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Photo by Nathaniel St. Clair

Now that ObamaCare is “the law of the land” for the foreseeable future, as House Speaker Ryan grimly conceded after the failure of RyanCare, a new situation is upon us.  The time is past for comparing ObamaCare to what preceded it. .  This sort of comparison has been done with fulsome praise of Obama’s health care concoction by all too many progressives; the result has been that the real shortcomings of ObamaCare were hidden or played down.  But now with RyanCare lying in ruins, the GOP-hatched health plans are not the problem nor is the problem what went before ObamaCare.  ObamaCare is now the problem, and it is important to recognize what a big problem it is – if we are to realize the potential of this moment for Single Payer as Ralph Nader and others suggest we might.  So just how bad is ObamaCare? 

Just How Bad is ObamaCare? 

To answer that let us turn to one of the daily columns of the Senior Policy Fellow of Physicians For a National Health Program (PNHP), Dr. Don McCanne, columns that he labels modestly “Quote of the Day”.  These columns, each of which tersely summarizes and dissects a single article from the all too voluminous health care literature, are a must read for those interested in health care policy.  In one of his columns, Dr. McCanne spells out where we stand under ObamaCare.  I call it the Column of the “Only’s”.  McCanne writes:

“…Where do we stand today (under ObamaCare, jw).  Last year: * ONLY 63 million adults say they went without health care or medication they needed because of the cost * ONLY 25 percent of adults buying plans on their own say they found it difficult or impossible to find a plan that fit their needs * ONLY 31 percent of adults with health problems say it was difficult or impossible to find a plan that fits their needs * ONLY 26 percent of adults with low incomes and health problems say it was difficult or impossible to find a plan that fits their needs * ONLY 20 percent of adults say they did not go to a doctor when they were sick because of the cost * ONLY 19 percent of adults say they did not fill a prescription because of the cost * ONLY 18 percent of adults reported they had skipped a recommended test, treatment, or follow-up visit because of the cost * ONLY 70 million adults said they had problems paying medical bills in the past 12 months or were paying off medical bills over time * ONLY 46 million adults are currently paying off medical debt over time (unchanged from 2012)”

To which I might add,

*ONLY 29 million Americans are without health insurance. 

*ONLY 15-20% of the health care dollar is allowed for non-medical expenses, i.e., for bureaucracy and profits. ( Medicare is an exception where less than 2% is spent on administration and where insurer profits do not exist since it is government provided insurance.) 

*ONLY ~18% of GDP is spent on health care – compared to Canada’s ~11% of GDP for its “Medicare for All” program which covers everyone and gives better results than ObamaCare.  And the U.S. expenditure is rising whereas Canada’s has remained stable as a percentage of GDP for many decades. 

On this last point the meaning of our 18% of GDP versus Canada’s 11% merits some examination and some effort to put it into perspective.  The difference is a bit more than 6% when rounding errors are taken into account.  This 6% difference in our roughly $17 trillion GDP amounts to a bit over $1 trillion per year for the U.S. By this calculation, we could save ~ $1 trillion a year by substituting Single Payer for ObamaCare.  Astounding when one thinks of it.  For comparison, the US military budget amounts to $700 billion per year, and the entire “national security budget” (military plus spying on you and me and everyone else on the planet, etc) amounts to about $1 trillion.  That $1trillion would buy a lot of infrastructure, a lot of inner city schools, a lot of college education – and on and on it goes. 

The fundamental flaw with ObamaCare and RyanCare is the same. 

Interestingly White House guru Steve Bannon complained with some irritation that RyanCare was “written by the insurance companies.”  But so too was ObamaCare.  That simple fact is the fundamental flaw in both plans.  As long as the Big Insurers are in charge, they will work to game the system, to decrease care, increase costs to the patients and so increase their profits. 

And that means that the system will grow ever more expensive and less satisfactory.  This is nothing new.  The superb scholars and critics of the health care system, Drs.  David Himmelstein and Steffie Woolhandler, leaders of PNHP, have long said this about ObamaCare and all other schemes based on Big Insurance Inc. And Bernie Sanders, who is showing signs of getting weak kneed in his support of SP of late, now delaying reintroduction of his SP legislation that brought him so many votes in 2016, said on CNN, “Obamacare has serious problems.  Deductibles are too high, and premiums are too high, and the cost of health care is going up at a much faster rate than it should.”  Even Donald Trump is saying that ObamaCare will “explode.” ( As its equally evil twin RyanCare would have, we might add.)  This conclusion is escaping almost no one (save perhaps for Paul Krugman) although the Democratic and Republican Establishments are fleeing from it in a panic. 

The developing “explosion” of ObamaCare is a recipe to anger voters in 2018 and 2020 even more than it did in 2016.  And that anger is an opening for SP, Medicare for All.  The people are fed up.  That is why we are entering a golden moment now for putting SP back on the table.  But there is a danger confronting the Single Payer movement.  In the past Single Payer activists have been played by the Democratic Establishment, which is always working feverishly to keep the Insurers happy.  Every time the question of ObamaCare vs. SP has come up, the SP activists have been pressured to bow to the Obamabots for the sake of “unity.”  At the present golden moment of opportunity, that would be a mistake of monumental proportions. 

We will now be offered ObamaCare 2.0 by the Establishment.  Fool us once, shame on us.  Fool us, 2.0, etc.  Let that not be our fate.  Medicare for All is within sight.