HuffPost Politics, May 5, 2016
John Geyman Professor Emeritus of Family Medicine at the University of Washington School of Medicine
This 2016 election season brings us three very different alternatives concerning future health care in this country: (1) continuation of the Affordable Care Act (ACA) with changes as necessary; (2) a Republican “plan” for health care; and (3) single-payer NHI. Despite some expansions of coverage, especially through Medicaid, the ACA has failed to make health care more affordable, has accelerated waste, bureaucracy and profiteering, and is unsustainable. Yet Hillary Clinton calls for expansion of the ACA to 100 percent coverage with no possible way of doing it by retaining some 1,300 private insurers. She also claims disingenuously that NHI will raise our taxes—without acknowledging that Gerald Friedman’s classic 2013 study found that 95 percent of Americans will pay less for insurance premiums, deductibles, co-payments, actual care and out-of-pocket payments, and that only the wealthiest five percent would pay more. (6)
Although no concrete plan has yet been advanced by the GOP, we can expect that it will repeal the ACA, then “replace” it with long discredited reliance on free markets in health care, consumer directed health care, health savings accounts, selling insurance across state lines, and high-risk pools.
Neither the ACA nor GOP options will make health care more affordable or accessible. Single-payer NHI is the only alternative that will achieve universal coverage in an affordable and sustainable way. A strong case for it has been made elsewhere on economic, sociopolitical, and moral grounds. (7) It will meet conservatives’ principles regardless of party affiliation, including efficiency, maximal choice, minimal waste, value, and everyone contributes in proportion to his or her income. (8) Long an iconic guru of free-market economics, Kenneth J Arrow, has recently acknowledged that “a single-payer system is better than any other system”, as long as private practice is preserved (as it would be with NHI). (9)