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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

April 26th, 2013 11:42 AM

Congressional ‘Obamacare’ Issues Beg the Questions that Single-Payer Answers

In recent days, many of us have read and tried to follow the reports that Congressional offices are engaged in discussions about how to make sure their health insurance coverage available under the Affordable Care Act (Obamacare) remains affordable for Congresspersons and their staff members.  If you’d like to read more about the hullabaloo, this piece from the Washington Post probably explains it as clearly as any.

Basically, a mischievous amendment drafted and inserted by Republicans and later agreed to by Democrats anxious to  pass the ACA leaves some challenging issues to be resolved regarding the employer’s (in case the Federal government, a.k.a., you and me) contributions to paying their share of premiums for Congressional members and their staff members.  Negotiations and discussions continue, but some fear that some Congressional staff may leave their positions rather than take on the bigger financial burdens of paying more of their health insurance premiums.  Stay tuned, if you are worried about how this plays out. 

For the human beings involved who have health needs and families to support just as the rest of us do, I hope a fair resolution is reached in the short term. In the longer term, this should serve as yet another reinforcement of the need to move well beyond the incredibly unaffordable Affordable Care Act to the common sense, common decency, and simplicity of a single-payer, Medicare for all for life model for our dysfunctional health care system.

If Congressional members and their staffs are having difficulties comprehending and navigating the details of the ACA, imagine the millions and millions of “average” Americans who will face incredible confusion, expense, and delays of access to needed health care as we slog through the details of the ACA.   Most of us will not have anyone to negotiate or advocate for us when we try to make decisions about health coverage.  We will have “navigators” who will explain various plans available on the exchanges but that’s vastly different from having true advocates to make sure we aren’t overburdened with costs or enrolling in coverage that really isn’t coverage at all but simply compliance with the mandate to carry the financial product that is insurance.  I am already worried, just as millions of others are.

Why would single-payer, Medicare for all for life be so much better?  Simplicity – everybody is in, nobody is out.  Vastly reduced administrative costs – strip out the profit made on misery and deception and advertising and claims denials and delays.  Incredibly improved access to providers of our choice.  No need to navigate me to one plan or another.  No need to bankrupt me with co-pays, deductibles and out-of-pocket  expenses.  No need for anyone in charge of profit-making to lemon drop (get rid of those with costly medical conditions or who are aging) or cherry pick (keep the healthy, less costly folks enrolled).  We all have one single standard of high quality care under a social insurance model, not a model aimed at maximizing profits.

Some of us will face harsh realities more quickly than Congressional members of staffers on the Hill.  In just four days, I must decide once and for all whether or not to spend more than $800 a month on my coverage for the next several months or just go bare until the exchange (more stealthily named the “marketplace”) is up and running here in Colorado in January 2014.   No matter what I, as a two time cancer survivor and 58 year old, think is possible financially for me or even wisest from a health standpoint over the next eight months, once I get to October of this year, I will be able to begin exploring what I may be able to find under the ACA for my coverage.  I am so grateful that my husband is covered under Medicare and a supplemental (as are many member of Congress, I suspect).

When my time comes to decide about my health and my life, there will be no committee convened that worries about my costs or my coverage as is the case with the current effort on behalf of the Congressional members and staffs my tax dollars cover.  I will decide alone, likely in front of my computer screen, making calculations about paying my bills and other living expenses.  And I guarantee that my coverage will be bare bones as no one will want to cover me and though under the ACA they will not be able to deny me coverage, insurance companies will be able to age-rate my premiums and make sure they factor in my health history.  My premiums will likely be so high that I will either have to opt to pay a penalty for not having coverage or I will be grossly under-insured.   

None of this is necessary.  None of it.  Under a Medicare for all for life, single-payer model, we are all in one risk pool, we all pay a fair and progressive tax or premium for our coverage, and our medical and health decisions will no longer be business calculations.  We will be free of this mess.  We must thunder forward through the confusion of this difficult transition to the unnecessary complexity of the ACA to the day when we all are covered simply as a matter of human right and public good.

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