Wayne O'Leary

Why Not a Single-Payer?

Not long ago, Senator Claire McCaskill (D-Mo.), one of Hillary Clinton’s leading campaign surrogates, opined that “socialist” Senator Bernie Sanders could not and should not be the 2016 Democratic nominee for president because he advocates a Canadian-style, single-payer health-insurance system. Clinton herself revealed she had toyed with the single-payer idea in the 1990s, but quickly abandoned it as unrealistic.

The official health-care stance of both Hillary and her supporters (and most establishment Democrats, for that matter) is to pledge fealty to Obamacare, which, they claim, is working — not only working, but a great success. Democrats have thereby painted themselves into a corner; the Affordable Care Act (ACA) is, by any measure, a partial success at best. Regardless, since Republicans want to destroy the law, Democrats feel duty-bound to defend it, warts and all.

The general public remains split on the issue, with slightly more opposing Obamacare than endorsing it, not a good sign five years after its passage and going on three years after full implementation. A November Gallup poll found 52% disapproved of the current president’s signature accomplishment, while just 44% approved. The law’s defenders and apologists are either in denial or resigned to making the best of a bad situation. Even those benefitting from aspects of Obamacare have mixed feelings, as recent press coverage makes clear.

Item: Shopping for a new policy on the federal insurance exchanges in search of the best and cheapest plan has already become an annual rite for many Americans, one a New York Times report calls “the shop and switch routine.” It’s a frenetic process accompanied by confusion, stress, and anxiety, as typical consumers wade through innumerable policy choices from multiple insurers in an effort to offset the premium increases, higher deductibles, and network changes of a volatile marketplace. Yearly switching has become the disruptive “new normal” in a system based on mindless competition, and it’s being encouraged by the Obama administration, which says 86% of the harried insured can find better deals if they continue to shop around.

Item: Obamacare’s “employer mandate,” which starting in January 2016 requires all businesses with 50 or more full-time employees to offer health insurance or face penalties, is threatening the survival of small enterprises operating on the margin, discouraging them from expanding and hiring. Larger firms of 100 or more workers, required to offer coverage during 2015, have discovered their lower-paid employees (as many as 7.5 million) can’t afford the monthly premiums and pay a nominal ACA fine instead. Participation rates among minimum-wage workers of as little as 2% have been found in some instances.

Item: Average premiums for medium-benefit ACA exchange plans are, according to the Kaiser Family Foundation, set to rise 10% in 2016, this following a 28% overall average increase (after subsidies) in 2015. And employee premiums affected by Obamacare’s employer mandate have already risen an average of $600 per year since 2011 (4.9% annually) in anticipation of the misguided “Cadillac tax” the ACA will impose in 2018 on employer-provided plans considered too generous. The same impending tax has furnished the excuse for a 50% rise in employee deductibles since 2009.

Item: Exchange customers who fail to file required income-tax returns (or file too late or incorrectly), including low-income individuals who normally don’t have to file at all, may lose their health-care subsidies. As many as 710,000 are subject to this penalty for 2015.

Item: Despite initial government predictions that ACA exchange enrollments would reach 11 million in 2015 and 21 million in 2016, they will barely top out at 10 million by the end of next year, leaving 29 million Americans uninsured. Analysts credit a dropout rate of 15%, resulting from sign-ups who couldn’t afford their premiums.

Item: Prime insurer UnitedHealth Group announced it may strand 540,000 policyholders by leaving the Obamacare exchanges in 2017 due to weak customer growth, high medical costs, and financial losses. Aetna has hinted at a similar departure. Both companies want more federal money to offset their exchange losses, a pitch made by Marilyn Tavenner, CEO of the insurer lobby America’s Health Insurance Plans (AHIP), who just happens to be past administrator of the Centers for Medicare and Medicaid Services, which runs the federal exchanges — a classic demonstration of Washington’s revolving door.

Another one million health-care consumers are also in jeopardy of losing their low-cost coverage, those enrolled in one of the 23 nonprofit health cooperatives created under the ACA to provide at least some real price competition for the large corporate insurers (4/1/15 TPP). Through a disgraceful combination of government incompetence and ideologically driven politics, approximately half of the original co-ops (representing 500,000 members) have been allowed to fail financially, or have been deliberately pushed to the brink of extinction, confirming Dr. Howard Dean’s fear that they wouldn’t be able to replace the lost public option as a bulwark against corporate monopoly.

The callous elimination of the co-ops has been bipartisan. Congressional Republicans, acting on behalf of the for-profit insurers, led the way by refusing to approve sufficient seed money to cover start-up costs and meet state solvency requirements — only $2.4 billion (40%) of the $6 billion budgeted for and promised. But the Obama administration has done nothing proactive to help, essentially letting the co-ops sink or swim on their own, according to angry co-op representatives. Congressman Jim McDermott (D-Wash.) and former Sen. Kent Conrad (D-N.D.) go further, insisting the co-ops were “sabotaged.”

Nevertheless, the defenders of Obamacare remain unperturbed. Economist Paul Krugman, a normally perceptive guy, maintains all is well with the ACA, which was never expected “to cover all the uninsured.” Its failure to control rising premiums or high deductibles he calls “a slight disappointment” and its lagging enrollments one of the inevitable “rough patches” of a new system.

Attempts to materially improve that system — to escape the straitjacket imposed by a total reliance on free-market capitalism — are just as cavalierly dismissed. Hillary Clinton, borrowing Republican rhetoric, derisively calls the Sanders Medicare-for-All proposal nothing more than a middle-class tax increase. The message coming from the Democratic establishment is clear: the flawed ACA is the only permissible alternative to the GOP’s health program of status quo ante. Surely, we can do better.

Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He holds a doctorate in American history and is the author of two prizewinning books.

From The Progressive Populist, January 1-15, 2016

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