Trump would be wise to fix, rather than dismantle, Obamacare.

Universal health care does exist– outside the USA.  Notable examples are the British and Canadian systems. On this side of the Atlantic, Canada is a great example of single payer insurance coverage that could simplify– and cheapen—health care insurance, while providing coverage for every American in the country.

In 2013, Ralph Nader prepared a comparison of the two and listed 21 reasons the Canadian system works better. Voters might begin taking a closer look at it for the next round of arguments during the next election:

Number 21:

In Canada, everyone is covered automatically at birth – everybody in, nobody out.

Number 20:

In Canada, the health system is designed to put people, not profits, first.

Number 19:

In Canada, coverage is not tied to a job or depaendent on your income – rich and poor are in the same system, the best guaranty of quality.

Number 18:

In Canada, health care coverage stays with you for your entire life.

Number 17:

In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”

Number 16:

In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, for thousands of Americans, it’s pay or die – if you can’t pay, you die.

Number 15:

In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.

Number 14:

In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.

Number 13:

In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

Number 12:

In Canada, simplicity leads to major savings in administrative costs and overhead.

Number 11:

In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”

In the United States, the first thing they ask you is: “What kind of insurance do you have?”

Number 10:

In Canada, the government negotiates drug prices so they are more affordable.

In the United States, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:

In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:

In Canada, there are no necessary co-pays or deductibles.

Number 7:

In Canada, the health care system contributes to social solidarity and national pride.

Number 6:

In Canada, delays in health care are never due to the cost of insurance.

Number 5:

In Canada, nobody dies due to lack of health insurance.

In the United States, on the other hand, many thousands will continue to die every year due to lack of health insurance.

Number 4:

In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, the poor pay a larger share of their income for health care than the affluent.

Number 2:

In Canada, the administration of the system is simple. You get a health care card when you’re born. And you swipe it when you go to a doctor or hospital. End of story.

Number 1:

In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital, every citizen in, nobody out.

In America, though, the preoccupation by the unscrupulous with getting rich, would almost certainly create a need to provide enforcers to prevent the fraud by medical providers almost sure to result. This would increase the costs of program administration, and likely create yet another (and anticipated) objection to universal healthcare.

Wonder what the framers of the constitution really meant when they said ‘we are endowed by our creator with certain inalienable rights, and [that] among them are life, liberty and the pursuit of happiness?’  If you can afford it?


UPDATED November 16, 2016.