Dr. Marc Yacht: The nation needs single-payer health care

The Affordable Care Act 2010 – popularly known as Obamacare — has allowed about 18 million uninsured people to acquire health coverage so far.

About 33 million remain uncovered, and the bulk of those reside in states that have rejected ACA Medicaid expansion dollars.

The numbers are confusing, but overall the uninsured rate nationwide has dropped from 18 percent to 13 percent. Adults and children have benefited as uninsured rates decrease.

Although the numbers are encouraging, all is not well with Obamacare.  Alaska recently accepted expansion money, leaving 21 states denying billions of dollars to provide health coverage to their low-income people. Florida remains one of those states and is second to Texas for the percentage of the population that is uninsured – 16 per cent.

States rejecting Obamacare have higher uninsured rates.  On average, 12.74 percent remain uninsured nationwide.  Those cooperating states have seen their uninsured rates drop to an average 9.35 percent.

States refusing Obamacare do little to assist the needy in securing health insurance. Medical providers may also compromise cooperation by hindering care for those who have Obamacare.  Also, poor people and the unemployed may find Obamacare unaffordable.

ACA requires states to qualify citizens at 138 percent of federal poverty guidelines. In Florida, such qualification levels exist for targeted programs such as Improved Pregnancy Outcome. This results in unaffordable deductibles and high premiums for most low-income families who are unable to receive Medicaid subsidies.  Obamacare, with its high deductibles and expensive premiums, is simply out of reach.

Yet, at certain income levels, Obamacare can offer advantages even in those states that have refused expansion money.  Florida has signed up 750,000 residents.  Small business, particularly, has seen employee health care premiums drop when signing up for Obamacare. Those unemployed continue to fall through the cracks.

Obamacare would leave millions uninsured in the best of circumstances.  It is not universal health care and probably will never evolve into that.

The plan still allows enormous administrative costs and profiteering by insurers and medical providers.  Although the plan has reduced costs through regulation, Obamacare can’t substantially reduce the costs that insurance companies charge for administering often-complex health insurance coverage.

ACA 2010 has not solved the problem of an inefficient, fragmented, and outrageously costly system of care.   There are simply too many insurers, too much oversight, and too many factors that drive up costs.

The Medicare Act (1965) insured those 65 years and older.  The law made government the payer yet protected the private provision of healthcare services.  In the ensuing years, fee regulation and provider oversight would set the standard for private insurers.  However, the fragmentation of health payers other than Medicare would drive costs to astronomical levels.

Although Medicare administrative rates remained under 5 per cent, private insurer costs have reached 20 percent and more. Fragmentation and profiteering have made the nation’s healthcare system the most expensive in the world.

A more efficient model would be “Medicare for all.” The protection of the private delivery of medical care would continue. The fraud and exorbitant profits would be better addressed. A single-payer system is not, depending on design, socialized medicine.

The claim that “single payer” is politically impossible can be overcome.  Lobbyists may have the money, but the people have the vote.  The United States is long overdue to provide efficient, responsible and affordable health care to every citizen through universal health coverage.


Dr. Marc J. Yacht, MD, MPH is a retired public health physician.  Column courtesy of Context Florida.

Marc Yacht


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