Obama-Care Fails: Maine Targets State Single Payer
The following was released by the health reform advocacy group known as "Maine All-Care" which is dedicated to promoting universal, affordable and high quality health care for the people of Maine.
Health Care Reform: Is It “Fair”? – A Critique of the Affordable Care Act and a Proposal for Maine
Alice E. Knapp, Esq.
Good people reasonably disagree on the merits of “Obamacare” (the federal Patient Protection and Affordable Care Act or “ACA”). Recent Congressional Budget Office estimates, however, project the ACA will leave approximately 27 million Americans uninsured in 2016 and beyond. While I might once have been persuaded that the law’s coverage gains justifies its failings, I now equate leaving 27 million Americans uninsured with having passed a law that freed but 90% of this nation’s slaves.
I view the ACA as symptomatic of this country’s corrosive slide into divisive, winners/losers politics. The law’s defenders have remained silent on why they believe it appropriate to extend through Medicaid expansions near free, comprehensive health insurance to millions of low income Americans while leaving millions of moderate income Americans similarly unable to afford comprehensive coverage to fend for themselves.
Visiting the Kaiser Foundation’s Health Reform Subsidy Calculator and entering two hypothetical, 52 year old residents of a high cost state like Maine illustrates the inadequacy of the ACA’s individual mandate premium subsidies and their arbitrary nature.
Using incomes based on the projected 2014 Federal Poverty Level (FPL), entering the first such resident with gross annual income of $46,021 (400% of 2014 FPL) yields a subsidy reducing that individual’s projected $750 monthly premium for the ACA’s “silver plan” to $364/month.
Entering the second resident at a gross annual income $115 higher at $46,136 (401% of 2014 FPL) yields no subsidy, leaving that individual to pay the full $750/month “silver plan” premium cost representing 19.5% of his/her gross income.
The high cost and coverage inadequacies of the private health insurance market leave both individuals facing upwards of $6,000 in annual, “silver plan,” out-of-pocket expenses (deductibles and coinsurance), on top of their premium expense, should illness or injury require them to use their insurance, and family coverage is exponentially more expensive.
This brings me to the language used by individual mandate proponents, which essentially vilifies the uninsured. Proponents’ “shared responsibility” argument suggests that those who fail to voluntarily purchase insurance in the individual market aren’t doing their part. I dare say most 5 year olds could tell you that a system under which some get free government funded coverage; some get tax free, employer provided coverage; some get subsidies to help pay the cost of having to buy their own coverage; and the rest are left to pay the full cost of expensive, poor quality coverage, is not “sharing” responsibility for health care costs in any meaningful sense of the word.
Proponents also suggest the uninsured cost the rest of “us” when they get the care they need through the emergency room. Besides the fact that there are an awful lot of “us” who are not paying very much for our health insurance, this promotes the unconscionable myth that the uninsured receive all the healthcare they need through charity care.
Federal law requires hospitals only to “screen and stabilize” emergency room patients. If you present to the ER feeling poorly and are diagnosed with a malignancy that will kill you in time left untreated, do not expect a free course of radiation and chemotherapy, nor will patients with chronic conditions be sent home with free, refillable supplies of expensive prescription drugs required to stabilize their condition. Accordingly, some 3,000 uninsured Americans die prematurely each month for lack of access to necessary treatment. Countless more are thrown into bankruptcy as they desperately try to pay for needed care.
Language matters, and the scripted dishonesty of arguments defending the individual mandate mask the core unfairness of the ACA approach. A country that turns its back on some in need while providing handsomely for others is not one grounded in equal opportunity, and this shameful paradigm weakens the cohesiveness of our great nation.
American health care spending compared to that of countries with universal healthcare systems is more than adequate to provide coverage for all, and it is a national disgrace to continue on the path of irrational and grossly inequitable spending. National healthcare reform having once again failed millions of Americans, as the province of Saskatchewan once did for Canada, the time has come for Maine to lead the way by implementing a statewide single payer health care system.
Scripted dishonesty is a good characterization of all political speech about health system reform, from both major parties. Americans are poorly served by our health care system, yet we are mortgaging our future to pay for the mediocre, inefficient care that we receive. The individual mandate would be laughable if it weren't so harmful. How can the proponents argue for a so-called 'market-based' health care system while mandating that every American must 'buy' a product which is so manifestly wasteful and inefficient? How is a mandated purchase anything like a market? And how is it a market if the taxpayer must subsidize many (most?) of the purchases? What we need now is to make comprehensive health system reform possible for a state like Maine, which might actually make history if Congress will simply get the federal government out of the way. If Utahns are sincerely in favor of state-based health system reform, then they must use the current election cycle to push our Congressional delegation towards support of the States' Right to Innovate in Health Care Act (see a draft of this legislation by clicking on the 'Solutions' tab of this website).
Dr. Joe Jarvis