The Affordable Care Act isn’t working, and that’s not just partisan rhetoric, but a cold hard fact. According to one Washington Examiner article, 40% of counties throughout the country are down to only one provider on the exchange, and almost 50 counties will have zero providers by the end of this year. So much for providing insurance to all. In addition, millions that did obtain coverage were then unable to find a doctor or network willing to take their government-subsidized healthcare plan. Insurance is only good if it covers care you are actually receiving. Furthermore, it also placed previously-affordable healthcare out of the reach of millions of middle-class families as premiums skyrocketed.
As the latest pathetic attempt to repeal and replace Obamacare was killed in the Senate last night, it seems apropos to consider what the alternative healthcare options would be at this point. Few people besides Sen. Rand Paul seem to even consider the free market as a viable choice for providing Americans with healthcare. This is currently one of the most economically feasible options, but simultaneously the least likely. Much like competition in the marketplace of car insurance, competition on the health insurance market would translate to more choices and more affordable options for Americans, while still meeting certain requirements set by the government. Government insurance could still then be provided to those that might otherwise be denied due to pre-existing conditions, and of course Medicare and Medicaid would continue as they have been, but at a much lower cost to the taxpayer.
However, it seems as though the signing of the Affordable Care Act in 2009 was an irreversible first step towards socialized medicine in the United States. Despite, and because of, the many problems with ACA, many Americans are now demanding that healthcare shift to a single-payer, Medicare-type system for all.
Let’s take a look at one state that is as close to single-payer as it can currently get. The taxpayers in California pay for 70% of healthcare costs throughout the state, mainly because of the AHA Medicaid expansion (Medi-Cal in California). However, this $260 billion dollars still manages to underpay providers and undercut resources (such as home-health aides, medications, etc.), which translates to a limited access to care. One simple example would be the Medi-Cal reimbursement rate for physicians, which is about 1/3 of what private insurers pay, often times even less. To stay financially viable, physicians and hospitals must limit their acceptance of Medi-Cal patients, thus creating a situation where Medi-Cal patients have insurance, but have no doctor willing to see them. That sounds like a good system.
If the Bernie Sanders-supported “Medicare for all” program is enacted, how many doctors will leave the profession because they simply cannot afford to pay off their loans and live a comfortable life making 1/3 of what they used to be making? Not to mention, how many resources, from prescriptions to specialty providers to home-health aides, will be severely restricted or eliminated entirely due to lack of funding and not enough resources? Are Americans okay paying twice as much, if not more, in taxes to pay for such a system? These are serious questions that Americans needs to come to terms with before begging for a single-payer system.
As we stand on the precipice of this slippery slope, we may as well look at some of the government-run healthcare systems that do work and will not bankrupt the nation (which, by the way, already runs into the red just shy of $20 trillion). Take for example Singapore. The state-run healthcare system works similar to a nationwide Health Savings Account except that each individual must put a certain amount of money into this account for healthcare costs; this money is used first, with a government-run insurance (similar to Medicare) providing coverage for high-dollar healthcare needs. In this system, only 25% of the country’s healthcare costs are paid by taxpayer dollars (used to subsidize the accounts of low-income individuals, etc.) whereas some estimates put that number around 60% for the U.S.
Switzerland provides another example of government-run healthcare that may be feasible. The current system in Switzerland likely reflects what president Obama had envisioned for AHA: a government mandate requires that everyone has insurance, but the difference is that there are over 100 health insurance companies competing on the market. The healthcare system is private, unlike the U.K. or Canada where it’s a public, government-run system similar to the VA here. The key point here is that the competition allows for individuals to find a plan that is right for their coverage needs and their budgets. Only about 9% of Switzerland’s GDP is made up of healthcare costs, whereas that figure is at 18% for the United States.
These two examples are very different from the Canadian and United Kingdom versions of government healthcare. Both of these systems, particularly that in the U.K., are well-known for their long wait times, lack of prescription coverage, and negative impact on medical research. There is a reason why Canadians and Britons continue to come to the United States for elective surgeries and cancer treatment.
The bottom line is that our current healthcare system is a mess and it is inaccessible to many, despite what ACA-supporters believe. It is only a matter of time before Obamacare implodes, and we better all hope that our elected officials are brave enough to do something about it before then.