Two goals, neither achieved

By Bill Davidson, M.D.
CommonSense2, January 2014

In creating the Affordable Care Act (ACA) President Barack Obama had hoped to accomplish two goals. The first was to secure his legacy as the president who achieved quality, affordable health care for all Americans. His second objective was to reward and assure for his Democratic presidency the continued support of the private insurance and pharmaceutical industries as well as their Wall Street patrons. Unfortunately, the two objectives are mutually incompatible and as a result neither will be achieved.

When Barack Obama ran for president in 2007 there were 50 million uninsured Americans, over half a million medical bankruptcies, and by many standards of quality America trailed the rest of the industrialized world. Correcting these woes was certainly a worthy goal and one that could have secured Obama’s favorable place in history.

Unlike most of his predecessors, Barack Obama came to the presidency with an understanding of how that goal could be achieved. As a little known senator from Illinois, he had learned about and then advocated for a single-payer solution, i.e. Medicare for All.

He knew that every other industrialized country in the world employed a single-payer system, which delivered universal care at an affordable price without compromising on quality. He knew that Medicare, America’s single-payer system for the elderly, worked well and was extremely popular. He was also aware that the Veterans Administration’s single-payer system delivered great care at lower prices, because it could group negotiate with the drug and medical technology companies.

As his presidency began, Obama’s party held majorities in both legislative houses and prospects looked good for achieving his first goal. But he wanted more.

To achieve his second goal of currying favor with the insurance and pharmaceutical industries, he turned his back on a single-payer solution and chose instead the individual mandate paradigm, which compels everyone to buy private health insurance.

Almost immediately, the Congressional Budget Office informed the administration that unlike a single-payer system, the individual mandate would leave 20 million Americans uninsured and that number might rise even higher with “red state” governors resisting Medicaid expansion. Would that damage Obama’s legacy? Probably not. Those left uninsured would be the working poor who are politically “invisible.”

Obama also needed to cut a deal with the pharmaceutical industry which would allow them to continue to be the most profitable business in the U.S. Like his predecessor, George W. Bush, Obama did this in secret behind closed doors and the chance to bargain effectively for lower prices was lost. Again, this was a risk to his legacy worth taking as most Americans were use to extravagant prices for medicines and unaware that the rest of the world gets drugs for half as much.

The real threat to Obama’s legacy has only just begun. The computer glitches are indicative of a system that is incredibly complex and dysfunctional. Prior to Obamacare, 1 out of 3 dollars spent on health care went to administer it. Adding another level of bureaucracy, Obamacare will make that administrative burden even more onerous and expensive.  The failure to bend the cost curve will ultimately doom Obama’s legacy, but there will be an additional factor that will soon become apparent. The insurance products that are being peddled by the industry come with such high deductibles and co-pays that our citizens will soon learn that they cannot afford to get sick and their health insurance is an illusion.

Obama is learning that the insurance industry support is capricious. Numerous variances have been granted to accommodate their avarice. Had the industry been willing to upgrade their woefully inadequate policies he could have avoided the embarrassment of “having lied” to the American people about “keeping their insurance.” In the end, the insurance industry will abandon him for a more lucrative deal with other politicians.

By abandoning a single-payer approach to health care reform, Barack Obama will have neither a worthy legacy nor political support.

Dr. Bill Davidson is a retired cardiologist who now works part-time at the Veterans Administration hospital in Lebanon, Pa.