Marc Yacht: Obamacare helps, but it isn't enough

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Healthcare inequities are costing American lives, increasing disabilities, and bankrupting families forced to choose between healthcare and essentials. Obamacare covers 16 million but an additional 32 million remain unprotected. Although insurer abuses such as cherry picking, pre-existing conditions, denials and rate gouging are being addressed, exorbitant administrative costs and high premiums continue. America’s healthcare problems persist.

Efforts to insure all Americans started with Theodore Roosevelt, who believed, “No country could be strong whose people were sick and poor.” In 1906 the American Association of Labor Legislation led a campaign for health insurance. The American Medical Association supported the 1915 Bill. Surprisingly, the president of the American Federation of Labor denounced compulsory health insurance.

The private insurance industry opposed the bill due to the negative impact on commercial insurance. Further debates invoked socialism and inconsistency with American values to thwart its success. Sound familiar? The Wagner Bill in 1943 called for compulsory national health insurance. Strong opposition killed the effort.

President Harry Truman fully supported national health insurance through Social Security. Opposition was fierce. The Korean War and anti-communist and anti-socialist chants buried the attempt. President Lyndon Johnson found success with passage of Medicare and Medicaid in spite of fierce opposition from conservatives and the American Medical Association. President Richard Nixon also favored universal healthcare.

The Nixon proposal became the template for Hawaii’s success insuring all state residents. An angry Congress lobbied by the private insurance industry made sure no other state would adopt the plan. Hawaii remains a top state for health coverage. The Bill and Hillary Clinton effort failed. The Patient Protection and Affordable Care Act of 2010 (Also known as ACA and Obamacare) passed. The opportunity for coverage reached out to 48 million uninsured. Medicare continues to assure coverage to seniors over 65.

The Good: Sixteen million Americans have been insured by ACA. Pre-existing conditions will not thwart coverage. College students can remain on their parents’ plan until the age of 26. Medicare patients no longer have to worry about the “donut hole” that potentially caused significant personal pharmacy costs. It requires coverage and institutes penalties to employers and consumers who do not follow the law. Cooperating states have seen healthcare costs stabilize or decrease. Subsidies have allowed more individuals to afford coverage.

The Bad: Twenty-two states have not adopted ACA. The rest including Washington, D.C., accepted the Medicaid expansion. Six states, including Florida, are discussing whether to take the Medicaid expansion dollars. In Florida about one million residents cannot afford insurance due to lack of available subsidies.

ACA protected for-profit insurers, and as a result there are many costly administrative layers. Fragmented billing to multiple insurers keeps administrative costs at 20 percent or higher; Medicare and Medicaid reduce administrative costs to less than 5 percent.

Conservatives continue to attack ACA, crippling expansion. Thirty-two million remain uninsured. Patients may have difficulty getting services close to their homes.

The most efficient solution for universal health coverage would expand Medicare for all, but it languishes in Congress. Few could disagree that a single-payer system would be cost-effective, reach out to more people and cover all the uninsured. Obamacare has captured one-third of the 48 million, but that is not satisfactory when 32 million are left without needed coverage.

A bipartisan solution is needed. Democrats and Republicans must come together and resolve the issues of ACA that leave so many uncovered and have minimal impact on the costs for healthcare. We remain the only industrialized nation that has not resolved this issue. America’s health is ranked 37th in the world. Political and professional leaders must demand a healthier nation through healthcare access. Teddy Roosevelt, circa 1900, understood that, “No country could be strong whose people were sick and poor.” Such sentiments were valid then and they are true today.

Dr. Marc Yacht is a semi-retired physician living in Hudson, Florida. Column courtesy of Context Florida. 

Marc Yacht



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