Health care debate far from finished

By Sara Foss
The Daily Gazette (Schenectady, N.Y.), Feb. 26, 2014

The other night I attended a debate at The Linda in Albany, WAMC’s performing arts studio, on whether the U.S. should adopt a single-payer health care system.

Sponsored by the Albany Medical College chapter of an organization called Students for a National Health Program, the debate pitted a doctor who favors a single-payer system against a doctor who opposes such a system.

Under a single-payer system, the government, rather than insurers, would pay all medical costs, much as it does through Medicare for Americans 65 or older.

The pro single-payer side was represented by Dr. Paul Song, a California oncologist from the group Physicians for a National Health Program. Offering an opposing view was Dr. Mitchell Heller, a New Jersey-based emergency room physician representing the Benjamin Rush Society, a libertarian organization that supports limiting the government’s role in health care.

I’ll admit my bias upfront: I support a single-payer model.

And though both men were able debaters, I wasn’t surprised when an after-debate poll showed Song had won. Heller did a great job of articulating his vision for the health care system — a vision most people found horrifying.

When Song cited the fact that medical bills are the biggest cause of bankruptcy in the U.S., and that many of the people declaring bankruptcy actually have insurance, as evidence that America’s health care system doesn’t work, Heller replied that bankruptcy really wasn’t bad at all. If a patient declares bankruptcy, it means he or she received needed treatment, he explained, which is true.

However, most of the people in the audience seemed to think that America can do better — that it can create a system where people receive the treatment they need and don’t have to go into bankruptcy to get it.

Will the Affordable Care Act create such a system?

Nobody at the debate seemed to think so.

One of the things I found most interesting about the discussion was the simple fact of its existence.

After all, the U.S. health care system is undergoing a big transformation, courtesy of the Affordable Care Act. But this hasn’t stopped people from advocating for something different. Conservatives often complain that the ACA goes too far, while progressives believe it doesn’t go far enough. Listening to the debate, one thing seemed clear: Nobody is especially happy with the state of health care in America and Obamacare is unlikely to change that.

Recent surveys show health care costs remain the top concern for local business leaders.

The Siena Research Institute’s annual survey of upstate New York business leaders found that 80 percent of respondents cited health care cost as the challenge they are most concerned about; 69 percent said they believe the law will have a negative impact on their business.

Polls show that Obamacare also remains unpopular among the general public.

According to a January Gallup poll, nearly half of Americans say the Affordable Care Act will make the U.S. health care situation worse in the long run, while slightly more than one-third think it will make the situation better. A majority of uninsured Americans who visited a health insurance exchange website reported having a negative experience, which is especially troubling, since these are the people who stand to benefit most from the law.

One of my friends, a self-employed photographer who hasn’t had health insurance in years, was initially very excited about Obamacare and its promise of affordable, easy-to-purchase health insurance. But after spending roughly 30 hours on the federal website and phone, trying to sign up for a plan, her enthusiasm had cooled.

It’s possible that public opinion of the Affordable Care Act will improve as the kinks get worked out and benefits begin to kick in. But only time will tell, and much will hinge on whether patients are satisfied with their overall experience with the health care system.

And since the system is overly complicated, needlessly opaque and expensive, satisfaction seems unlikely.

Costs will continue to rise and employers will continue to pass those costs along to their employees, who will come to regard statements and letters from their HMOs with confusion and dread, if they don’t already. Yes, the Affordable Care Act will enable millions to obtain health insurance. But health insurance comes with its own set of frustrations, as anybody who’s ever seen their co-payments steadily rise or been denied coverage for recommended treatment can tell you.

Meanwhile, the rollout of Obamacare continues. More than 501,205 New Yorkers have received insurance through the state’s online marketplace; in the past two weeks more than 88,000 people enrolled. Will these people be satisfied with their new insurance? Or will they yearn for something better? Again, only time will tell.

Reach Gazette columnist Sara Foss at Opinions expressed here are her own and not necessarily the newspaper’s. Her blog is at