Obamacare isn’t socialism, but a block against single-payer plan
By Michael J. Pramenko
On Nov. 22, I nearly lost my breakfast reading Josh Penry’s Daily Sentinel op-ed column. He compared Obamacare to socialism in an ongoing organized effort to convince Americans that the current health reform effort is straight out of the old Soviet Union.
Back in the 1980s, President Reagan signed a law, know by the name “EMTALA,” that guarantees access to health care via an American emergency room to all comers. Sound a bit like socialism?
Ever since the pasage of that law, health reform policy wonks have been trying to find a more efficient alternative to using the ultra-expensive emergency room as the safety net for uninsured Americans.
A solution would reduce the expensive cost shift to private insurance. If you rule out a single-payer system, your solutions are few and complex.
All this raises some important questions for Obamacare critics:
What do critics propose to end the overuse of the most expensive place in the world to receive health care, a U.S. emergency room?
What do critics propose to enable access to valuable health care long before the need for emergency care?
What do critics propose to end the abuses of the health insurance industry that have cancelled insurance plans on an annual basis for decades — sometimes in the middle of life-saving treatments?
What mechanism do critics propose to insure access to health insurance for those Americans with pre-existing conditions?
How do critics propose to stop the unsustainable inflation in health care without subjecting Americans to unfair insurance practices designed by shareholder-driven, for-profit health insurance companies?
Certainly, Obamacare delivers reasonable answers to these questions. Meanwhile, the Republican-controlled House of Representatives has voted more than 40 times to either repeal or dismantle Obamacare. At the same time, not a single vote has been cast on a replacement, although a Republican bill was introduced in the House in September.
It reminds me of the quote from Aesop, “When all is said and done, more is said than done.”
Make no mistake, avoiding a single-payer socialized system of health care while addressing the basic policy objectives above is not simple. Saving private health insurance companies from more liberal versions of health care reform required legislative gymnastics by Obamacare authors.
In fact, the provisions in Obamacare proving to be the most difficult to implement are the very provisions that were used to ensure the need for private health insurance in America. The individual mandate and health insurance exchanges, including HealthCare.gov, are designed for the private health insurance companies. If you want guaranteed coverage for pre-existing conditions for those Americans currently without insurance, you either favor the concepts in Obamacare or you’ll need a single-payer system.
Arguably, a single-payer system would save money and would be extraordinarily easier to implement. Many countries have found that they don’t need health insurance companies while outperforming the United States on cost and quality in health care.
Wanting to avoid the prospect of a single-payer system, Republicans originally advanced the ideas of an individual mandate and insurance exchanges. Health insurance companies followed.
In light of these truths, Penry’s column leaves us with many more questions than answers.
It also explains why a viable alternative has not been voted on in the House of Representatives as the “repeal and replace” mantra continues. They have mastered the repeal efforts — it’s that nagging replacement part that is proving so difficult.
We are unlikely to see an actual vote on a comprehensive health reform plan from the Republicans. Current proposals on that side of the aisle fall far short of the protections alluded to above. Fair-minded Republicans, including some at the Colorado Medical Society and on the Club 20 Health Reform Committee, understand that Obamacare represents an alternative to socialized medicine and the socialized emergency room.
More importantly, if Obamacare were to fail under the weight of the provisions designed to protect the insurance industry, a re-energized cry for a far simpler and less expensive single payer system would emerge.
Michael J. Pramenko, M.D., is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a past president of the Colorado Medical Society.